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Endometriosis - Causes, Symptoms, Diagnosis, and Treatment

What is endometriosis?

Endometriosis (en-doe-me-tree-O-sis) is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus (endometrial implant). Endometriosis most commonly involves your ovaries, bowel or the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond your pelvic region.  It is one of the most common health problems for women.

Most often, endometriosis is found on the:

- Ovaries
- Fallopian tubes
- Tissues that hold the uterus in place
- Outer surface of the uterus
- Lining of the pelvic cavity

Other sites for growths can include the vagina, cervix, vulva, bowel, bladder, or rectum. In rare cases, endometriosis has been found in other parts of the body, such as the lungs, brain, and skin.


What are endometriosis causes?

The cause of endometriosis is unknown. One theory is that the endometrial tissue is deposited in unusual locations by the backing up of menstrual flow into the Fallopian tubes and the pelvic and abdominal cavity during menstruation (termed retrograde menstruation). The cause of retrograde menstruation is not clearly understood. But retrograde menstruation cannot be the sole cause of endometriosis. Many women have retrograde menstruation in varying degrees, yet not all of them develop endometriosis.

Another possibility is that areas lining the pelvic organs possess primitive cells that are able to grow into other forms of tissue, such as endometrial cells. (This process is termed coelomic metaplasia.)

It is also likely that direct transfer of endometrial tissues during surgery may be responsible for the endometriosis implants sometimes seen in surgical scars (for example, episiotomy or Cesarean section scars). Transfer of endometrial cells via the bloodstream or lymphatic system is the most likely explanation for the rare cases of endometriosis that develop in the brain and other organs distant from the pelvis.

Finally, there is evidence that shows alternations in the immune response in women with endometriosis, which may affect the body's natural ability to recognize and destroy any misdirected growth of endometrial tissue.

Women might be more likely to get endometriosis if she has:
- Never had children
- Menstrual periods that last more than seven days
- Short menstrual cycles (27 days or less)
- A family member (mother, aunt, sister) with endometriosis
- A health problem that prevents normal passage of menstrual blood flow
- Damage to cells in the pelvis from an infection


What are endometriosis symptoms?

Pain  

Secondary dysmenorrhea is a typical symptom, condition worsen with lesion aggravating over time. The pain often occurs in lower back and lumbosacral area, and even vagina, perineum and legs, 1-2 days before menstruation. The most desperate pain is usually on the first day of the period and abates during the following days , the pain stops after the menstruation. The amount of pain corelate poorly with the extent of lesion., with some women having little pain despite having severe adhesion, while other women may have great pain even though they have only a few small areas of endometriosis. A few women may have a constant pain in lower abdomen, worsen with the menstrual cycle.

Irregular menstruation   

15%-30% of patient have heavy menstrual flow, prolonged menstrual periods, and spotting. Irregular menstruation may relate to ovarian lesion anovulation, luteal phase deficiency, adenomyosis, and fibroids.

Infertility   

Infertility rate of Patients with endometriosis is up to 40%. The reason of which may include:
①anatomical distortion: Adhesions between tissues and organs in pelvic cavity and Fallopian tubes peristalsis abate in patient with serious endometriosis affect the act of ovulation and fertilization.
②Ovarian dysfunction: Incidence of ovarian disease is 17%-27% in patients with endometriosis. It may relate to the rising of PGs in peritoneal fluid effects follicle growth and ovulation.
③Autoimmune reaction: B-lymphocytes produce EMAb interfere with the transportation and implantation of early fertilized egg. Macrophage in abdominal cavity swallow germs and interfere with egg cell division leads to infertility.

Painful sex   

Rectouterine pouch cause local tissue edema ,adhesion or fixed retroversion of uterus. Fornix of vagina during sex intercourse, uterine contraction and elevation may give rise to the pain, most obvious before the menstruation

Ovarian endometriosis ruptured cyst   

After cyst ruptured ,stale thick dark blood would flow into abdominopelvic cavity causes sudden gnawing pain with nausea , vomiting and anus bulge. Pain occurs before and after menstruation or after sex intercourse, the symptom of which similar with rupture of tubal pregnancy.

Other special symptom   

①rectal endometriosis: cause stomachache ,diarrhea, constipation minor hemafecia ,  hemorrhage due to intestinal mucosa hyperemia.
②endometriosis of the urinary system: ectopic endometrium violates bladder wall may cause painful urination and frequent urination during periods. Ectopic endometrium violates and oppresses ureter may cause pain on side of lower back and hematuresis ,but only in rare cases.
③endometriosis to abdominal wall scar after surgery: recurrent pain on the scar and enlarging of the lump months or years after surgery..
④The reports about endometriosis of other parts of body, such as lung, brain tissues and limbs are rarely seen.The symptoms of which is the recurrent pain at lesion parts and bleeding or forming lumps, and lead to corresponding symptoms.


How is endometriosis diagnosed?

Exams for diagnosing endometriosis includes:

Pelvic exam. Your doctor will perform a pelvic exam to feel for large cysts or scars behind your uterus. Smaller areas of endometriosis are hard to feel.

Ultrasound. Your doctor could perform an ultrasound, an imaging test to see if there are ovarian cysts from endometriosis. During a vaginal ultrasound, the doctor will insert a wand-shaped scanner into your vagina. During an ultrasound of your pelvis, a scanner is moved across your abdomen. Both tests use sound waves to make pictures of your reproductive organs. Magnetic resonance imaging (MRI) is another common imaging test that can produce a picture of the inside of your body.

Laparoscopy. The only way for your doctor to know for sure that you have endometriosis is to look inside your abdomen to see endometriosis tissue. He or she can do this through a minor surgery called laparoscopy. You will receive general anesthesia before the surgery. Then, your abdomen is expanded with a gas to make it easy to see your organs. A tiny cut is made in your abdomen and a thin tube with a light is placed inside to see growths from endometriosis. Sometimes doctors can diagnose endometriosis just by seeing the growths. Other times, they need to take a small sample of tissue and study it under a microscope.

If your doctor does not find signs of an ovarian cyst during an ultrasound, before doing a laparoscopy, your doctor may prescribe birth control pills to control your menstrual cycle. Sometimes this treatment helps lessen pelvic pain during your period. Some doctors may offer another treatment that blocks the menstrual cycle and lowers the amount of estrogen your body makes before doing a laparoscopy. This treatment is a medicine called a gonadotropin (go-na-doh-TRO-pen) releasing hormone (GnRH) agonist, which also may help pelvic pain. If your pain improves on this medicine, the doctor will likely think that you have endometriosis.

Laparoscopy is often recommended for diagnosis and treatment if the pelvic pain persists, even after taking birth control pills and pain medicine.


How is endometriosis treated?

Western doctors believes that there is no cure for adenomyosis, there are just some treatments for the pain and infertility that it causes. Common treatments are as follow: 

Pain medication. For some women with mild symptoms, doctors may suggest taking over-the-counter medicines for pain. These include ibuprofen (Advil and Motrin) or naproxen (Aleve). When these medicines don't help, doctors may prescribe stronger pain relievers.

Hormone treatment. When pain medicine is not enough, doctors often recommend hormone medicines to treat endometriosis. Only women who do not wish to become pregnant can use these drugs. Hormone treatment is best for women with small growths who do not have bad pain. Hormones come in many forms including pills, shots, and nasal sprays. Common hormones used for endometriosis include:
- Birth control pills
- GnRH agonists and antagonists
- Progestins
- Danazol

Surgery. Surgery is usually the best choice for women with severe endometriosis — many growths, a great deal of pain, or fertility problems. There are both minor and more complex surgeries that can help. Your doctor might suggest one of the following:
- Laparoscopy
- Laparotomy or major abdominal surgery
- Hysterectomy

Appropriate herbal formulas can treat endometriosis syptoms as well, some even found able to clear up the lesion.






 

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