ENDOMETRIOSIS

 

INTRODUCTION:  Endometriosis is a benign lesion with cells similar to those lining the uterus, growing aberrantly in the pelvic cavity outside the uterus. During menstruation, this ectopic tissue bleeds, mostly into areas having no outlet, which causes pain and adhesions. Endometrial tissue can also be spread by lymphatic or venous channels. There is a high incidence among patients who bear children later and have fewer children. It is usually found in nulliparous women between 25 and 35 years of age and in adolescents, particularly those with dysmenorrhea that does not respond to nonsteroidal anti-inflammatory drugs (NSAIDs) or oral contraceptives. There appears to be a familial predisposition to endometriosis. It is a major cause of chronic pelvic pain and infertility.

CLINICAL MANIFESTATIONS:  Symptoms vary but include dysmenorrhea, dyspareunia, and pelvic discomfort or pain (some patients have no pain).  Dyschezia (pain with bowel movements) and radiation of pain to the back or leg may occur.  Depression, inability to work due to pain, and difficulties in personal relationship may result.  Infertility may occur.

ASSESSMENT AND DIAGNOSTIC METHODS:  A health history, including an account of the menstrual pattern, is necessary to elicit specific symptoms. On pelvic examination, fixed tender nodules are sometimes palpated, and uterine mobility may be limited, indicating adhesions. Laparoscopic examination confirms the diagnosis and enables clinicians to determine the disease’s stage.

MEDICAL MANAGEMENT:  Treatment depends on symptoms, desire for pregnancy, and extent of the disease. In asymptomatic cases, routine examination may be all that is required. Other therapy for varying degrees of symptoms may be NSAIDs, oral contraceptives, gonadotropin-releasing hormone (GnRH) agonists, or surgery. Pregnancy often alleviates symptoms because neither ovulation nor menstruation occurs.

Pharmacologic Therapy:  Palliative measures (eg, use of medications, such as analgesic agents and prostaglandin inhibitors) for pain.  Oral contraceptives.  Synthetic androgen, causes atrophy of the endometrium and subsequent amenorrhea.  GnRH agonists decrease estrogen production and cause subsequent amenorrhea. Side effects are related to low estrogen levels (eg, hot flashes and vaginal dryness).

Surgical Management:  Laparoscopy to fulgurate endometrial implants and to release adhesions.  Laser surgery to vaporize or coagulate endometrial implants, thereby destroying the tissue.

RELATED;

1.  PELVIC INFLAMMATORY DISEASE

2.  OVULATION AND THE MENSTRUAL CYCLE

REFERENCES