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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.

CAUSES OF 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

SYMPTOMS OF ENDOMETRIOSIS

The major symptoms of Endometriosis are pain and infertility.

Pain

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).

Infertility

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.

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DIAGNOSIS OF ENDOMETRIOSIS

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.

The ONLY definitive way to diagnose endometriosis (implants) is by laparoscopy, this is a procedure that allows the surgeon to view inside your abdomen (pelvic cavity).

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.

Endometriosis can be suspected based on different patterns of symptoms in women, and sometimes during a physical examination. Other tests that are often carried out before a laparoscopy may include an ultrasound, blood tests, vaginal cultures and MRI. These tests are done to “rule out” further causes of pelvic pain.

MANAGEMENT AND TREATMENT OF ENDOMETRIOSIS

There is currently no known cure for Endometriosis but there are treatments to reduce pain and improve the quality of life of those affected

  • Hormonal Treatment
    Endometriosis is a hormone-dependent condition aggravated by estrogen, making it necessary to suppress the production of estrogen to prevent menstruation. Hormonal therapy is therefore used to stop endometriosis from growing. This form of treatment usually puts the person affected in an artificial pregnancy state or an artificial menopausal state, which are temporary and can be reversed when the patient has stopped taking the hormones
  • Surgical Treatment
    Laparoscopic surgery is the only definitive way to diagnose endometriosis because it causes less scarring, less pain and less time in hospital. It better visualizes the areas where endometriosis can grow and small bleeding points can be more easily seen and in most cases the disease can be diagnosed and treated in the same procedure. However, there are a number of different techniques used by surgeons treating endometriosis which should be discussed before surgery is performed.
  • Medical Treatment
    Strong pain relievers are designed to get rid of the pain associated with endometriosis, though they are not intended to reduce the amount of endometriosis present. They may be used as only treatment or in combination with other treatments. There are different pain relief options which must be administered by a professional medical consultant.
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