ENDOMETRIOSIS

Endometriosis is a common condition where tissue that behaves like the lining of the womb (the endometrium) is found outside the womb.

These pieces of tissue can be found in many different areas of the body, but they are most commonly found on the ovaries, on the lining of the pelvis behind the uterus and covering the top of the vagina.

The condition is often related to women. Most of them are diagnosed between the ages of 25 and 40.

Endometriosis is a long-term (chronic) condition that causes painful periods or heavy periods. It often also causes pain in the lower abdomen (tummy), pelvis or lower back, as well as fertility problems. It may also contribute towards a lack of energy and depression.

However, the symptoms of endometriosis can vary significantly and some women have few symptoms or no symptoms at all.

You should see your Doctor if you have symptoms of endometriosis so they can try to identify a cause and refer you to a specialist for a diagnosis if necessary.

Symptoms of endometriosis

Symptoms of endometriosis can vary significantly from person to person. Some women have no symptoms at all.

The most common symptoms include:

  • painful periods or heavy periods
  • pain in the lower abdomen (tummy), pelvis or lower back
  • pain during and after sex
  • bleeding between periods
  • difficulty getting pregnant

The experience of pain varies between women. Most women with endometriosis get pain in the area between their hips and the tops of their legs. Some women have this all the time, while others only have pain during their periods, when they have sex or when they go to the toilet.

Other symptoms may include:

  • long-term exhaustion and tiredness
  • discomfort when urinating or passing stools
  • bleeding from your back passage (rectum) or blood in your stools
  • coughing blood (in rare cases where the endometriosis tissue is in the lung)

How severe the symptoms are depends largely on where in your body the endometriosis is, rather than the amount of endometriosis you have. A small amount of tissue can be as painful as, or more painful than, a large amount.

Where does it occur?

Areas of the body that can be affected by endometriosis include:

  • the ovaries and fallopian tubes
  • the outside of the womb
  • the area between the rectum (back passage) and womb
  • the thin layer of tissue that lines the inside of the abdomen (peritoneum)
  • the bowel or bladder
  • the vagina
  • the rectum
  • the muscle layer of the wall of the womb
  • scars from previous operations
  • in rare cases, the skin, eyes, spine, lungs or brain

Causes of endometriosis

The exact cause of endometriosis is unknown, but there are several theories about what causes it. 

Retrograde menstruation

Retrograde menstruation is when the womb lining (endometrium) flows backwards through the fallopian tubes and into the abdomen (tummy) instead of leaving the body as a period. This tissue then embeds itself on the organs of the pelvis and grows.

It is thought that retrograde menstruation happens in most women, but many are able to clear the tissue naturally without it becoming a problem. It is possible that this is how endometriosis occurs in some women.

Retrograde menstruation is the most commonly accepted theory for endometriosis. However, it does not explain why the condition can occur in women who have had a hysterectomy.

Genetics

Endometriosis is sometimes believed to be hereditary, being passed down through the genes of family members. It can affect women of every ethnicity, but is less common in women of African-Caribbean origin and more common in Asian women than in white women. This suggests that genes may play a part.

Spread through the bloodstream or lymphatic system

Although it is not known how, endometriosis cells are believed to get into the bloodstream or lymphatic system (a network of tubes, glands and organs that is part of the body’s defense against infection). This theory could explain how, in very rare cases, the cells are found in remote places such as the eyes or brain.

Problems with the immune system

It is believed that some women’s immune systems are not able to fight off endometriosis effectively. Many women with endometriosis are found to have lower immunity to other conditions. However, this may be a result of the endometriosis rather than the cause of the condition.

Environmental causes

It is thought that endometriosis may be caused by certain toxins in the environment, such as dioxins, that affect the body, the immune system and the reproductive system.

However, while research suggests there is a link between endometriosis and high levels of dioxin exposure in animals, it is not currently known if this is also the case in humans.

Metaplasia

Metaplasia is the process of one type of cell changing into another to adapt to its environment. It is this development that allows the human body to grow in the womb before birth.

It has been suggested that some adult cells may retain this ability to change, and that the shedding of menstrual blood or blood products into the pelvis during menstruation may stimulate them to transform into endometrial cells.

Diagnosing endometriosis

It can be difficult to diagnose endometriosis because the symptoms can vary considerably and there are many other conditions that can cause similar symptoms. Your gynaecologist may therefore recommend a number of different tests.

Your gynaecologist will usually ask you about your symptoms, your periods and possibly your sexual activity. They may also carry out an internal pelvic exam to look for signs of other problems that could be responsible for your symptoms.

In some cases, an ultrasound scan may be recommended. This type of scan uses high frequency sound waves to create an image of part of the inside of the body. It can be used to look for cysts in your ovaries that may have been caused by endometriosis, but it is not an accurate test to diagnose endometriosis itself.

Endometriosis can only be confirmed with a surgical examination called a laparoscopy.

Laparoscopy

During a laparoscopy, you will be put to sleep using a general anaesthetic and a special viewing tube with a light on the end (a laparoscope) will be passed into your body through a small cut in your skin at your belly button.

The laparoscope has a tiny camera that transmits images to a video monitor so that the specialist can see any endometriosis tissue inside your tummy.

The specialist will then either take a small sample of tissue (biopsy) for laboratory testing or insert other surgical instruments to treat the endometriosis.

Treating endometriosis

“There is no cure for endometriosis and it can be difficult to treat. The aim of treatment is to ease the symptoms so that the condition does not interfere with your daily life”.

That is what Doctors would like you to believe, but using Acupuncture and Ozone Therapy endometriosis can be cured. There have been many arguments about the effectiveness of Acupuncture but non can ascertain it without experiencing it for themselves.

Treatment will be given to relieve pain, slow the growth of endometriosis tissue, improve fertility and prevent the disease returning.

Deciding which treatment

When deciding which treatment is right for you, there are several things to consider, including:

  • your age
  • whether your main symptom is pain or difficulty getting pregnant
  • whether you want to become pregnant (some treatments may stop you getting pregnant)
  • how you feel about the treatment
  • whether you have tried any of the treatments before

Treatment may not be necessary if your symptoms are mild and you have no fertility problems or if you are nearing the menopause, when symptoms may get better without treatment.

Endometriosis gets better by itself without treatment in about 3 in every 10 cases, but it becomes worse without treatment in about 4 in every 10 cases.

One course of action is to keep an eye on symptoms and decide to have treatment if they get worse.

Hormone treatments

The aim of hormone treatments is to limit or stop the production of oestrogen in your body. This is because oestrogen encourages endometriosis to grow and shed. Without exposure to oestrogen, the endometriosis tissue can be reduced, which helps ease the symptoms.

However, hormone treatment has no effect on adhesions (“sticky” areas of endometriosis that can cause organs to fuse together) and cannot improve fertility.

Complications of endometriosis

The main complication of endometriosis is difficulty getting pregnant (subfertility) or not being able to get pregnant at all (infertility). In some cases, there may also be adhesions or ovarian cysts.

Fertility problems

Endometriosis can sometimes damage the fallopian tubes or ovaries, causing fertility problems, although it is estimated that up to 70% of women with mild to moderate endometriosis will eventually be able to get pregnant without treatment.

If you are having difficulty getting pregnant, in vitro fertilisation (IVF) offers a good chance of conception, although women with endometriosis tend to have a lower chance of getting pregnant with IVF than others (such as women with blocked fallopian tubes).

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