IS ENDOMETRIOSIS ?
Endometriosis is a puzzling disease commonly affecting
women of reproductive age. The name comes from the word
endometrium, which is the tissue that lines the inside
of the uterus and builds up and sheds each month in
the menstrual cycle. In endometriosis, tissue like the
endometrium is found outside the uterus, the endometrial
tissue develops into implants, growths, lesions or tumors.
The most common locations of endometrial growths are
in the abdomen- involving the ovaries, ligaments supporting
the uterus, area between the vagina and rectum (recto-vaginal),
outer-surface of the uterus and the lining of the pelvic
cavity. (Fig 1) Sometimes the growths are also found
in abdominal scars, intestines and appendix, on the
rectum, in the urinary bladder, and vagina. They have
been rarely found outside the abdomen in the lung and
Like the lining of the uterus, endometriosis lesions
usually respond to the hormones of the menstrual cycle.
They build up tissue each month and break down. The
result is internal bleeding, degeneration of the blood
and tissue shed from these implants, inflammation of
the surrounding areas, formation of scar tissue (adhesions),
and cyst formation.
- Cramps and menstrual pain
- Pelvic pain
- Pain during sexual intercourse
- Trouble getting pregnant (infertility)
Other symptoms include painful bowel
movements, diarrhea or constipation and other intestinal
upsets with periods. The severity of pain is not necessarily
related to the extent or size of the lesions. Tiny lesions
(called petechial) may cause more discomfort than large
cysts or growths.
Each woman has her own pattern of symptoms. Symptoms
may appear at mid-cycle or peak during your menses.
Although your doctor may advice you a clinical exam,
laboratory tests, ultrasonography, endometriosis is
generally considered uncertain until proved by laparoscopy.
THE STAGES OF ENDOMETRIOSIS
With laparoscopy can stage your endometriosis.
The stages are
(I) Minimal (II) Mild (III) Moderate (IV)
Staging depends on number, size, site, depth of implants
and also on the extent of adhesions and whether other
pelvic organs are involved or not.
Hormone therapy controls or blocks
the hormones that drive the menstrual cycle. This
limits the swelling of the endometrium and endometrial
implants. Hormone therapy may be used by itself or
along with surgery. While you are on therapy, pregnancy
is not likely to occur.
CONTROL PILLS (OC’s)
Birth control pills contain estrogen and progesterone,
and work by stopping ovulation. There are given
in a continuous dose, so you have no periods at
all, thus reducing growth and bleeding in the implants.
Side effects : Weight gain, nausea,
blood clots and phlebitis (inflamed veins)
Progestins are a form of progesterone. Continuous
dose prevents ovulation and limits implant growth.
Side effects: Mid-cycle bleeding
or spotting, acne, headaches, weight gain and bloating.
Danazol is chemical derivative of synthetic testosterone
(male hormone). It inhibits ovulation and stops periods.
Side effects : Weight gain, hair
growth, acne, vaginal dryness, hot flashes, decreased
sex drive and mood changes. Liver problems may require
you to stop treatment.
- GnRH AGONISTS
GnRH agonists prevent the release of hormones (FSH
and LH) from pituitary gland inhibiting production
of estrogen and progesterone. It inhibits ovulating
and stops periods, and implants shrink.
Side effects : Hot flashes, headaches,
mood swings, vaginal dryness. During the therapy,
bone mass may decrease.
OPTIONS : SURGERY
For some women, surgery is the best
way to combat the effects of endometriosis.
Conservative surgery, either by open method (laparotomy)
or through the laparoscope involve removal or destruction
of the implants, can relieve symptoms and allow pregnancy
to occur. As with other treatments, recurrences are
Radical surgery, involving hysterectomy (removal of
the uterus) and removal of all implants and the ovaries
(to prevent further hormonal stimulation), becomes necessary
in longstanding severe cases.
LAPAROSCOPIC SURGERY LAPAROTOMY
RADICAL SURGERY: HYSTERCTOMY + BIL SALPINGO-OOPHORECTOMY
This can be performed by laparotomy or laparoscopically