Endometriosis

The lining of the uterus, known as the endometrium, is normally shed once a month during menstruation and the regrows. In endometriosis, some pieces of the lining become attached to organs in the pelvic cavity, such as the ovaries and the lower intestine. The misplaced pieces of lining react to the hormones of menstrual cycle and bleed during periods. The blood cannot leave the body through the vagina and causes irritation of the surrounding tissues, leading to pain in the abdomen and eventually scarring. Irritation of the ovaries may lead to painful cysts.

Endometriosis is a common condition, affecting as many as 1 in 5 women of childbearing age. Women who do not have children until they are in their 30s and those who remain childless are more likely to develop the condition. Severe endometriosis can often cause problems with fertility.

The exact cause of endometriosis is not known, but there are many theories. One theory is that fragments of endometrium shed during menstruation do not leave the body in the usual way through the vagina. Instead, they travel along the fallopian tubes, from where they may pass into the pelvic cavity and become attached to the surfaces of nearly organs.


What are the symptoms?

Endometriosis may not produce symptoms. If symptoms do develop, their severity varies from woman to woman. Symptoms may also vary depending on which organs are affected by the condition. They may include:

- Pain in the lower abdomen, which usually becomes more severe just before and during menstrual periods.
- Irregular periods or very heavy menstrual bleeding.
- Pain during sexual intercourse.
- Lower abdominal pain on urination.

If the endometrium grows on the lower intestine, you may develop diarrhoea or constipation, pain during bowel movements, and in rare cases, bleeding from the rectum during menstruation.

What might be done?

In women who do not have symptoms, endometriosis may only be suspected following investigations for infertility. To help make a diagnosis, your doctor will carry out a pelvic examination. The diagnosis may be confirmed with a laparoscopy (left), in which the organs in the pelvic and abdominal cavities are examined using a viewing instrument.

There are many different treatments for endometriosis, and the one chosen depends on your age, which organs are affected, the severity of symptoms, and whether you wish to have children in the future. You may be offered hormonal or surgical treatment. In mild cases, treatment may not be necessary.

If your symptoms are troublesome, your doctor may prescribe one of several different hormonal treatments that stop menstruation for several months. These drugs may include the synthetic hormone gonadorelin, gonadorelin analogues, and danazol, all of which suppress production of the female sex hormone oestrogen and have the effect of stopping menstruation. Alternatively, you may be given the combined oral contraceptive pill. This treatment is usually given for approximately 6 – 12 months, during which time the endometriosis should improve. If the condition does recur, it is usually milder than before.

Small fragments of endometrial tissue that do not respond to a period of hormonal treatment may be destroyed by laser surgery during a laparoscopy. However, endometriosis sometimes recurs after this treatment, and further operations may be necessary.

If you have severe endometriosis and you do not plan to have children or have gone through the menopause, your doctor may recommend that you have a hysterectomy to remove the uterus. Both ovaries will also be removed, together with other areas that are affected by endometriosis. If the ovaries are removed before you have reached the menopause naturally, you will develop menopausal symptoms. To alleviate these symptoms, your doctor will probably recommend hormone replacement therapy.

What is the prognosis?

Although treatment is usually successful, endometriosis may recur until the menopause occurs and the menstrual cycle ends. Endometriosis is unlikely to recur if the ovaries are removed.

LAPAROSCOPY
During laparoscopy, a rigid viewing instrument called a laparoscope is used to view the inside of the pelvis and the abdomen through small abdominal incisions. Laparoscopy may be used to look for disorders of the female reproductive organs, such as endometriosis, and to investigate other abdominal disorders, such as Appendicitis. Some types of surgery, such as female sterilization, may also be carried out during the procedure. Laparoscopy is always performed under general anaesthesia. Recovery is faster than after normal surgery due to the smaller incisions.

FEMALE STERILIZATION
Sterilization, by a method known as tubal ligation, is a permanent means of contraception for women who do not want any more children or for whom pregnancy would be harmful. The operation can be performed through two small incisions in the abdomen (laparoscopic sterilization) or single incision in the pubic area (minilaparotomy). The operation seals the fallopian tubes, usually by using clips or by cutting and typing them, so that sperm cannot travel through the tubes to fertilize eggs.