ENDOMETRIOSIS

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Hi,friends,today i'll post a brief review on ENDOMETRIOSIS.Endometriosis is a very common disease in women of reproductive age group.It is an enigmatic condition because the exact cause and pathology is not clearly known.

Endometrium is the lining of the uterus,the female reproductive organ where the baby[fetus] grows.Endometriosis is a condition where this endometrium with it's glands and supporting tissue[the stroma] is found in organs outside the uterus.There is a related condition called ADENOMYOSIS,where the endometrial tissue is found in the muscle layer of the uterus[myometrium]

Endometriosis is an estrogen dependent condition,so it occurs more in the reproductive age group.But in some instances,it may also occur in post-menopausal women who are on estrogen replacement therapy.This disease is more common in women who have family history of this disease.

Ovary is a very common location where extra-uterine endometrial tissue is seen.Other locations where this tissue may be found are umbelicus,scars in abdomen.rectum, bladder[although rarely],thorax[chest where lung is located],parts of gut[namely caecum,ileum].This disease causes extensive adhesions in the pelvis[the part of the body, where female reproductive organs,rectum,urinary bladder are located].These adhesions distorts the anatomy of pelvic organs,thus causing a variety of symptoms.

CLINICAL FEATURES:1. pain associated with menstrual bleeding.[dysmenoorhea]
2. pain during sexual intercourse[dyspareunia]
3. chronic pain in lower abdomen .
4. acute exacerbation of pain
5. during menstruation, bleeding may occur from several organs[bleeding along with urine{hematuria};bleeding with stool{hematochezia}].Rarely there may be bleeding along with cough[hemoptysis],if endometriotic tissue is located in the lungs.
6.last but not the least,endometriosis is a very common cause of infertility

CAUSE OF ENDOMETRIOSIS:CAUSE IS NOT PROPERLY UNDERSTOOD.SEVERAL THEORIES ARE THERE.Endometriosis may occur due to passage of endometrial tissue during menstrual bleeding from the uteus into the abdominal cavity via the fallopian tube.It may also occur due to spread through blood vessels and lymph vessels.I'm not going into much details of the causes as it will be a little disinteresting for most of my friends.

INVESTIGATIONS:Although many investigations can be performed, the most relevant investigations are TRANSVAGINAL ULTRASONOGRAPHY[heps to detect ovarian involvement,which is called the chocolate cyst of the ovary].LAPAROSCOPY IS THE MOST USEFUL INVESTIGATION.It helps in the detection of endometriotic lesions in the abdominal cavity,which appear like bluish black nodules[powder burn appearance]It also helps to detect the degree of adhesions in the pelvis.

TREATMENT:MEDICAL:1.COMBINED ORAL CONTRACEPTIVE PILLS.

2.PROGESTATIONAL AGENTS:medroxyprogesterone acetate[oral& injectable preparations are available} & gestrinone.

3.GNRH ANALOGUES:leuprolide & goserelin ;These drugs may cause reduction in bone density[osteoporosis] & symptoms like hot flashes,vaginal dryness.To counter these effects drugs like progestins,tibolone,biphosphonates may be given along with GNRH ANALOGUES.

4.DANAZOL:it has some serious side effects like weight gain , fluid retention in the body,acne,deepening of voice,development of fascial hairs[hirsuitism]vaginal dryness,hot flashes etc.

SURGICAL:Surgical treatment depends upon the age,desire for child-bearing,severity of symptoms etc.
1.destruction of the endometriotic lesions & removal of adhesions in the pelvis by laparoscopic approach.
2.hysterectomy with removal of the endometriotic lesions along with removal of the chocolate cyst of the ovary, if present with preservation of the healthy ovarian tissue.This is done in women who have completed their family,but are yet not of that age to undergo total removal of uterus & ovaries.
3.Pre-sacral neurectomy & laparoscopic uterine nerve ablation[LUNA] for relieving the pain.
FOR FURTHER INFORMATION PLEASE DISCUSS THIS WITH YOUR DOCTOR.
Please feel free to post any question in the comment section.

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