Endometriosis

Endometriosis

Endometriosis is a condition which occurs when endometrial-like cells, which should be located in the uterine cavity, grow in other places in the body. This condition affects 3-18% of women.

Endometriosis is a medical condition in which endometrial-like cells grow outside of the uterus, which is where they should normally be located. It is estimated to affect between 3-18% of women in the general population.

1. Endometriosis interna, also known as adenomyosis, is a condition in which the endometrium grows into the muscles of the uterus, instead of just the inner surface. Adenomyosis can be divided into two types, localized or diffuse. In localized adenomyosis, the uterine tissue grows locally, while in the diffuse form, the tissue grows throughout the entire uterus. Upon examination, it was observed that the uterus had grown in a similar manner to that of uterine fibroids.
2. Endometriosis externa, also known as simply Endometriosis, is a condition where the lining of the uterus is found outside of the uterus. This may include the ovaries, fallopian tubes, uterine ligaments, or even the liver, diaphragm, lungs, or other tissues in the abdominal cavity. In some cases, it may also be found in incisions or wounds that have been made in the abdominal area.

What causes Endometriosis?

Endometriosis is believed to be caused by the shedding of endometrium and the reversal of blood flow through the fallopian tubes, allowing it to enter the abdomen in the pelvic area. This phenomenon occurs in 70-80% of normal people's menstruation, but not everyone experiences it. Normal tissues of the body are typically destroyed by white blood cells and immunity, but in patients with endometriosis, the resistance to these cells was found to be lower than in individuals without the disease. There is a theory of birth, and many other theories of endometriosis, yet none of them can fully explain the occurrence and progression of the disease. Ultimately, the cause of endometriosis is still uncertain.

Symptoms of endometriosis can be divided into 4 types:

1. Pain is a common symptom of endometriosis and can manifest in various ways, including menstrual cramps, chronic pelvic pain, pain while defecating (especially when constipated), pain during urination or pain in the abdominal surgery wound (which is often particularly painful during menstruation). Endometriosis can also cause pain during sexual intercourse and can lead to an ulcer-like appearance due to a build-up of chemicals at the affected area, which stimulates the nerve endings to perceive pain more intensely than normal. Illness may also be caused by scarring from the inflammatory reaction.

2. Abnormal menstrual bleeding, such as heavy or infrequent periods, can be attributed to endometriosis. This is due to the disease causing a thickening of the uterine lining, causing the uterus to expand, leading to more bleeding in the uterine cavity and endometrial hyperplasia. It can also cause adhesion of the muscles of the uterus, leading to an inadequate stopping of the bleeding. People with this disease can also experience irregular menstruation, as well as those with fibroids of the uterus.

3. Endometriosis can cause infertility in women due to it being present in 20-50% of cases. The disease can lead to the body fighting against attached cells, leading to inflammation and fibrosis. This can cause the egg to fall out of the ovary, the fallopian tube to become blocked, or prevent the egg from being caught in the tube. Even if the disease is not severe, it can lead to reduced egg and embryo quality, resulting in poor fertilization or poor cell division. Endometriosis can also cause pain during sexual intercourse, leading to an avoidance of it, thereby reducing the chances of conceiving.

4. Endometriosis can lead to the formation of a cyst, known as a 'chocolate cyst', on the ovary. The cyst is filled with blood, which has been trapped and accumulated over a long period of time. It can also cause an enlarged uterus due to adenomyosis. Symptoms of these lumps in the lower abdomen can include pain, pressure and discomfort.

Diagnosis of Endometriosis

The preliminary diagnosis of this disease is based on the symptoms that the patient tells the doctor, along with findings of a lump or pain, or a membrane-like appearance behind the uterus and on the ligaments of the uterus.

To make the diagnosis more accurate, the next step is to perform an ultrasound and the most definitive examination is to perform an endoscopy into the abdomen, with a small biopsy to confirm the pathology.

Seeing lesions through open abdominal surgery or endoscopic abdominal surgery, which involves making a small incision at the navel and inserting a camera to look at the organs in the abdomen, will provide the most accurate diagnosis.

 Additionally, ultrasound and endoscopic surgery laparoscope (laparoscopy) is useful for differentiating endometriosis from cancer, and for separating it from other diseases that cause endometriosis-like symptoms, such as pelvic inflammatory disease, uterine fibroids, and a malformed uterus. There is no way to identify endometriosis through venipuncture.

What are the treatments for endometriosis?

This disease can be managed through the use of medication. Additionally, surgery may be an option depending on the desired outcome, such as relieving pain, abnormal menstrual bleeding, infertility, chocolate cysts, or treating other endometriosis-related complications.

Treatment for smaller lesions or fewer symptoms

There are multiple medications that can diminish the size of the lesions or scars caused by this disorder. These medications can help to reduce the body's response, including:

1. Progesterone is a hormone commonly used to reduce the symptoms of endometrial atrophy both in the uterus and outside the uterus. Contraceptive injections and oral contraceptives are the most common methods of administering progesterone. While contraceptive injections can reduce symptoms, they can also cause irregular menstrual cycles or no menstruation at all. Oral contraceptives cause regular menstruation, but with a lower dose of hormones. When the drug is discontinued, the effects of progesterone wear off.

2. Danazol is a hormone that helps to prevent ovulation and reduce the amount of hormones that stimulate the uterine lining. This helps with endometrial atrophy and often results in some symptom improvement. However, side effects of danazol include irregular or no menstruation, increased hair growth, a deeper voice (which does not change back to normal after the drug is discontinued), abnormal lipids in the blood, and the potential to harm the liver. Because of these side effects, obstetricians now typically do not use this drug.

3. Gonadotropin-releasing agonist (GnRHagonist) is a hormonal drug that stimulates the ovaries and causes them to stop producing hormones. This results in a menopause-like state and causes the uterine lining to become much smaller due to the lack of hormones stimulating it. Side effects of this drug are similar to menopause, including irritability, hot flashes, vaginal dryness, and bone thinning. This drug is available both as an injection and a nasal spray, and is typically only used temporarily and not for long-term treatment.

4. Surgery to treat endometrial atrophy involves the removal of lesions or diseased parts. Abdominal laparoscopic surgery is the most commonly used procedure due to its good results, less scarring, less pain, and faster recovery. This procedure seeks to restore the area to its most normal condition and removes as many visible lesions as possible. Results of both conventional surgery and laparoscopic surgery are generally of similar quality.

Treatment to reduce pain

Your doctor will usually suggest beginning with a pain reliever like Paracetamol or an NSAID like Brufen or Ponstan, or another form of medication. Take it when you feel pain or as soon as you start to feel pain for the best results. These medicines can reduce the pain, but they cannot cure the illness. Oral contraceptive pills can also reduce menstrual cramps and irregularities and may slow the progression of the illness. Birth control pills have a similar effect, though they may cause you to not have your period or have irregular menstrual bleeding. Another option is laparoscopic surgery, which requires a small incision on the abdomen. This method is effective for both diagnosis and treatment. It is particularly useful for lumps in the uterus or chocolate cysts on the ovaries and for people suffering from infertility. This type of surgery, performed by a specialist, has good results and a low chance of recurrence.

Treatment for infertility problems

When the disease is severe, there are fibrosis attached to various organs, including the uterus, ovaries and fallopian tubes, and the fallopian tubes are blocked. Better treatment is surgery to destroy the lesions and fascia. and correcting abnormalities of organs And although the lesions are few, they can cause infertility as well.

Summary

We still have not identified the root cause of endometrial hyperplasia, which is found in 3-18% of women. Symptoms may be absent or range from pelvic pain and menstrual pain to irregular menstruation and infertility. Treatment options are both medical and surgical, depending on the patient's purpose and issue. Pain management can be accomplished with either medication or surgery, with surgery as the ultimate solution if drugs fail to improve the condition.

Surgery is an effective solution for infertility issues, and has undergone much improvement over time. Utilizing assisted reproductive technology following surgery further increases the likelihood of successful outcomes.

Dr. Teerasak Thamrong Teerakul Physician at the Fertility Center, Vibhavadi Hospital