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Definition

It is a condition in which tissue that usually lines the inside of the uterus (endometrium) develops outside(endometrial implant). Endometriosis generally involves the ovaries, bowel or the tissue layering the pelvis. Seldom, the endometrial tissue may widen beyond the pelvic region.

In endometriosis, dislocated endometrial tissue goes on to act as it usually would i.e., it thickens, ruptures and bleeds with every menstrual cycle. As this dislocated tissue has no means to exit the body, it gets trapped. When endometriosis is associated to the ovaries, cysts called as endometriomas may appear. The encompassing tissue can become aggravated, in due course developing scar tissue and adhesions.

Symptoms

The main indicator of endometriosis is pelvic pain, most often related to the menstrual period. Although several women experience cramping during their menstrual cycle, women with endometriosis usually describe menstrual pain that's far severe than the usual and has worsened over time.

Common signs may include:

  • Painful periods (dysmenorrhea)
  • Pain during or after sex
  • Pain during urination and bowl movement
  • Heavy bleeding
  • Infertility
  • Other symptoms like dizziness, nausea or bloating

Risk Factors

Many factors contribute to greater risk of developing endometriosis, such as:

  • Infertility
  • One or many female relatives with the condition
  • Any condition that blocks the normal passageway of the menstrual flow out of the body
  • Past history of pelvic infection
  • Uterine abnormality

Endometriosis generally develops many years after the onset of menstruation. Signs of endometriosis stop temporarily with pregnancy and permanently with menopause, unless on estrogen.

Diagnosis

To diagnose endometriosis, the doctor will check for symptoms, including area of pain and the time of occurrence.

Physical tests include:

Treatment

Treatment for endometriosis is typically with medications or surgery. The approach depends on the severity of the pain and symptoms and chances of conceiving.

Pain Medications: The doctor prescribes over-the-counter pain relievers to ease the menstrual pain.

Hormone Therapy: Supplemental hormones are occasionally helpful in reducing or eliminating the pain of endometriosis. That's because the increase and decrease of hormones during the menstrual cycle leads to thickening of the endometrial implants, ruptures them and leads to bleeding. Hormone medication may impede the growth and avert new implants of endometrial tissue. Hormone therapies include:

  • Hormonal contraceptives
  • Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists
  • Medroxyprogesterone (Depo-Provera)
  • Danazol

Conservative Surgery: In cases where the patient is trying to conceive, surgery to remove as much endometriosis as possible while preserving the uterus and ovaries (conservative surgery) may increase the chances of conceiving.

Assisted Reproductive Technologies: Assisted reproductive expertise, such as IVF, help in conceiving and doctors often suggest one of these approaches if conventional surgery is futile.

Hysterectomy: In extreme cases, surgery to remove the uterus and cervix (total hysterectomy) as well as both the ovaries may be the suggested best treatment. Hysterectomy is normally considered as a last resort, especially for women in their reproductive age.

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