Endometriosis
Endometriosis is a common gynaecological condition affecting women of reproductive age.
Endometriosis occurs when the tissue resembling the uterus (or womb) grows outside the uterus on other organs or structures in the body.
Endometriosis has been found on the pelvic organs which include ovaries, outer surface of the uterus, the Fallopian Tubes, the lining of the pelvic cavity, the tissues that hold the uterus in place (utero-sacral ligaments). It can also involve the vagina, cervix, vulva, bladder and bowel (including rectum and appendix). In rare cases it has been found in other parts of the body such as diaphragm, lungs, brain and skin.
Endometriosis is one of the top three causes of female infertility. It is the most common cause of pelvic pain in women between age 10 and 50 years.
The average woman is 27years and has spent several years searching for the cause of her pain and/or infertility before receiving the diagnosis of endometriosis.
SYMPTOMS OF ENDOMETRIOSIS
Patients may experience
painful cramps in the lower abdomen, back or in the pelvis during menstruation,
painful sex
heavy menstrual bleeding,
painful bowel movements or urination and
infertility.
CAUSES OF ENDOMETRIOSIS
The exact cause of endometriosis is not known.
Popular theories include retrograde menstruation (the blood flows into the pelvic cavity instead of outside through the vagina). Genes have been isolated which are associated with severe endometriosis. Endometriosis can be associated with a defect in the immune system.
Other factors including stress, dioxins and xenoestrogens could aggravate symptoms. They have not been shown to be valid concepts of aetiology.
Diagnosis of Endometriosis
Dr Cook will ask you about general health, your symptoms and perform a pelvic examination to feel for the presence of large cysts or scars.
An ultrasound scan may also be performed to look for ovarian cysts (ovarian endometrioma).
The ultimate diagnosis is the visually proven endometriosis that can be done by diagnostic laparoscopy or keyhole surgery.
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Treatments for Endometriosis
There are several treatment options available to minimise the pain as well as control heavy bleeding. Pain Medication for Endometriosis
Non-steroidal anti-inflammatory medications will be prescribed by Dr Cook in cases of severe pain. Other forms of simple analgesia (over the counter pain relievers) may be helpful for mild pain.
Hormone Treatment for Endometriosis
Hormone treatment is recommended if there are small growths and mild pain. Progesterone type medications or a medication that decreases or blocks the production of Oestrogen. Progesterone can be an oral pill (Visanne), injections, intra-uterine device. Birth control pills help to decrease the amount of menstrual bleeding.
Surgery for Endometriosis
Surgery is an option for women having multiple growths, severe pain, or fertility problems.
Laparoscopy
During this surgery, the areas of endometriosis are removed. This is a minimally invasive technique and does not harm the healthy tissues around the growth. The tissue is sent to for histopathological diagnosis. Excision of endometriosis is known to be the optimal treatment for endometriosis. It will achieve improvement in pain. Laparoscopy with excision of endometriosis has also been shown to improve fertility. An increased pregnancy rate is observed for up to 12 months following excision of endometriosis. Some women may still require IVF to achieve a pregnancy.
Hysterectomy
It is a surgery that involves removal of the uterus. This procedure is done when there is significant pain and generally when other options have failed and if the patient is not planning a pregnancy.