Endometriosis an Agonising Gynaecological Problem in Women

What is meant by Endometriosis?

‘Endometriosis’ is a common gynaecological problem affecting 5-10% of women. As the name itself implies it is a disease relating to the endometrium, a lining of the uterus.

Endometriosis of the Fallopian Tube (Luminal Pattern) (Photo credit: euthman)

The endometrium plays an important role in the implantation of the fertilized ovum and in maintenance of the pregnancy throughout the gestational period. It is influenced by the hormones produced by the anterior pituitary and the ovaries of the women. The endometrium during the menstrual cycle under the influence of oestrogen grows thick and supplied with more blood. The glandular layers also grow thick and develop (Proliferation).

The level of oestrogen will be high through out the follicular phase and falls soon after ovulation. Immediately after ovulation corpus luteum develops and produces another hormone Progesterone. This hormone also influences the further development of the endometrium particularly the glandular layer which is necessary for the implantation of the blastocyst. If the pregnancy does not take place the corpus luteum regresses and the secretion of the hormone reduces and the progesterone levels falls down. Due to sudden withdrawal of progesterone the proliferated endometrium will be shed as the menstrual flow and a new cycle commences. The shed endometrial cells and the blood flows through the vagina as menstrual flow (Ante grade flow).

Sometimes the blood instead of flowing out through the vagina it leaks into the pelvic cavity through the fallopian tubes (Retrograde flow) and the endometrial cells stick to the tissues and organs in the pelvic cavity. Slowly these cells develop into small areas as patches. These endometrial patches also get influenced by the hormones and bleed during every cycle. Since there is no way for the escape of blood from the pelvic cavity the patches further grows and some times covered with the tissues. Ultimately these grow as cysts. With the result the women experience pain at every menstrual cycle and indirectly causing infertility.

What are the symptoms of Endometriosis?

The symptoms of the endometriosis are not seen immediately. As the disease progresses symptoms will appear differing in the intensity depending on the seat of development of the endometrial patches. The following symptoms are generally seen. Pain is experienced during and before the onset of menstrual cycle. The pain is observed in the lower abdomen. (Dysmenorrhoea)

• Pain during sexual intercourse
• Irregular menstrual cycles
• Heavy menstrual flow
• Painful micturition (Urination)
• If the intestines are affected diarrhoea, constipation or pain during bowel movements
• If the endometrial patches are seen on the rectum bleeding may be seen through the rectum.

How is Endometriosis diagnosed?

• Provisional diagnosis will be made basing on the history and symptoms.
• However confirmation of endometriosis will be made by laparoscopy and examining all the pelvic organs and tissues.

What are the treatment options available for Endometriosis?

The treatment depends on the women’s age and the site of the endometriosis.

• Hormones are used in the treatment of the endometriosis. Hormonal treatment aims to suppress the production of oestrogen and thereby the menstrual cycle. Gonodotropic analogues are usually given. (Gonodorelin or Gonodorelin analogues) such as Danazol which suppresses the production of oestrogen thereby stopping the menstrual cycle.
• Oral contraceptives are also used for about 5-12 Months which gives a beneficial affect in reducing the problem.
• Surgical removal of the patches and adhesions will be done or laser ablation is also used to treat endometriosis. But the endometriosis usually recurs again.
• If the endometriosis is seen in elderly women hysterectomy will be done. If it is decided not to have children total hysterectomy will also be done to for a radical treatment.

Prognosis of Endometriosis:

Treatment is usually successful. However endometriosis recurs again. Removal of ovaries is only the last resort adopted for a radical cure.