When diagnosed and treated early, prognosis is good. Medical and surgical treatments can relieve 90% of the pain of endometriosis in women. However the recurring rate for all types of conservative surgery is 20% within 5 years. Even without treatment, 3 out of 4 women with mild endometriosis can still become pregnant. Of those women that do choose laparoscopic surgery, about 40%become pregnant afterwards.
Endometriosis produces inflammatory indicators that include:
* Scarring * Pain * Fibrosis: dark strings of blood
* Lesions: dark blue or chocolate in color
Blood from endometriosis differs from normal blood in that it contains hemosiderin deposits. All indicators may occur as part of an immune response to this blood typically occurs on the surface of organs in the pelvic and intra-abdominal areas. These include:
* Fallopian tubes * Uterus * Intestines * Ureters / bladder (resulting in irritable bowels)
Larger lesions may also be found in the ovaries in the form of “chocolate cysts”. Pain is more severe before, during, or after the menstrual cycle. Complications of the disease include:
* Internal scarring * Adhesions (fibrous bands) * Pelvic cysts * Chocolate cysts
* Intestinal obstruction
Diagnosis of endometriosis is made based upon the following methods:
* Health history * Physical examination * Ultrasound
* MRI (Magnetic Resonance Imaging) * Laparoscopy
All of these are necessary to distinguish between endometriosis and other disorders that exhibit similar symptoms such as ovarian cyst syndrome and ovarian cancer stages are characterized based on the danger of disease, and not the level of pain or infertility.
* Stage I (Minimal): Superficial lesions
* Stage II (Mild): Deep lesions in the cul-de-sac
* Stage III (Moderate): deep lesion in ovary, culde-sac, and adhesions are present
* Stage IV (Severe): large lesions, large cysts, and extensive adhesions.
* Retrograde Menstruation (reversal in menstrualflow) * Genetic Birth Defects
* Transplantation * Environmental Chemicals
The histology of endometriotic tissue is markedly different from that of normal tissues. The following markers are often present:
* Ruptured Cells * CA-125 (An Antigen) * Chocolate cysts
Treatment and Potential Side Effects
Side effects include occasional, weight gain, breast tenderness, nausea, and irregular bleeding are mild side effects. Oral contraceptive pills are usually well-tolerated in women with endometriosis.
Progestins are more potent than birth control pills and are recommended for women who do not obtain pain relief from or cannot take a birth control pill. Side effects are more common and include breast tenderness, bloating, weight gain, irregular uterine bleeding, and depression. Since the absence of menstruation induced by high doses of progestins can last many months after cessation of therapy, these drugs are not recommended for women planning pregnancy
Danocrine is a synthetic drug thatcreates a high androgen (male type hormone) and low estrogen hormonal environment by interfering with ovulation and ovarian production of estrogen. 80% of women who take this drug will have painrelief and shrinkage of endometriosis implants, but up to 75% of women develop side effects from the drug. These side effects include weight gain, edema, decreased breast size, acne, oily skin, hirsutism (male pattern hair growth), deepening of the voice, headache, hot flashes, changes in libido, and mood changes. All of these changes are reversible, except for voice changes; but the return to normal may take many months. Danazol should not be taken by women with certain types of liver, kidney, and heart conditions
These drugs act by interrupting local estrogen formation within the endometriosis implants themselves. They also inhibit estrogen production in the ovary, brain, and other sources, such as adipose tissue. Research is still ongoing to characterize the effectiveness of aromatase inhibitors in the management of endometriosis. Bone loss with prolonged use and cannot be used alone withoutother medications in premenopausal women because they stimulate development of multiple follicles at ovulation.
* GnRH agonists
* Progesterone hormone tablets
* The Mirena Coil
Treatment of infertility associated with endometriosis:
Endometriosis is more common in infertile, compared to fertile, women. However, it is estimated that up to 70% of women with mild and moderate endometriosis will conceive within three years without any specific treatment. The reasons for a decrease in fertility are not completely understood, but might be due to both anatomic and hormonal factors. Most doctors believe that surgical treatments are superior to hormonal or medical treatments for endometriosis when the goal is enhancement of fertility. Assisted reproduction techniques may also be used when appropriate in combination with surgical therapy.
Surgical Treatment of Endometriosis
Surgical treatment for endometriosis can be useful when the symptoms of endometriosis are severe or when there has been an inadequate response to medical treatment. Surgery is the preferred treatment when there is anatomic distortion of the pelvic organs or obstruction of the bowel or urinary tract. Surgical therapies for endometriosis may be either classified as conservative, in which the uterus and ovarian tissue is preserved, or definitive, which involves hysterectomy (removal of the uterus), with or without removal of the ovaries.
While surgical treatments can be very effective in the reduction of pain, the recurrence rate of endometriosis following surgical treatment has been estimated to be as high as 40%. Many doctors recommend for women who have had surgery for endometriosis to take oral medications after surgery to help maintain symptom relief.
Although there is no cure for endometriosis, treatment can help with pain and infertility. Treatment depends on how severe your symptoms are and whether you have future pregnancy plans. For pain only, any hormone therapy that lowers your body’s estrogen levels will shrink endometriosis implants and may reduce pain. If a patient seeks to become pregnant, surgery, infertility treatment, or both may help.
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Last updated October 2013
Image “Pain In Stmach” courtesy of marin / FreeDigitalPhotos.net