Endometriosis

Endometriosis: Causes, Symptoms, Diagnosis and Treatments

What is Endometriosis?

Endometriosis is an abnormality in which the tissue that forms the lining of the uterus grows outside of the uterine cavity and is one of the top three causes of infertility in women.

Under normal condition during menstrual cycle, the epithelial lining of the uterus -- called the endometrium -- begins to thicken in preparation for fertilized eggs. However, if the released eggs could not get sperm cell to fertilize it, the ’bed’ that has been well prepared for the eggs (that is, the endometrium) is thus shed during menstruation. We jokingly refer menstruation as the tears of the crying of a deprived endometrium.

In endometriosis, tissue very similar to the endometrium begins to grow outside the uterus in various parts of the reproductive system or even non-reproductive organs. It can appear in or on the ovaries, the fallopian tubes, the various structures that support the uterus, and the lining of the pelvic cavity. Sometimes, it's found in other places as well, including the cervix, vagina, rectum, bladder, bowel, and elsewhere. Such endometrium growing outside the uterus is called an endometrial implant.

The endometrial implant also responds to the levels of menstrual hormone like normal endometrial tissue -- it builds up and breaks down with the normal menstrual cycle fails to shed like normal endometrial tissue during menstruation. It only contributes to increase bleeding during menstruation. As a result, endometriosis can cause irritation, inflammation, and formation of scar tissue. If endometrial implant exists in the fallopian tube, it can thus clog the tube preventing the egg from coming in contact with the sperm cells.

Endometriomas are endometrial growths or implants formed in the ovary. they are also referred to as chocolate cysts or endometriotic cysts are a localised form of endometriosis and are usually found within the ovary. They are usually diagnosed on ultrasound.

What are the signs and symptoms of endometriosis?

While it may be nearly asymptomatic in some women, below are some of the common signs and symptoms of endometriosis :

    1. Pelvic pain

        2. Dyspareunia-Painful intercourse

    3. Dysuria-painful urination

    4. Severeabdominal pain or cramps

    5. Lower back pain

    6. Menorrhagia-heavy vaginal bleeding during menstruation

      7. General body weakness

    8. Infertility

Can I still get Pregnant after being diagnosed of endometriosis?

Endometriosis may pose great problem to a woman from getting pregnant.

Some woman got pregnant even after a confirmed case of endometriosis; it depends on the site and the severity of the endometrial implants.

 How is Endometriosis diagnosed?

Endometriosis is usually diagnosed by laparoscopy. Laparoscopy is both a diagnostic and treatment tool; it is used to visualize, diagnose and remove the endometrial implants.

It can also be diagnosed using sonography as well as MRI.

What are the treatment options for endometriosis?

Treatments include medications to suppress the symptoms and other treatment techniques.

1.         Pain medications to reduce the associated pain and the inflammations. Non-steroidal anti-inflammatory drugs called NSAIDs such as diclofenac, ibuprofen, mefenamic acid are used. These drugs are usually over-the-counter drugs.

2.         Hormonal supplements- most hormonal substances that are used as contraceptives reduces chances of pregnancy by interfering with proper preparation of the endometrium. so when used they prevent growth of endometrial implants and stop menstruation. A typical example is Depo-Provera whose active ingredient is medroxyprogesterone . A single dose of depo-provera may remain active in the body for 3months. However these types of drugs have been linked with increased incidence of osteoporosis in women.

3.         Danazol is also effective in reducing and preventing incidence of endometrial implants

4.         Surgery. This may be destructive or conservative. Laparoscopy is a conservative surgical procedure used to open and remove any endometrial implants. However in case of life-threatening endometriosis, hysterectomy can be the lasting cure. During hysterectomy, every affected organ is removed. It may involve removing the uterus, ovaries, and even the cervix. It is a complete cure and especially good for women who has passed reproductive age. It should be borne in mind that after hysterectomy, hope of any pregnancy is forfeited.

In Vitro Fertilization

In vitro fertilization (IVF) 

In vitro fertilization (IVF) simply means ‘fertilization in glass,’ more simply explained as ‘test tube baby’. In the IVF process, eggs are removed from the ovaries of the female, at the same time sperms are collected from the male partner. The eggs and sperms collected are made to fertilize in the laboratory and the fertilized egg (embryo) is then implanted in the woman’s womb to make her conceive.

The IVF process involves:

1.       Stimulating multiple follicles and eggs to develop

2.       Egg retrieval to get the eggs

3.       Fertilizing the eggs in the laboratory

4.       Embryo transfer to the uterus

Fertility experts believe that age must not be a factor of consideration when going for IVF process as we see a lot of couples who are below 30years of age who think that they are too young to go for IVF method and it’s a last resort not even knowing the statistical figures which clearly indicates that the success rate of IVF or any fertility procedure decreases with age.

IVF treatment method emerged in 1970s and was mainly used for females having tubal blockage but with the newly emerging technological and scientific knowledge and with increase in complications faced by infertile couples, IVF technique is now mainly used following cases:

1.       Women with both fallopian tubes blocked

2.       Women with single tube blockage and

3.       Inadequate male sperm count

4.       Esoteric infertility cases

5.      Coupled who have failed the traditional treatments like timed intercourse, follicular monitoring, IUI and lots more.

Gone are those days when age was a barrier to experience motherhood and menopause hurdle came along with the stigma of inability to reproduce. IVF has been a breakthrough providing hope for the young and older couples have lost hopes of motherhood.

Causes of Infertility- Part one

Fallopian Tubes Blockage: Causes, Symptoms and Treatment

Blocked Fallopian Tubes

The fallopian tubes are two thin tubes which carry mature egg from ovaries to uterus. They are of utmost importance in fertilization process. Fertilization happens as eggs travels via fallopian tubes to  the uterus. So when Fallopian Tubes are blocked, eggs/ova cannot find their way to the uterus while sperm cells no matter how motile or capacitated, are also blocked from reaching them so fertilization of the eggs fails fertilization and eventually pregnancy becomes far from reality. Blocking of fallopian tubes is one of the major causes of infertility among women and accounts for 40% cases of infertility.

Causes of Blocked Fallopian Tubes

1.Pelvic Inflammatory Disease (PID)
2.Endometriosis
3. Appendicitis
4. Prior abdominal surgery
5. Prior Ectopic Pregnancy6.Peritonitis7. Any prior surgery or  physical assault to Fallopian Tubes8. History of Abortion/miscarriage or uterine infection9. History of Sexually Transmitted Infections

Symptoms of Tubal Blockage

Below are some notable symptoms of fallopian tube blockage:

1.        Dysmenorhea-Painful Periods

2.        Lower Abdominal Pain

3.       Dyspareunia and dysuria-coital pain and painful urination respectively

4.       Pathologic Vaginal Discharge

Treatments for Blocked Tubes

To effectively deal with any form of infertility, the cause must be revealed and the underlying condition must first be removed.

1) Curative antibiotic treatment of any existing PID and sexually transmitted infections

2) Single Tubal Blockage –due to relatively uncomplicated nature, Single Tubal Blockage is not really difficult to solve because it involve less complex mechanism.  Drugs can be still be useful to induce ovulation at the second tube which is not blocked.

3) Both Tubes Blockage – Fertility drugs are not adequate when both tubes are blocked. In this case, Laparoscopic technique is the most direct option . This surgery involves either clearing the blockage or cutting out tissue causing obstruction.The chance of success of laparoscopy is higher in younger women.

4) In Vitro Fertilization – IVF is the most efficacious treatment for Blocked Fallopian Tubes and often the last resort for patients who wants to overcome infertility of any origin and get pregnant. More information on IVF and IVF centers?