Endometriosis

Definition

This is a disease which only develops in presence of female hormones of the reproductive life, namely Estrogen hormone. It involves the growth of tissue similar to the lining of the womb on the outer surface of the pelvic organs, namely the surface of the womb, fallopian tubes, ovaries, vagina, rectum, and the urinary bladder. Since it develops only under the effect of unopposed high estrogen levels, it usually fades off during pregnancy and lactation or after menopause.

Effects of Endometriosis

This tissue bleeds with every period under the effect of hormonal variation. But because this bleeding can not exit the body, because it is located on the outer surface of the womb, It usually causes inflammation and gradual formation of scar tissue wherever an endometriosis spot develops. Blood may collect within the ovarian tissue causing blood cysts which gradually increase in size destroying the surrounding normal ovarian tissue thus reducing the ovarian egg reserve.

Diagnosis of Endometriosis

Some cases may be diagnosed clinically with the help of ultrasonography if we see ovarian old blood cysts in presence of chronic pelvic pain and/or infertility.

But the gold standard investigation to diagnose Endometriosis is laparoscopy. There are some blood tests suggested to help diagnosing endometriosis, but they are all still a matter of research and they lack sufficient sensitivity.

Clinical Presentation

The disease may present in the form of pain and/or infertility. Pain is usually in the form of severe and prolonged colicky pain during menstrual periods (secondary spasmodic dyspareunia). It may also cause pain deep pelvic during sexual intercourse (deep dyspareunia), or chronic pelvic pain caused by scarring, adhesions and/or ovarian cysts.

The other group of clinical effects due to endometriosis involves infertility whether due to fallopian tube obstruction or reduction of the ovarian reserve leading to anovulation.

Treatment of Endometriosis

The treatment depends on the patient’s main complaint. Those suffering from infertility are mainly treated with artificial reproduction techniques (ART), namely IVF/ICSI (test tube baby). There is research evidence showing that medical and/or surgical treatment alone is not as effective as ART, but surgery may be useful in removing a large ovarian cyst or a severely damaged fallopian tube to increase the chances of success of ART.

On the other hand, cases who suffer mainly from pain may be managed temporarily with medical treatment to stop the ovarian function (such as combined contraception pills, Danazol, Elagolix or GnRH analogues).

But the best long-standing treatment for the pain is by laparoscopy to remove all the abnormal tissue seen in the pelvis and to clear adhesions as much as possible. The more efficient this surgery gets, the better the chances of success and the lower the chance of recurrence will be. A good advice would be to go on contraception pills after surgery to reduce the recurrence rate.

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