ch 14. Endometriosis

Posted: May 17, 2012 in Gynocology
  • Every month, a woman’s ovaries produce hormones that tell the cells lining the uterus (womb) to swell and get thicker. The body removes these extra cells from the womb lining (endometrium) when she gets her period.
  • If these cells (called endometrial cells) implant and grow outside the uterus, endometriosis results.Women with endometriosis typically have tissue implants on the ovaries, bowel, rectum, bladder, lining of the pelvic area and other Ectopic Locations.

Etiology :

  1. The cause of endometriosis is unknown.
  2. Retrograde menstruation :One theory is that the endometrial cells shed when you get your period travel backwards through the fallopian tubes into the pelvis, where they implant and grow. This is called .
  3. Aging : Endometriosis is typically diagnosed between ages 25 – 35, the condition probably begins about the time that regular menstruation begins.
  4. Genetics : Changes in Chromosome 10 can create Endometriosis.Any past family history of Endometriosis.
  5. Biomarkers : The one biomarker that has been used in clinical practice over the last 20 years is CA-125. However, its performance in diagnosing endometriosis is low, even though it shows some promise in detecting more severe disease.

    Retrigrade Menstuation

    Can for Endometrial Cyst or Chocolate cyst as a further complication.

Stages of Endometriosis :

Stage 1 (Minimal): Just a few endometrial implant; mostly found in the cul-de-sac and pelvic area.
Stage 2 (Mild): Moderate levels of endometriosis to mild levels that not only affect the above areas but can now affect the ovaries.
Stage 3 (Moderate): Moderate amount of disease and in extensive places around the pelvic cavity, with adhesions.
Stage 4 (Severe) : Extensive endomtrial implants sprinkled all throughout the pelvic cavity with adhesions; higher probability of infertility.

Symptoms :

  1. Dysmenorrhea – painful, sometimes disabling cramps during menses; pain may get worse over time (progressive pain), also lower back pains linked to the pelvis
  2. Chronic pelvic pain – typically accompanied by lower back pain or abdominal pain
  3. Dyspareunia – painful sex
  4. Dysuria – urinary urgency, frequency, and sometimes painful voiding

Diagnosis :

  1. Laparoscopy:  A surgical procedure where a camera is used to look inside the abdominal cavity
  2. Ultrasound and magnetic resonance imaging (MRI) : Use of imaging tests may identify endometriotic cysts or larger endometriotic areas. It also may identify free fluid often within the Recto-uterine pouch.
  3.  Biopsy : The diagnosis is based if Endometrium like tissues can be found on ectopic Locations.

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