What is Endometriosis?
Endometriosis is a condition that affects a woman’s reproductive organs. It happens when the tissue that lines the uterus begins to grow outside the uterus.
Every month, the tissue growing outside the uterus act like those in the womb, they build up, break down and then bleed but unlike the tissue in the womb, this blood has no way to escape.
It is a chronic and debilitating condition that causes painful or heavy periods. It may also lead to infertility, pelvic pain, fatigue, bowel and bladder problems
Estimated, over one million women in Nigeria are affected by Endometriosis, 20% to 50% of women being treated for infertility have endometriosis.
The actual cause of Endometriosis is unknown but several theories propose that Retrograde Menstruation; Coelomic Metaplasia and Müllerian remnant might cause the condition to develop in some women.
- Retrograde Menstruation: Occurs when the womb lining (endometrium) flows backward through the fallopian tubes and into the abdomen instead of leaving the body as a period. This tissue then embeds itself on the organs of the pelvis, grows and continues to thicken and bleed over the course of each menstrual cycle.
- Coelomic Metaplasia: Metaplasia is the process where one type of cell changes or morphs into a different kind of cell. When cells lining the coelom, (i.e cavity between the body wall and intestines) change their cell type to form endometrial tissue, Coelomic Metaplasia occurs. Cells of the endometrium and coelom arise from the same cell type during embryonic development, and their differentiation is under the control of hormones, primarily estrogen.
- Müllerian remnant: Embryonic remains from the developing uterus may persist in the pelvic cavity as they migrate into their final position and form the basis of future endometriosis
The major symptoms of Endometriosis are pain and infertility.
- Pain is the most common symptom of endometriosis, occurring in around 80% of patients, it is usually described as:
- Pelvic, lower abdominal or back pain with intermittent cramping of varying degrees
- Irritable Bowel Syndrome (IBS)-like symptoms including Dyschezia (pain associated with constipation)
- Frequent urination and/or pain during urination giving cystitis-like symptoms which may be recurrent
- Dyspareunia (painful sexual intercourse)
- Although pain may occur at any time during the menstrual cycle, it is often worst during menstruation (known as dysmenorrhea).
Despite it being well known that endometriosis causes infertility, precisely how it does so is unclear.
Endometriosis is present in up to 40% of women suffering from infertility whilst up to 50% of women with endometriosis are infertile.
Studies have reported findings in support of a diverse range of mechanisms which act at almost every step on the road to conception, including: defective ovum (egg) development and ovulation, hindrance of sperm function, molecular changes in the normal endometrium of the uterus which hinder implantation of the fertilised ovum (perhaps via progesterone resistance) and a reduction in embryo quality.
Studies have also shown that endometriosis reduces fertility by normal conception and the success of IVF treatment.
Due to inadequate knowledge among the general public and medical community, many endometriosis patients are misdiagnosed multiple times which then leads to unnecessary and inappropriate treatment.
A definitive way to diagnose endometriosis is by laparoscopy- an operation in which a camera (a laparoscope) is inserted into the pelvis via a small cut near the navel.
The surgeon uses the camera to see the pelvic organs and look for any signs of endometriosis. If endometriosis is diagnosed, the endometriosis may be treated or removed for further examination during the laparoscopy.
There is no test for endometriosis, meaning patients cannot have their blood, urine, or saliva tested to confirm the disease.
Management & Treatment:
There is currently no cure for Endometriosis but there are treatments to reduce pain and improve the quality of life of those affected.
Available treatment options include:
- Hormone treatment
- Pain relief
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