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|What Is Endometriosis?
Endometriosis is a condition where fragments of the womb end up in other parts of the body instead of being shed during a monthly menstrual bleed. It can be a painful condition and causes infertility in 2 out every 5 affected women. Every month the cells which line the inside of the womb (called endometrial cells) are shed as part of the normal menstrual cycle. With this disorder, some fail to leave the body and instead travel to other organs in the body where they attach themselves (image). Typically they end up in the ovaries and fallopian tubes or attached to the outer surface of the womb or intestines. They may also attach to the vagina, vulva, bladder, bowel and cervix or bury into abdominal surgical scars. These displaced cells continue to respond to hormones produced in the monthly cycle and bleed each month. The result is internal bleeding and inflammation. It can also lead to severe pelvic pain, irregular periods and infertility; as well as predispose a woman to ectopic pregnancy and ruptured ovarian cysts. Although endometriosis implants are problematic they are not cancerous (benign). Many women with endometriosis experience no symptoms so treatment is not necessary. If symptoms do occur, medication and surgery are the two most common treatment options.
Endometriosis affects women in their reproductive years, typically between the ages of 25 and 35. Exactly how many women have the condition is unknown because most experience no symptoms, but according to the American Endometriosis Association it may affect over six million American and one million Canadian women. It is one of the leading causes of pelvic pain, and it is the main reason for laparoscopic surgery and hysterectomies in America. Some studies estimate that up to 80 percent of women with chronic pelvic pain may have endometriosis. It is more common in white females than black or Asian. It is also more frequent in taller women with a low body mass index (BMI). Pregnancy after 35 may also increase the risk.
The cause of endometriosis is unknown. One theory is that it may have something to do with 'retrograde' or reverse menstruation (also known as the transtubal migration theory). This suggests that monthly menstrual tissue not only flows out the vagina (as it should) but also travels up and out of the womb via the fallopian tubes, eventually sticking (implanting) to other structures like the abdomen and further. The implanted tissue acts like it would were it still in the womb and has a monthly bleed. In mild cases the blood is reabsorbed, but in more severe cases cysts can form which irritate the pelvis. Some experts believe that while all women experience some menstrual tissue backup, it is a hormone imbalance or immune system problem that causes it to turn into endometriosis. Yet another theory suggests it may be something to do with tissue left over from when the woman was herself an embryo. There are also reported links between dioxin (TCCD) exposure and endometriosis. Dioxin is a poisonous by-product of pesticide, plastic and vinyl manufacturing.
Where endometriosis symptoms occur, the most common symptom is usually pelvic pain. Others include:
• Painful periods (dysmenorrhea)
Initially a pelvic exam will be carried out but this cannot conclusively diagnose endometriosis. Ultrasound scans can be helpful in ruling out other conditions such as pelvic inflammatory disease (PID) and ovarian cancer. However, an accurate endometriosis diagnosis is only possible by a direct visual inspection of the internal tissues of the pelvis and abdomen. This can be carried out a laparoscopy which is generally executed under general anesthetic but may be carried out under a local anesthetic. Your doctor will then be able to determine how advanced your condition is. For more, see: what are the stages of endometriosis?
There is no cure for endometriosis, but there are a variety of treatment options. The treatment goal may be to reduce pain symptoms, shrink endometriosis growths, restore fertility or prevent recurrence of the condition. To this end, endometriosis treatment options are:
OTC Pain Relief Drugs: Over the counter pain relief medication such as aspirin or ibuprofen. Note: Avoid taking aspirin during pregnancy.
Hormone Treatment: Gonadotropin-releasing hormone analogs (GnRH analogs) which have been effectively used to relieve pain and reduce size of endometriosis implants. Other options include oral contraceptive pills, progesterone drugs and danazol, a testosterone derivative.
Alternative Treatments: Homeopathy, acupuncture, Chinese medicine, allergy management and diet and nutritional approaches. See endometriosis alternative treatment.
After menopause, like uterine fibroids, endometriosis nearly always subsides.
Endometriosis & Infertility
Endometriosis is more common in women who are experiencing infertility, although it also found in fertile women. The condition does not completely prevent conception although studies indicate that women with even mild endometriosis take longer to conceive. The more severe the endometriosis, the more the difficulties a woman will have becoming pregnant. Remember, the key word here is ‘difficulties’. Endometriosis does not mean a woman cannot conceive, it may just take longer or require corrective surgery or infertility treatment. Endometriosis also increases the risk of pregnancy complications such as ectopic pregnancy - 16 percent in comparison to 1 percent of the normal population. See also, can endometriosis cause miscarriages?
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