Endometriosis

Introduction

  • Endometriosis is a chronic condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterus.
  • It most commonly affects the ovaries, fallopian tubes, and pelvic lining but can involve other organs in severe cases.
  • Symptoms include pelvic pain, irregular menstruation, and infertility.
  • While the exact cause is unknown, it is associated with hormonal, genetic, and immune factors.

Causes of Endometriosis

  1. Retrograde Menstruation
    • Menstrual blood flows backward through the fallopian tubes into the pelvic cavity.
  2. Hormonal Factors
    • Estrogen promotes the growth of endometrial-like tissue outside the uterus.
  3. Immune Dysfunction
    • Failure to recognize and destroy endometrial-like tissue.
  4. Genetic Predisposition
    • Family history increases risk.
  5. Surgical Scars
    • Endometrial cells may attach to surgical incision sites, such as after a cesarean section.

Symptoms of Endometriosis

  1. Pelvic Pain
    • Severe menstrual cramps (dysmenorrhea).
    • Chronic pelvic pain unrelated to menstruation.
  2. Menstrual Irregularities
    • Heavy bleeding (menorrhagia) or spotting between periods.
  3. Other Symptoms
    • Pain during intercourse (dyspareunia).
    • Painful bowel movements or urination, especially during menstruation.
    • Infertility, often discovered during evaluation for difficulty conceiving.

Complications of Endometriosis

  • Infertility: Affects 30–50% of women with endometriosis.
  • Chronic Pain: Persistent pelvic discomfort impacts quality of life.
  • Adhesions and Scar Tissue: Can cause pelvic organ distortion.
  • Ovarian Cysts: Known as endometriomas or “chocolate cysts.”
  • Increased Risk of Ovarian Cancer: Slightly higher risk in women with severe endometriosis.

Diagnosis of Endometriosis

  1. Medical History and Physical Examination
    • Symptoms such as chronic pelvic pain and infertility.
  2. Imaging Studies
    • Ultrasound: Detects ovarian cysts (endometriomas).
    • MRI: Identifies deep infiltrating endometriosis.
  3. Laparoscopy
    • Gold standard for diagnosis. Involves direct visualization and biopsy of endometrial lesions.
  4. Biomarkers
    • Elevated CA-125 levels may indicate severe disease but lack specificity.

Treatment Options for Endometriosis

1. Medications

Drug ClassExampleBrand NameManufacturerCost Range
NSAIDsIbuprofenAdvil, MotrinPfizer, Reckitt$5–$20 per bottle
Combined Oral ContraceptivesEthinylestradiol + ProgestinYasmin, MicrogynonBayer$20–$50 per month
ProgestinsNorethisteronePrimolut-NBayer$15–$40 per month
GnRH AgonistsLeuprolideLupron DepotAbbVie$1,000–$1,500/month
GnRH AntagonistsElagolixOrilissaAbbVie$800–$1,000/month
Aromatase InhibitorsLetrozoleFemaraNovartis$200–$300/month

2. Surgical Treatments

  • Laparoscopic Excision
    • Removes endometriotic lesions and adhesions.
    • Effective for pain relief and fertility improvement.
  • Hysterectomy
    • Removal of the uterus, and sometimes ovaries, in severe or refractory cases.

3. Assisted Reproductive Technologies (ART)

  • In Vitro Fertilization (IVF)
    • Commonly used for women with endometriosis-related infertility.

4. Lifestyle and Alternative Therapies

  • Dietary Modifications
    • Anti-inflammatory diet: Rich in omega-3 fatty acids, fruits, and vegetables.
  • Regular Exercise
    • Helps reduce estrogen levels and improve symptoms.
  • Acupuncture
    • May provide pain relief for some women.

Monitoring Parameters

  • Symptom improvement and quality of life.
  • Side effects of medications (e.g., hot flashes with GnRH agonists).
  • Regular follow-ups for fertility planning or recurrence evaluation.

Patient Counseling Points

  • Educate on the chronic nature of endometriosis and the importance of long-term management.
  • Explain treatment options, emphasizing that no single therapy works for everyone.
  • Discuss the impact of the condition on fertility and available reproductive options.
  • Provide resources for emotional support and coping strategies.

Use in Children

  • Rare but possible in adolescents; early treatment is crucial to prevent progression.

Use in Pregnancy

  • Symptoms may improve during pregnancy due to hormonal changes but often recur postpartum.

Use in Elderly

  • Symptoms typically resolve after menopause; focus on managing long-term complications like adhesions.

FAQs About Endometriosis

Q1: What causes endometriosis?

  • The exact cause is unknown, but retrograde menstruation and hormonal factors play a role.

Q2: Can endometriosis be cured?

  • No, but symptoms can be managed effectively with treatment.

Q3: How is endometriosis diagnosed?

  • Through laparoscopy, imaging tests, and symptom assessment.

Q4: What are common symptoms of endometriosis?

  • Pelvic pain, heavy periods, painful intercourse, and infertility.

Q5: Can endometriosis cause infertility?

  • Yes, it is a leading cause of infertility in women.

Q6: Is pregnancy possible with endometriosis?

  • Yes, but it may require treatment or assisted reproductive techniques.

Q7: What foods worsen endometriosis symptoms?

  • Processed foods, trans fats, and excessive caffeine or alcohol.

Q8: Are natural remedies effective for endometriosis?

  • Some may help, but they should complement, not replace, medical treatments.

Q9: How long does it take to see improvement with treatment?

  • Pain relief may begin within weeks of starting therapy.

Q10: Does menopause cure endometriosis?

  • Symptoms often improve after menopause but can persist in some cases.

Q11: Can endometriosis return after surgery?

  • Yes, recurrence is common, especially without hormonal management.

Q12: What are the risks of untreated endometriosis?

  • Chronic pain, infertility, adhesions, and a slightly increased risk of ovarian cancer.

Q13: Can adolescents get endometriosis?

  • Yes, and early treatment can help prevent progression.

Q14: Is endometriosis hereditary?

  • Women with a family history have a higher risk.

Q15: Are there support groups for endometriosis?

  • Yes, many online and in-person groups offer support and resources.