Endometriosis; Key Q&A.What causes endometriosis?The most widely accepted cause of the endometriosis is retrograde menstruation. This occurs when tissue from the uterine lining, called endometrial endometrial /en·do·me·tri·al/ (en?do-me´tre-il) pertaining to the endometrium. endometrial, n relating to the end-ometrium or cavity of the uterus. tissue, flows backward through your fallopian tubes while you're menstruating. The tissue gets trapped and can't leave the body. However, no matter where it is in the body, endometrial tissue still responds to your hormones each month. This tissue can become inflamed, bleed and develop into scar tissue. When the tissue is attached to organs in the pelvic and abdominal cavities, it may cause severe pain, infertility and other problems. Other theories suggest that a weak immune system response, hormonal imbalances or environmental causes may be related to the development of endometriosis. Experts also find strong evidence suggesting a genetic link. What does endometriosis feel like? Pain in the pelvic region ranging from very mild to severe is the most common symptom, but you may not experience any symptoms. Some women describe the pain as sharp and burning. It may last all month long, but is usually worse during menstruation, deep penetration during intercourse or bowel movements. Other symptoms may include: Diarrhea and painful bowel movements especially during menstruation Abdominal tenderness Intestinal pain Abnormal menstrual bleeding Severe menstrual cramps Pelvic pain distinct from menstrual cramps Backache back·ache n. Discomfort or a pain in the region of the back or spine. Pain during or after sexual penetration Painful bowel movements Pain with exercise Painful pelvic examination Infertility How can I be sure I'm being diagnosed correctly if pain associated with the disease can often be confused with other medical problems? Even without a definitive diagnosis, your health care professional may still prescribe hormonal treatments. If the pain decreases, there is an assumption that endometriosis was the cause of the pain. However, endometriosis cannot be definitively diagnosed without laparoscopy laparoscopy or peritoneoscopy Procedure for inspecting the abdominal cavity using a laparoscope; also surgery requiring use of a laparoscope. Laparoscopes use fibre-optic lights and small video cameras to show tissues and organs on a monitor. and biopsy. The American College of Obstetricians and Gynecologists (ACOG ACOG American College of Obstetricians and Gynecologists. ACOG American College of Obstetricians & Gynecologists ) recommends a biopsy of the outer lining of the uterus to confirm the presence of endometrial tissue. Can I get pregnant if I have endometriosis? Yes, you can. Nearly all women who have endometriosis are fertile, and there are many who have the disease and go on to have children. Is there any way I can prevent endometriosis? No. We don't know definitively what causes the condition, so we don't know how to prevent it. However, research suggests that having children early, having more than one child and long-term use of oral contraceptives may reduce the risk. What options are available to treat endometriosis? The most common medical therapies for endometriosis are hormonal contraceptives and other hormonal regimens, such as GnRH agonists (gonadotropin-releasing hormone drugs), which reduce estrogen release, limiting the effects of hormones on the endometrial tissue. Danazol, a synthetic androgen, is also used, but it can cause some undesirable side effects, including weight gain, hirsutism Hirsutism Definition Excessive growth of facial or body hair in women is called hirsutism. Description Hirsutism is not a disease. The condition usually develops during puberty and becomes more pronounced as the years go by. (hair growth) and lowering of the voice. Surgical treatments range from removing only the endometrial implants via laparoscopy to removing the uterus and ovaries. How do I know which is the best treatment option for my case of endometriosis? It's tough to know which is the best treatment for you, especially because no comparative studies have been conducted to determine which approach is better. There are pros and cons for all treatment options. Up to 90 percent of women with the disease can find relief via medical therapies, and birth control pills may be used indefinitely to manage symptoms. Others turn to surgery. However, women try to avoid surgery to remove the uterus because it's a serious procedure that will leave them infertile and carries no guarantee of banishing endometriosis forever. Because of the risks associated with surgery, the usual course of treatment is to proceed from the least invasive or risky to the more invasive treatment. That means medical treatment first. If that doesn't work, your doctor may recommend laparoscopy, with surgery to remove the uterus as a last resort. References Ryan, Kenneth, Ross Berkowitz, et al., eds. Kistner's Gynecology and Women's Health. 7th ed. St. Louis: Mosby, 1999. pp. 501-502. "FDA Approves New Labels for Estrogen and Estrogen with Progestin progestin /pro·ges·tin/ (-jes´tin) progestational agent. pro·ges·tin n. 1. A natural or synthetic progestational substance that mimics some or all of the actions of progesterone. Therapies for Postmenopausal post·men·o·paus·al adj. Of or occurring in the time following menopause. postmenopausal Change of life Gynecology adjective Referring to the time in ♀ when menstrual periods stop for ≥ 1 yr Women Following Review of Women's Health Initiative Women's Health Initiative A 15-yr, $628 million project involving 1. An observational study of the health habits and medical Hx of ±100,000 ♀ 2. Data." FDA News/Press Release. January 8, 2003. http://www.fda.gov. Accessed March 2003. Grady D, Herrington D, Bittner V, et al, for the HERS Research Group. Heart and estrogen/progestin replacement study follow-up (HERS II): Part 1. Cardiovascular outcomes during 6.8 years of hormone therapy. JAMA 2002;288:49-57. Hulley S, Furberg C, Barrett-Connor E, et al, for the HERS Research Group. Heart and estrogen/progestin replacement study follow-up (HERS II): Part 2. Non-cardiovascular outcomes during 6.8 years of hormone therapy. JAMA 2002;288:58-66. Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial A randomized controlled trial (RCT) is a scientific procedure most commonly used in testing medicines or medical procedures. RCTs are considered the most reliable form of scientific evidence because it eliminates all forms of spurious causality. . JAMA 2002; 288:321-333. 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"Menopausal Hormone Replacement Therapy and Risk of Ovarian Cancer." JAMA 2002. Vol. 288:334-341.368-369. Droegemuller, William. "Endometriosis and Adenomyosis adenomyosis /ad·e·no·my·o·sis/ (-mi-o´sis) benign ingrowth of the endometrium into the uterine musculature, sometimes with hypertrophy of the latter; if the lesion forms a circumscribed tumorlike nodule, it is called adenomyoma. : Etiology, Pathology, Diagnosis and Management," in Comprehensive Gynecology, 4th Ed., Stenchever, Droegemuller, Herbst, Michell (2001), p. 531-564. "About DES (diethylstilboestrol Noun 1. diethylstilboestrol - a potent estrogen used in medicine and in feed for livestock and poultry DES, diethylstilbestrol, stilbestrol, stilboestrol )" Endometriosis.org. http://www.endometriosis.org. Dated 1999. Accessed August 2001. "Endometriosis Family Study Identifies High Risk of Cancer and Autoimmune Diseases." Endometriosis Association. http://www.endometriosis.org. Dated 1999. Accessed August 2001. Guidelines on the Treatment of Endometriosis: Update. American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin no. 11, Obstetrics and Gynecology, Dec. 1999. Reproductive Conditions-Endometriosis. Veritas Medicine. http://www.veritasmedicine.com. Dated 2001. Accessed August 2001. The Endometriosis Association. http://www.endometriosisassn.org. July 2005. Endometriosis.org http://www.endometriosis.org. July 2005. Endometriosis. Mayo Clinic. Available at: http://www.mayoclinic.com. Accessed October 2005. Berkley KJ, Rapkin AJ, Papka RE. The pains of endometriosis. Science. 2005 Jun 10;308(5728):1587-9. Keywords: endometriosis, menstruation, symptoms, laparoscopy, hysterectomy, fertility |
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