Endometriosis

Endometriosis is a disease that occurs mainly in women between the ages of 25-40 years of age. It is a painful condition that affects the cells of the uterus (called the endometrium lining). The endometrial lining when healthy sheds itself every month as new cells grow to form a new lining. This is basically menstruation. When endometriosis is present, these endometrial cells (which should remain in the uterus lining) tend to establish themselves elsewhere in the body. And therefore every month these cells shed and bleed, only they are not where they should be and either is the blood.

Where can these cells go then?

· Uterus
· Ovaries
· Bladder
· Bowel
· Fallopian tubes
· Within the perineum cavity (this is the lining of the abdominal cavity)
· In rare cases, they have been found in other areas of the body.

How do they get there?

The condition is thought to arise from what is referred to as retrograde bleeding. This occurs when blood/and cells from the endometrium (during a period) travel through the fallopian tubes and into the peritoneal cavity.

What happens then?

These cells then respond to hormonal changes, which mean they can shed and bleed when your period comes (just as your endometrial cells do in your uterus at the time your period is due). This can cause terrible complications, as the abnormal endometrium growth becomes sticky and can spread. This can join organs to each other or to the peritoneum, these are what are called adhesions. These adhesions can also form into cysts that become blood filled.

Symptoms

Endometriosis can occur with or without symptoms. Some of the symptoms include:
· Severe pain during menstruation
· Pain during ovulation
· Pain during bowel movements
· Pain during sexual intercourse

Diagnosis

The only way to really diagnose endometriosis is through a laparoscopy. A laparoscopy is a procedure performed under general anaesthetic, where a tiny tube with a camera attached is inserted into the pelvic region (usually below the navel). The surgeon can then view the reproductive organs to make a diagnosis. Symptoms alone are not enough to diagnose.

Is diagnosis really that important?

Yes, especially if you want to conceive children. Infertility can occur if the fallopian tubes become blocked, therefore the passage for eggs to pass from the ovaries to the uterus becomes impossible (the fallopian tubes are the 'corridors' between the ovaries and the uterus). So if you plan to have children and suspect you may have endometriosis please see your doctor for further investigation. For those with endometriosis fallopian tube blockage can occur in 30-40% of cases.

Treatment

If the condition is mild, there are some treatments to prevent the disease from worsening, such as the use of the contraception pill (your doctor will be able to inform you of other available treatments). If the condition is more severe, the use of some drugs can help to dissolve the endometrial deposits. These deposits in some cases may need to be surgically removed (usually through laparoscopic surgery, which only involves small surgical incisions). In very extreme cases, if the endometrial deposits have spread widely, some of the reproductive organs may need to be removed. Sadly there is no way to prevent this disorder. This is why it is important for diagnosis to occur as soon as you suspect you have this disease, as treatment can reduce the spread of these endometrial deposits.

- Louise Ganey (RN)