Women’s Health Centre, BNH Hospital
Endometriosis is defined as the abnormal growth of endometrial cells (the same cell that from the inside of the uterus) in a location outside of the uterus. This is most commonly found on the surface lining of the pelvic cavity.
Endometriosis can be classified into the following 2 types :
- Endometriosis Externa : this type of endometriosis is the most commonly found. The implant are usually found in the pelvic cavity, the ovaries, the colon, and peritoneum. They can also be found around the ureter, lungs and old surgery scars.
- Endometriosis Interna : in this type of endometriosis, the endometrial cells grow into the myometrium (the middle layer of the uterine wall) which leads to dysmenorrheal (cramps and painful menstruation) and adenomyoma (which cause painful and excessive bleeding during periods).
Endometriosis is typically found in women of child-bearing age but is rare in postmenopausal women. Endometriosis is estimated to affect 10% of women in child-bearing age in the United States while 40-70% of infertile women and women who suffer from menstrual cramps are diagnosed with endometriosis.
Sign and symptoms
- Dysmenorrhea, especially in women who have never experience the condition before, with progressive worsening of the symptom (i.e., progressive dysmenorrhea)
- The occurrence of pain during sexual intercourse (dyspareunia)
- Chronic pelvic pain : when this occurs other conditions, such as pelvic inflammatory disease (PID) or gastrointestinal diseases must first be ruled out.
- Pelvic mass or vaginal bleeding
- Other symptoms related to the location of the disease, such as coughing up blood during menstruation or experiencing pain in surgical scars (i.e., episiotomy or Cesarean section scars), however this is rare
- No symptoms
- Physical examination and pelvic examination
- Magnetic Resonance Imaging (MRI)
- CA 125 blood test
- Laparoscopy (procedure in which a lighted scope is inserted through a tiny incision in the abdomen to examine and retrieve tissue samples for biopsy)
Laparoscopic findings in patients with endometriosis can be described as follow :
- Blue-black or red spots (powder burned spots) or small cysts on the peritoneum (Membrane that forms the lining of the abdominal cavity)
- ndometriomas or ‘chocolate cysts’
- Solid nodules which are commonly found on the uterosacral ligament Additional, adhesions in the pelvic cavity may be present.
- Hoemonal treatment such as oral contraceptive pills or injectable contraception
- Administration of a GnRH-agonist, a GnRH-agtagonist, or an aromatase inhibitor
- Treatment via laparoscopic surgery
- Combination of drug and surgical treatment
There is some controversy regarding the optimal treatment of endometriosis. The gynecologist must explain the natural course of the disease to patients, most especially that the disease is not fully understand and physicians are now trying to identify the actual cause of the malady.
Warning signs of endometriosis
Consult with your gynecologist if you experience the following symptoms :
- Menstrual cramps that worsen progressively over time
- Chronic pelvic pain
- Pain during sexual intercourse
- Abnormal vaginal bleeding
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