Endometriosis is a complicated, debilitating disease that is poorly understood and all too frequently misdiagnosed. Most patients have experienced excruciating pain for years. More than 5. 5 million women in North America, and 176 million women worldwide suffer from endometriosis. Many of these women receive inadequate treatment. Endometriosis is a condition where the cells that line the uterus grows outside the uterus in other areas. Endometriosis is considered to be a common gynecological condition. It is a chronic, painful, and often progressive disease in women.
The causes of this disease are unknown, often times it is very difficult to diagnose, due to the wide range of symptoms and severity of the disease. Endometriosis occurs when the cells from the mucus membrane lining the uterus (endometrium) forms implants that attach, grow and function outside of the uterus, usually forms in other areas in the pelvic region, however there have been cases where it has spread to other areas of the body. Endometrial cells contain receptors that bind to estrogen and progesterone. They promote uterine growth, and thickening.
When those cells become implanted in organs and other areas outside of the uterus, hormonal activities still occur, causing pain, bleeding, and scar tissue. Endometrial implants vary widely in size, shape, and even color. Sometimes these spots can disappear, or there is the chance they can grow and spread. Early stage implants are usually small, and appear to look like small clear pimples. If these implants continue to grow they may form flat injured areas known as lesions. They are small nodules, or cysts called endometriomas, which can range from sizes that are smaller than a pea to larger than a grapefruit.
Implants can also vary in colors, they may be colorless, red, or very dark brown. These are called chocolate cyst. They are endometriomas that are filled with thick, old, dark brown blood. Implants can form in many areas, most the most common areas are in the pelvis, these include; ovaries, fallopian tubes, uterine surface, cul-de-sac, bowel, bladder, rectum, the peritoneum. There are the uncommon places that endometriosis has been found, such as; spinal column, nose, lungs, pelvic lymph nodes, the forearm, and the thighs.
Each month, the exiled endometrial implants respond to the monthly cycle, just like they would if they were still in the uterus. They then will fill with blood, thicken, break down and bleed. These spots cannot be shed through the vagina like it would normally during your menstrual cycle. Instead, the implants develop and form into cyst and spots. Each month these lesions will continue to go through this cycle. They may continue to grow with each monthly cycle. These lesions can develop and cause obstructions or adhesions. They cause pain, inflammation and some cases it causes infertility. Endometriosis occurs among women all over the world.
Researchers have not been able to determine what the cause is to this disease. They believe that a combination of genetic, biologic, and environmental factor may be things that can lead to the process of endometriosis. One of the main theories on how endometriosis occurs is retrograde menstruation. This occurs during a women’s period, when the menstrual tissue flows backward through the fallopian tubes rather than out of the vagina. The theory is that the redistributed uterine tissue attached and grew in areas outside the uterus. And this is what formed the endometriosis implants. However, this theory doesn’t explain endometriosis completely.
Some women will have retrograde menstruation, but not all will develop endometrial cyst. Diagnosis of endometriosis isn’t all that simple. Because some women who have endometriosis don’t always have symptoms, or the symptoms they have may be being caused from something else, the diagnosis cannot be based on symptoms alone. There is only one method that is definitive for diagnosing endometriosis. Laparoscopy is an invasive diagnostic procedure. This is used to diagnose, evaluate, and sometimes treat endometriosis. During this procedure the doctor will view the uterus, ovaries, tubes, and peritoneum.
The doctor will make a small incision in the abdomen, insert a laparoscope, and examine your pelvic areas. If the doctor is able to reach your lesions, they will sometimes cut and burn those lesions. Symptoms that occur with endometriosis are increasingly painful periods, deep pain with sexual intercourse, cyclic pain that get to the point of interfering with everyday life, painful bowel movements. Some cases there is rectal pain or bleeding, blood in the urine, severe pain during ovulation, back or leg pain during menstruation, fatigue, cycles of constipation and diarrhea, nausea, and vomiting.
Endometriosis symptoms are usually worse during menstruation, but some women experience pain throughout the entire month. There are many conditions that mimic the pelvic pain experienced with endometriosis. These should be ruled out during an examination for endometriosis. These can be; Primary Dysmenorrhea, Adenomysosis, uterine fibroids, pelvic inflammation disease, miscarriage, ectopic pregnancy, pelvic cancer, uterine polyps, the use of an intrauterine device for contraception, urinary tract infections, celiac disease, appendicitis, interstitial cystitis, diverticulitis, and irritable bowel syndrome.
Unfortunately, right now there is no definite cure for endometriosis. But there are treatments for women with this disease that will help them maintain, and live an active healthy life. There have been doctors who’ve believed hormonal treatments can cure endometriosis. This has been proved that these hormonal treatments only quiet the symptoms by slowing down the load of estrogen that feeds the endometriosis. They do not however provide long term relief and cannot rid the body of the disease. Only surgery if done properly has the chance of doing so. Some have thought that having a hysterectomy will also cure this disease.
The endometriosis tissue grows under the ovaries, on the ovaries, on the bowl or bladder, next to the uterus, but rarely does it appear directly on the uterus. Removing of the uterus will leave the disease behind. There have been doctors who have felt that if you remove the ovaries, because the ovaries are what produce the endometriosis that this will rid of the disease. Studies have shown that endometriosis can produce its own estrogen. Because, endometrial implants can produce their own estrogen, they can continue to grow even after a hysterectomy.
Endometriosis cannot be spread from one person to another person. While the cause of endo isn’t known for sure, research has proved that it is not an infectious disease. It also cannot be transmitted sexually. Endometriosis is often misdiagnosed as pelvic inflammatory disease, which is caused by sexually transmitted diseases. But endo is not related to STDs (sexual transmitted diseases). A lot of times endometriosis is misdiagnosed because the gynecologist doesn’t have the proper knowledge of the disease. That is common, because this disease isn’t as widely known as others.
Some things to look for when searching for a doctor that will help you with your diagnosis and treatments are; knowledge and expertise in treating the various aspects of the complex disease. They should have exceptional laparoscopic skills, treats endometriosis laparoscopically with wide excisional techniques, listens and is non-judgmental. Most importantly find a doctor who will listen to what you are saying, and they will talk to you in terms that you will understand. As a patient you need to be open with your doctor. Many women downplay their symptoms due to being told prior that their disease is “all in their head”.
You should go to your appointment with a list of questions written down, that way you will not forget anything. There have been cases of endometriosis spreading to the lungs and shoulder. The most common symptoms are chest and shoulder pain which can radiate into the neck and down the arm. The pain normally occurs prior to or during menses. In some patients it can cause problems the entire month. Medical therapy usually fails. You can diagnose this form of endometriosis the same, with a laparoscopy. Unlike surgery in the pelvis region, results on diaphragmatic endometriosis is great. Complete relief of symptoms are over 90%.
