The uterus, also called womb, is a hollow, pear-shaped organ located in the lower abdomen between the bladder and the rectum. The Inside of the uterus is covered with a sensitive layer of tissue called endometrium, which changes throughout menstrual period and during pregnancy. To function properly, the tissue of the endometrium must grow normally inside of the uterus, and flow outside the uterus during each period. Growth of this tissue (implant) beyond the uterus results in endometriosis.
Endometriosis is a gynecological condition developed on endometrial tissue behind the uterus, or under the ovaries or the fallopian tubes. In certain women, the condition can also occur on the suspensory ligaments of the ovary (ligament supporting the womb) and on other organs of the body such as bladder, bowels, vagina, brain, lungs, etc. Complication of endometriosis can lead to formation of scar tissue on the fallopian tubes and ovaries, leading to immobility of the tubes.
Endometriosis is a common problem among women aged 25 to 35 years. It is one of the main causes of female infertility. 30% to 40% of patients with the disease have problems to conceive. The risk of infertility increases depending on the organ affected. When the disease develops on the fallopian tubes or ovaries, conception becomes more challenging.
In a normal endometrium, every month, endometrial Cells obey to the hormonal fluctuations during the menstrual cycle: they flow outside the uterus. Sometimes, those cells attach themselves outside the uterus or on other organs, causing endometriosis. The cause of this disorder is not well known; scientists speculate theories.
One of those theories is “retrograde menstrual flow”, a disorder in which menstrual flow travels into the pelvic cavity rather than being expelled through the uterus. Those implants are most often found under the ovaries, behind the uterine muscle (adenomyoma), on the fallopian tubes, on the bladder, in the vagina and outer surface of the bowels. In some rare cases, endometriosis can implant in the lung, on the skin, around the brain, on the liver and on the spine.
It is not clear if genetic factor is link to endometriosis; however, studies have shown that women who have mother with the disease are more at risk of having the disease than women who do not. It is also found that the disease is more frequent among women who have excessive or prolonged menstrual bleeding (Menorrhagia).
In the genesis of endometriosis, it can be asymptomatic in some women. When finally symptoms immerge, they can occur anywhere in the body. The severity of the pain varies from one person to another, and depending on the organ affected. The most common symptoms of endometriosis include:
- Painful menstrual cramps (dysmenorrhoea)
- Pain in lower abdomen before and after menstruation
- Painful pelvic cramps before and after menstruation
- Premenstrual spotting (premenstrual staining)
- Painful sexual intercourse (dyspareunia)
- painful bowel movements and bleeding
- Excessive or prolonged menstrual bleeding (Menorrhagia)
- Infertility, endometriosis remains one of the leading cause of infertility in women
Diagnosis of Endometriosis
Most of the times, the diagnosis is based on the symptoms and on personal and family history of the patient. After a precise description of the symptoms by the patient, most doctors may already suspect endometriosis. However, to confirm the diagnosis, your doctor may suggest some tests: pelvic exam, endovaginal ultrasound (also called transvaginal or sonohysterography), and Pelvic laparoscopy.
Pelvic exam – A pelvic exam is an external and internal examination of the genital organs of women to detect certain diseases or gynecological abnormalities. The exam includes many steps:
- The health care provider will inspect organs outside of the vagina (clitoris, labia, rectum), and possibly touch them in search of pain, polyp, or cervical lesion.
- Then he will place an instrument (the speculum) into the vagina, seeking for vaginal discharge, bleeding, and lesions. During the test, the doctor can wipe away cervical cells (Pap smear, also called Pap test or cervical smear) to detect early abnormalities of the cervix.
- The last step of the test is the checking of the fallopian tubes, ovaries and uterus by inserting one or two gloved fingers into your vagina with one hand, and placing the other hand on your belly with a little pressure.
Transvaginal Ultrasound – also called endovaginal ultrasound, is the use of sound waves to examine a woman’s reproductive organs: uterus, ovaries, cervix, and vagina. The test allows to detecting ovarian cysts and endometrial cysts (endometriosis). However, a normal ultrasound result does not exclude the presence of endometriosis. In some cases, other imaging exams like magnetic resonance imaging (MRI) can help the doctor to detect early outbreaks of endometriosis that thrive on the uterine muscles (adenomyosis). The most reliable method for diagnosing endometriosis is laparoscopy.
Laparoscopy –this is a medical procedure that allows a health care provider to examine the ovaries, fallopian tubes, and uterus with a Laparoscope.
Laparoscopy is usually done when you are under general anesthesia; with an oxygen mask cover your nose and mouth to help you breathe. Then the doctor makes one or two small incisions in your navel and inserts an instrument called laparoscope in your abdomen. Most of the times, along with the instrument, a gas is inserted into your abdomen to better examine your organs. The doctor guides the laparoscope to the uterus, ovaries, fallopian tubes appendix, bladder, bowels, and liver to view any abnormality. This is a complex medical procedure, talk to your health care provider for more details.
Treatment of endometriosis depends on age, symptoms, and your decision to whether or not give birth in the future.
Hormone therapy – In less severe case of endometriosis, you doctor can recommend hormone therapy. For some women, progesterone pills or injections are sufficient to stop the progression of the disease. Some of common hormonal drugs used in the treatment of endometriosis include Danazol, Aromatase inhibitors, Medroxyprogesterone (Depo-Provera). While those medications may treat the disease in some women, they have many side effects:
Danazol side effects: high cholesterol level, skin disorder (such as acne, oily skin), weight gain, flushing, anxiety, dizziness, headache, fatigue, appetite changes, stomach upset, bloating, muscle cramps, chills, facial hair, depression, deepening of the voice, decreased libido, etc.
Aromatase inhibitors side effects: bone loss, Sore muscles, joint pain, arthritis, high cholesterol level, increase risk of heart disease, stomach upset, mild nausea, etc.
Medroxyprogesterone (Depo-Provera) – weight gain, dizziness, headache, fatigue, nervousness, decreased libido, pelvic pain, backache, breast pain, leg cramps, depression, bloating, nausea, rash, insomnia, edema, leucorrhea, acne, vaginitis, abdominal pain, etc.
Surgery – In severe case of endometriosis, surgery (laparoscopy, laparotomy) to remove the endometriosis-related tissue and adhesions may be necessary. After surgery, your doctor will recommend you to follow a hormonal treatment to prevent recurrences of the disease. The removal of the uterus (hysterectomy) is done only for women who do not want to have children in the future.
Untreated endometriosis can aggravate to immobility of the tubes; this immobility leads to infertility by preventing the release of the egg and disrupt the transition from fertilized egg of the tubes to the uterus.