What is Endometriosis?
Endometriosis affects up to 10% of women between the ages of 15 and 44. It most often occurs on or around reproductive organs in the pelvis or abdomen.
Affected areas include:
- Fallopian tubes
- Ligaments around the uterus (uterosacral ligaments)
- Liningofthe pelvic cavity
- Ovaries
- Outside surface of the uterus
- Space between the uterus and the rectum or bladder
More rarely, it can also grow on and around:
- Bladder
- Cervix
- Intestines
- Rectum
- Stomach (abdomen)
- Vaginovulvar
Endometrial tissue growing in these areas does not shed during a menstrual cycle like healthy endometrial tissue inside the uterus does. The buildup of abnormal tissue outside the uterus can lead to inflammation, scarring and painful cysts. It can also lead to buildup of fibrous tissues between reproductive organs that causes them to “stick” together.
Endometriosis Causes
Doctors do not know exactly what causes endometriosis, but there are a few theories of what might cause it:
Endometrial tissues are transported to other areas
of the body through the blood or lymphatic systems, similar to the way cancer cells can spread through the body.
Endometrial cells may attach to the walls of the
abdomen or other areas of the body after a surgery, such as a C-section or hysterectomy.
Endometriosis seems to affect some families more often than others, so there may be a genetic link to the condition.
Endometrial tissue goes into the fallopian tubes and the abdomen instead of exiting the body during a womans period.
Other cells in the body may become endometrial cells and start growing outside the endometrium.
Endometriosis Symptoms
Pain is the main symptom of endometriosis. Endometriosis is very complex disease and the symptoms differ from person to person. Some symptoms of ednometriosis correlate with other medical conditions, making diagnosis even more difficult. The stage of the disease does not always correlate with the level of pain. Some symptoms are due to organs being affected directly or due to the irritation caused by endometriosis lesions.
Endometriosis can be symptomatic or asymptomatic, although, with the right questions / clinical investigations, an asymptomatic patient can become symptomatic. Also, in cases of asymptomatic (pain wise) endometriosis, if fertility is affecte, then this becomes symptomatic, as infertility is a symptom of endometriosis. The pain can be cyclic or acyclic, but it usually gets worse during menstruation.
Common symptoms include:
- Pain before, during or after periods
- Pain before, painful ovulation
- Pain or bleeding with bowel movements
- Pain during or after intercourse
- Pelvic pain
- Painful urination
- Partial bowel obstruction
- Leg and back pain
- Right chest and shoulder pain during periods
- Bloating and severe lower abdominal discomfort
- Pain when breathing
- Pain when sitting down
- Fatigue
- Nausea and vomiting
- Heavy periods
- Infertility
Endometriosis Pain
The most common causes of pain in endometriosis are:
- Organ compression, tension, nerve structures - in the case of ovarian endometriomas, nodules.
- The appearance of fibrous tissue, which can also compress, infiltrate nerve tissue.
- Continuous discharge of inflammation mediators from nodules, lesions.
- The occurance of angiogenesis and nervous reshaping processes in the affected areas.
- Adhesions and fibrosis that may reduce organ mobility and ruptured cysts.
What is Adenomyosis?
It is a chronic painful condition, with growth of the inner layer of the uterus (endometrium) in the thickness of the uterine wall (myometrium).
What causes adenomyosis?
Experts aren’t exactly sure what causes adenomyosis, but risk factors may include:
- Age: Most women with adenomyosis are in their later childbearing years, between 35 and 50. The major symptoms of adenomyosis reduce after menopause.
- Childbirth: Many women with adenomyosis have given birth to more than one child. Endometrial tissue could invade the myometrium when an embryo implants in the uterine wall. However, more research is needed to confirm this.
- Previous surgeries: Studies suggest that prior uterine surgeries, such as caesarean section or dilation and curettage (D&C), could make adenomyosis more likely. Research is ongoing about this risk factor.
Adenomyosis diagnosis
The diagnosis of adenomyosis was until recently done after hysterectomy and histopathological examination of the uterus. Now, with the help of ultrasound and MRI, the diagnosis (suspicion of the diagnosis) can be made without surgery.
The clinical examination reveals an enlarged uterus, painful to the palpation. Pelvic ultrasound based on some ultrasound signs that may raise suspicion of adenomyosis; however, it should exclude other gynecological pathologies – most commonly uterine fibroids.
Adenomyosis treatment options
As a non-surgical treatment option, there are a variety of prescription drugs for adenomyosis / to reduce the pain and heavy bleeding. Oral contraceptives, various progesterone preparations and the use of slowrelease uterine progesterone devices can be used as well.
Surgical treatment for focal adenomyosis / adenomyoma is deep laparoscopic excision of the affected tissue. A great advantage of this technique is that the gynecologist can resect the affected tissue and preserve fertility, especially when fertility is desired.
Hysterectomy is considered a radical intervention and is indicated as the last option in patients with diffuse adenomyosis. This should not be done for patients with endometriosis and adenomyosis suspicion, nor for patients with focal adenomyosis/adenomyoma or in patients stil desiring fertility.
Another surgical option for diffuse adenomyosis, in patients with severe pelvic pain and hysterectomy, can be done, is the laparoscopic resection of the presacral nerve.
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