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    Dr. Rajesh Shah's advice on Endometriosis

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Endometriosis

Dr. Rajesh Shah

Introduction

Endometriosis is a common health problem in women. It is a common cause of severe recurring pain in women. One in every 5 women belonging to 13 to 45 age group suffer from endometriosis. Yet, it is not uncommon in women after menopause.

The primary problem lies with the 'endometrium', which is the normal inner lining of the uterus. The uterus houses the baby when the woman is pregnant. In endometriosis, these cells of inner lining of the uterus grow in places other than the uterus. Most commonly, these cells are found growing in locations like the ovaries, fallopian tubes, or anywhere within the pelvic cavity. In rare cases, these tissues are found in the lungs, skin, eye, diaphragm and the brain.

Symptoms of endometriosisIn normal conditions, the endometrium within the uterus is shed periodically during the bleeding that occurs in the menstrual cycle. But, in endometriosis, the endometrium being situated elsewhere in the body is unable to exit the body. Nevertheless, it proliferates and cyclically, the bleeding also occurs, but into the body cavity wherein it is situated!! The endometrium detaches itself, and remains shed within the cavity. The shed materials consist of degraded blood and tissues, which are sufficient to cause irritation and often severe pain in the affected area. Endometriosis depending upon its location can even affect the normal functions of organs like bladder, bowels and the intestines.

Repetitive irritation and pain can cause internal changes in the normal structures of the affected body part due to adhesions and scar formations. In very advanced cases, the internal organs of the pelvis fuse together in a condition called 'frozen pelvis'. Endometriosis is a leading cause for infertility in women.

Symptoms

The most common presentation is pelvic pain. Largely, the pains are timed with the occurrence of the menstrual cycle though it can certainly occur at other times. These pains vary in nature, though commonly they are severe, crampy and spasmodic. These can cause nausea and vomiting also.

Pain may be felt:

  • Before/during/after menstruation, progressively these pains become worse with every cycle.
  • During ovulation, i.e. around 14 days before the onset of the menstrual cycle
  • In the bowel during menstruation
  • When passing urine
  • During or after sexual intercourse
  • In the lower back region
  • Heavy, excessive menstrual bleeding
  • Nausea and vomiting

Other symptoms may include:

  • Diarrhea or constipation (in particular in connection with menstruation)
  • Abdominal bloating (again, in connection with menstruation)
  • Heavy or irregular bleeding
  • Fatigue

Causes

Many theories have been put forth to explain the cause of endometriosis, though none till date have clearly explained it! So, the real cause of endometriosis remains unknown.

Some theories worth considering are:

  • Excessive production of estrogen which is a major sex hormone in women
  • Metaplasia, a condition in which the endometrial tissue spontaneously starts growing in a location by replacing the native tissue cells of that site.
  • Retrograde menstruation, a condition where some amount of the normal menstrual fluid flows back into the pelvis. Generally when this occurs, the defense (immune) cells are capable of clearing away this back-flow. However, in women prone to endometriosis, the contents of the back-flow latch onto other neighboring tissue and begin to proliferate.
  • Genetic predisposition is another factor worth considering as women with first degree relatives suffering from endometriosis are 5 times more susceptible to endometriosis themselves.

Diagnosis

Physical examination along with a well taken history should make the physician suspect endometriosis. The 'gold standard' for diagnosing endometriosis is biopsy study of the tissue sample obtained through laparoscopic procedures.

Other investigations that aid in diagnosing are:

  • Ultrasonographic studies
  • MRI and CT scans to identify the offending tissues
  • CA-125 is a marker which is elevated in endometriosis though its elevation is not specific indication for this condition.

Complications

Endometriosis can cause a number of complications in some persons:

  • Acute abdomen: this is considered an emergency. Endometriosis affecting the intestines in particular can cause intestinal obstruction giving rise to acute, spasmodic, abdominal pain with nausea and vomiting.
  • Collapse of lungs during menstruation (catamenial peumothorax)
  • Infertility due to obstruction of the fallopian tubes

Treatment options for Endometriosis

Conventional treatment

The causes of endometriosis are unfortunately still uncertain. Hence, no conventional treatment fully cures this condition! Since, intensity, severity and extend of the condition varies from person to person, treatments are given taking into consideration the symptoms, age and opinions regarding fertility.

The main objectives are:

  • NSAIDS and other pain medications like aspirins, paracetamol in combination with mild sedatives.
  • Hormonal therapies:
    • Combined oral contraceptive pills
    • Progestins
    • Mirena
    • Danazol
    • GnRH-antagonists
    • Aromatase inhibitors

Unfortunately, all hormone therapies have varying degrees of side-effects and provide only temporary relief from symptoms.

Surgical interventions

Most doctors commonly agree that laparoscopic surgery is the only definitive method of diagnosing endometriosis.

Laparoscopic surgery:

The success of surgery depends greatly on the skill of the surgeon and the thoroughness of the surgery. The aim is to remove all endometriosis lesions, cysts, and adhesions.

Today, most endometriosis surgery is being done through the laparoscope, although a full abdominal incision called a laparotomy may still be required in rare cases for extensive disease or bowel resections.

There is a view that surgical removal of the uterus (hysterectomy) can give permanent relief. But, there are many evidences where endometriosis has recurred even after hysterectomy.

Homeopathic treatment

Homeopathy has its time-tested usefulness. Drugs used in endometriosis are geared towards altering the activity of the ovaries and therefore slow down the growth of the endometrial tissue. Homeopathic medicines possibly depress the over-secretion of estrogen by the endometrial tissue. Homeopathic medicines are unique in the respect that they can act as immune-modulators and possibly enhance the action of the immune-system in clearing away the irritating factors in endometriosis. Homeopathy is recommended as a supportive line of treatment in the cases of endometriosis.

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