Treatment of endometriosis
Medically Reviewed by Dr Sravya, MBBS, MS
Introduction
Endometriosis is a rare condition affecting 10.8 million people globally, with a higher incidence in women aged thirties and forties, but it can begin in girls as young as eight. The disease affects over 190 million women in their reproductive years, affecting them from menarche to postmenopause. Diagnosis requires laparoscopic surgery, pelvic pain, infertility, surgical assessment, and magnetic resonance imaging. Treatment of endometriosis includes hormonal medication and surgery such as laparoscopy, etc.
Let’s see the frequently asked questions: What precisely is endometriosis?
What factors contribute to endometriosis? What are endometriosis signs and symptoms? How do we identify endometriosis? What are the treatment options for endometriosis?
What precisely is endometriosis?
Understanding the underlying causes can aid in the prevention of such occurrences. Among the most common causes are
- Endometriosis is a female reproductive system illness in which cells that resemble those found in the endometrium, the layer of tissue that normally covers the uterine lining, develop outside the uterus.
- Lesions can be seen on the ovaries, fallopian tubes, tissue surrounding the uterus and ovaries (peritoneum), intestines, bladder, and diaphragm, among other places.
- Some of the symptoms include pelvic discomfort, heavy periods, pain with bowel movements, difficulty urination, pain during sexual intercourse, and infertility.
- Nearly half of those afflicted experience chronic pelvic discomfort, with 70% experiencing pain during menstruation. Infertility affects up to 50% of those affected. Approximately 25% of people have no symptoms, while 85% of those evaluated in a tertiary center for infertility have symptoms.
- Endometriosis can have social as well as psychological consequences.
- Endometriosis regions bleed every month (menstrual period), causing irritation and scarring. Endometriosis growths are not cancerous.
- Symptoms are frequently used in conjunction with medical imaging to make a diagnosis; nevertheless, biopsy is the most certain technique of diagnosis.
- Pelvic inflammatory illness, irritable bowel syndrome, interstitial cystitis, and fibromyalgia are all possible causes of comparable symptoms.
- Endometriosis is frequently misdiagnosed, and women frequently report being assured that their symptoms are insignificant or typical.
- The use of combination oral contraceptives may minimise the incidence of endometriosis and used for treatment of endometriosis
- Exercise and avoiding excessive alcohol consumption may also be beneficial.
- Endometriosis has no cure. However, a variety of therapies may alleviate symptoms. This might involve pain relievers, hormone therapies, or surgery.
- A nonsteroidal anti-inflammatory medicine (NSAID) such as naproxen is frequently prescribed as a pain reliever. Continuously taking the active component of the birth control pill or utilizing an intrauterine device containing progestogen may also be beneficial.
- A gonadotropin-releasing hormone agonist (GnRH agonist) may help infertile women become pregnant.
- Endometriosis surgery may be used to treat patients whose symptoms are uncontrollable with conventional therapy.
What factors contribute to endometriosis?
Causes
Endometriosis is a complicated condition that affects millions of women worldwide, from the start of their first period (menarche) through menopause, regardless of ethnicity or social class. Its development is assumed to be influenced by a variety of circumstances. Endometriosis is now considered to be caused by:
- Retrograde menstruation: During periods, menstrual blood with endometrial cells goes back via the fallopian tubes and into the pelvic cavity, while blood flows out of the body through the cervix and vagina. Endometrial-like cells can be transferred outside the uterus during retrograde menstruation, where they can implant and develop.
- Cellular metaplasia is the process through which cells transform from one form to another. Cells outside the uterus transform into endometrial-like cells and begin to proliferate.
- Transportation: Endometrial tissues are transported to other parts of the body through the blood or lymphatic systems, much like cancer cells.
- Direct Transplantation: Endometrial cells may adhere to the walls of the abdomen or other regions of the body during surgery, such as a C-section or hysterectomy.
- Genetic: Endometriosis appears to afflict certain families more frequently than others, suggesting a hereditary link to the disorder.
- Other variables may potentially play a role in the development or maintenance of ectopic endometrial tissue.
Risk factors
Several factors increase your chances of having endometriosis, including:
- Never having children
- Beginning your menstruation at a young age.
- Experiencing menopause at a later age.
- Menstrual cycles last fewer than 27 days.
- Menstrual cycles last more than seven days.
- Higher estrogen levels in your body or a larger lifetime exposure to estrogen produced by your body
- Body mass is low
- Endometriosis in one or more relatives (mother, aunt, or sister)
- A medical condition that prevents blood from exiting the body during menstruation.
- Reproductive system disorders
What are endometriosis signs and symptoms?
Endometriosis is marked by the following signs and symptoms:
- Period pain (dysmenorrhea): Pelvic discomfort and cramps can begin many days before a menstrual cycle and linger several days following. You may also have lower back and abdominal pain.
- Discomfort during or after intercourse: Endometriosis is commonly associated with discomfort during or after intercourse.
- Pain when peeing or passing bowel movements. These symptoms are most common during a menstrual cycle.
- Excessive bleeding: You may experience severe menstrual cycles as well as bleeding between periods (intermenstrual bleeding) on occasion.
- Infertility: Endometriosis is occasionally diagnosed in women seeking infertility treatment.
- Other symptoms and indications. During your menstrual cycle, you may have tiredness, diarrhea, constipation, bloating, or nausea.
- Signs and symptoms of the disease help us to determine the treatment approach for endometriosis.
How do we identify endometriosis?
Your doctor will ask you to describe your symptoms, including the location of your discomfort and when it occurs, in order to identify endometriosis and other disorders that can cause pelvic pain.
Endometriosis tests include:
- Examine the pelvis: During a pelvic exam, your doctor will palpate (feel) areas of your pelvis for abnormalities such as cysts on your reproductive organs or scarring behind your uterus. Small regions of endometriosis are sometimes difficult to detect until they have caused a cyst to develop.
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Laparoscopy: The only approach to correctly identify the breadth and severity of pelvic/abdominal endometriosis is by laparoscopy, a surgical technique that uses a camera to examine the abdominal cavity.
Laparoscopy allows for lesion visualization unless the lesion is visible externally (e.g., an endometriotic nodule in the vagina) or is extra-abdominal. A biopsy is necessary to obtain a diagnosis if the growths (lesions) are not visible. - Ultrasound: Before surgery, vaginal ultrasonography can be used to diagnose endometriosis or to localize endometrioma. This can be utilized to detect disease spread in those who have a strong clinical suspicion of endometriosis.
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Magnetic resonance imaging (MRI) : It is yet another non-invasive technique. for identifying lesions.MRI is not extensively utilized due to its high cost and restricted availability, even though it can diagnose the most prevalent type of endometriosis (endometrioma) with high accuracy.
The diagnosis helps in the planning of the treatment of the endometriosis.
Stages of endometriosis
- Endometriosis is categorized into four stages: I, II, III, and IV.
- It is vital to stress that staging only evaluates physical illness, not discomfort or infertility.
- A person suffering from Stage I endometriosis may have little disease and considerable pain, whereas a person suffering from Stage IV endometriosis may have substantial disease but little discomfort, or vice versa.
The different stages are summarised as follows:
1. Stage I (Minor)
- Only superficial lesions and probably a few filmy adhesions were discovered.
2. Stage II (Mild)
- In addition, there are several deep lesions in the rectouterine pouch.
3. Stage III (Moderate)
- As previously stated, there are endometriomas on the ovary and additional adhesions.
4. Stage IV( Severe)
- As previously stated, there are enormous endometriomas and severe adhesions. Implants and adhesions may be discovered outside of the uterus. Large ovarian cysts are commonly found.
- Treatment of the endometriosis depends on the various stages of the disease.
What are the treatment options for endometriosis?
Endometriotic cysts treatment are treated with either medication or surgery. The path you and your doctor choose will be influenced by the severity of your symptoms and your desire to become pregnant.
Conservative treatment :
1. Pain management:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve) help many individuals. If these do not relieve your discomfort, enquire about further options678.
2. Hormonal therapy:
- Hormonal treatment reduces the amount of estrogen produced by your body and can cause your menstruation to stop. This causes lesions to bleed less, resulting in decreased inflammation, scarring, and cyst development.
- Hormones that are commonly used include:
- Pills, patches, and vaginal rings are all forms of birth control.
- Agonists and antagonists of gonadotropin-releasing hormone (Gn-RH), such as elagolix sodium (Orilissa) or leuprolide (Lupron).
- Contraceptives that exclusively contain progestin
- Danazol (Danocrine) is a drug.
Surgical treatment
Treatment for Endometrial thickness involves surgery and is done by different approaches.
1. Laparoscopic endometriosis surgery
- The most frequent operation used to treat endometriosis is laparoscopy.
- A physician makes a few tiny incisions in your belly during this surgery. They introduce a tiny tube containing a light and a camera via one incision. They introduce little instruments into the other wounds.
- These instruments can be used to remove endometrial tissue (excision) or to damage the tissues (ablation).
- The surgeon will also be able to remove any scar tissue that has formed in the region.
- Laparoscopic procedures typically have a quicker recovery period and fewer scars.
2. Laparoscopic endometriosis surgery
- Endometriosis laparotomy involves making a wider incision (cut) in the abdomen to remove endometrial tissue. This is unusual.
- Endometrial tissue removal by laparoscopy or laparotomy can give temporary pain alleviation. However, the discomfort may return.
3. Hysterectomy endometriosis surgery
- During a hysterectomy, the uterus is surgically removed.
- Removing the ovaries reduces estrogen levels greatly and slows or stops endometrial tissue development.dometrial tissue removal by laparoscopy or laparotomy can give temporary pain alleviation. However, the discomfort may return.
Surgical treatment
- Endometriosis and infertility are commonly found together
- Surgery is more successful than medication in treating infertility caused by endometriosis.
- Surgery aims to remove endometrium-like tissue while preserving the ovaries without causing damage to normal tissue.
- Receiving hormone suppression medication following surgery may be beneficial in terms of endometriosis recurrence and pregnancy.
- Many people with endometriosis benefit from in-vitro fertilization (IVF) operations to improve their fertility.
- When compared to the short pretreatment, the ultralong pretreatment with GnRH-agonist has a larger likelihood of resulting in pregnancy for persons with endometriosis during fertility therapy.
Prevention
The use of combination oral contraceptives, as well as regular exercise and the avoidance of alcohol and caffeine, appears to be connected with a lower incidence of endometriosis.
Summary
Endometriosis is a condition where cells from the endometrium develop outside the uterus, causing symptoms such as pelvic discomfort, heavy periods, and infertility. The cause is unclear, but a family history is a risk factor. Symptoms can be combined with medical imaging, but biopsy is the most reliable method. Other causes include pelvic inflammatory illness, irritable bowel syndrome, interstitial cystitis, and fibromyalgia. Endometriosis is often misdiagnosed, but treatment options include a combination of oral contraceptives, exercise, and avoiding excessive alcohol consumption. Despite having no cure, various therapies, such as NSAIDs, birth control pills, and GnRH agonists, can alleviate symptoms and help infertile women become pregnant.