A Family Doctor's Tale - ENDOMETRIOSIS

DOC I HAVE ENDOMETRIOSIS

Endometriosis is not uncommon in Singapore women. Many cases of severe abdominal menstrual cramps are often found to be caused by endometriosis. In patients with menses cramps it is always advisable for them to go for a complete gynecological examination to determine the cause so a referral to a gynecologist is always a must.

Endometriosis is a disorder of the endometrial tissues (which line a woman's uterus )in which these tissues are implanted in places outside the uterus, usually in other parts of the pelvic cavity and abdomen.


 However, in women with Endometriosis, blood from the implanted endometrial tissue is trapped inside, becomes inflamed, and develops into scar tissue. Because of this inflammation, severe pain, infertility and bowel problems occur.




The cause of endometriosis is still not known.
There are a few theories:
1.during menstruation, some of the menstrual tissue is pushed back through the fallopian tubes into the abdomen where it implants and grows. 
2.it may be due to a genetic process
3.certain families are predisposed to endometriosis:
Higher socioeconomic groups
women who marry late and have no or few children
4.Stress may constrict the opening of the uterus .
Some endometrial tissues are pushed backward into the abdominal cavity instead of through the opening of the uterus


Endometriosis occurs usually years after the periods begin.
Symptoms may worsen as the endometrial area increases in size.
However after menopause, the implanted tissue shrinks away and the symptoms subside. 

Common symptoms include:

Severe menstrual cramps
Pelvic pain apart from menstrual periods
Diarrhea or painful bowel movements during menses
Menstrual irregularities
Menorrhagia
Painful intercourse
Backache
Pain with exercise
Painful pelvic exams
Painful and frequent urination
Bloating
Constipation
Fatigue


A diagnosis can only be made via laparoscopy. 
A laparoscope is a tube with a light in it which is inserted through a small incision in the navel area. The  misplaced endometrial tissue can then be found and the location, extent and size of the endometriosis detected.


There is no cure for endometriosis.
If the symptoms are mild, only medication for pain is required.
Treatment depends on the size, extent of the lesions, age of the patient and the desire for pregnancy.


If these women want to be pregnant, the best course of action is to have a trial period of unprotected intercourse for 6 months to 1 year. 

Once pregnancy occur, the endometriosis will clear by itself because there is no menses for nine months. 

Whether the endometriosis will recur after delivery depends on the patient. Most patients do not have a recurrence.


If the patient is not seeking pregnancy and where specific treatment of the endometriosis is required, hormone suppression treatment may be tried. 
This prevents ovulation and less endometrial tissue is formed. Because of this the endometriosis may reduced resulting in less symptoms. A course of treatment may last 6 months.


Where hormone suppression therapy do not work, some patients may require surgical treatment to remove the endometriosis tissue in the abdomen.

 In severe cases, where the uterus and ovaries are affected, removal by surgery of the uterus and/or ovaries is required especially in those nearing menopause or who do not wish to be pregnant.