The unwanted tissue – Endometriosis

What is Endometriosis ?

Endometriosis is the abnormal growth of endometrial tissue which lines the interior of the uterus, in a location outside the uterus. Areas of endometrial tissue found in ectopic locations (outside uterus) are called endometrial implants. These are commonly found on the ovaries, the fallopian tubes and the surface of the uterus. They less commonly involve the vagina, cervix, and bladder. Rarely, endometriosis may occur outside the pelvis. Endometrial implants are usually benign (i.e. non-cancerous and non-spreading).

Diagnosis: Ultrasound, pelvic exam or laparoscopy are used to diagnose endometriosis. The laparoscopic exam typically helps make a thorough evaluation of the condition, and estimate how extensive it is.

Causes: The cause of endometriosis is somewhat unknown. One theory suggests that the endometrial tissue is deposited in ectopic locations by the opposite flow of menstrual debris through the fallopian tubes into the pelvic and abdominal cavities. The cause of this retrograde menstrual flow is not clearly understood. But retrograde menstruation cannot be the only cause of endometriosis, as many women who have retrograde menstruation do not develop the condition.

Another possibility could be that tissues lining the pelvic organs comprise of primitive cells that are able to develop into other forms of tissue, such as endometrium.

It is also possible that there is a direct transfer of endometrial tissues at the time of surgery (for example, Cesarean section) which may be responsible for the endometriosis implants.

Transfer of endometrial cells via the blood or lymph is the most plausible explanation for endometriosis occurring in the brain and other organs remote from the pelvis.

Finally, there is evidence that some women with endometriosis have a compromised immune response, which may affect the body's natural ability to recognize ectopic endometrial tissue.

Treatment: There is no cure for endometriosis yet, but treatment can help with pain and infertility. If the patient has pain only, hormone therapy to lower the body's estrogen levels will shrink the implants and may reduce pain. But not all women with endometriosis have pain.

During pregnancy, this condition usually improves, as it does after menopause. If there is mild pain, and the patient has no plans for a future pregnancy or is near menopause (around age 50), there may be no need for treatment.

If there is pain or bleeding and the patient isn't planning to get pregnant soon, birth control hormones or anti-inflammatories (NSAIDs) may be prescribed to control pain.
Besides medicine, other things can also be tried at home to help with the pain. For example, apply heat to your belly, or exercise regularly.

Surgery removes endometrial growths completely. This can usually be done through small incisions, using a laparoscope. A laparoscopy procedure can remove pain and improve chances for pregnancy. The laparoscopic treatment for removal of uterine fibroids is also known as Myomectomy.

In severe cases, removing the uterus and ovaries (hysterectomy and oophorectomy) may be done. However, it is only to be used when the patient has no pregnancy plans and has had little relief from other treatments.

What is Adenomyosis?

In Adenomyosis, the inner lining of the uterus (endometrium) breaks through the muscle wall of the uterus (myometrium). This can lead to severe menstrual cramps, bloating before periods and heavy periods. The condition can happen throughout the entire uterus or be localized in one spot.

Adenomyosis is also a benign condition. However, the frequent pain and heavy bleeding associated with it can deteriorate a woman's quality of life.

Diagnosis: Adenomyosis can only be diagnosed with a full evaluation of the uterus after a hysterectomy. A doctor may suspect adenomyosis based on the symptoms described above and some examination procedures like a pelvic exam, or ultrasound or MRI screenings. These can help to rule out other conditions like uterine fibroids or uterine polyps that could be causing similar symptoms.

Causes: Adenomyosis may result from the direct invasion of endometrial cells from the lining of the uterus into the muscle that forms the uterine walls.

Another theory suggests that there is a link between adenomyosis and childbirth. An inflammation of the uterine lining during pregnancy might cause a break in the normal cell boundary lining the uterus.

Eventually, adenomyosis eventually goes away after menopause, regardless of how it develops, since its growth depends on estrogen production.

Treatment: Treatment options for adenomyosis include:
Anti-inflammatory drugs: These are given if the patient is near the age of menopause. Ibuprofen controls pain and reduces menstrual blood flow. The drug should be taken from two to three days before menstruation and should be continued taking during periods.

Hormone medications: Combined estrogen-progestin birth control pills or hormone-containing patches lessen heavy bleeding and pain. Progestin-only contraception, like an intrauterine device, or continuous use of birth control pills provides symptom relief but often lead to amenorrhea (the absence of your menstrual periods).

Hysterectomy: If pain is severe and menopause is years away, the doctor may suggest surgery to remove the uterus (hysterectomy). Removing the ovaries isn't necessary to control adenomyosis.

MRgFUS: Magnetic Resonance imaging - guided focussed ultrasound surgery (MRgFUS) is also another non-surgical alternative available for treating adenomyosis and uterine fibroids where focussed ultra sound waves are used to target the tissues and shrink them or destroy them. Leading hospitals in the city like Jaslok Hospital and Research Centre provide this treatment option.

Adenomyosis and Endometriosis can occur together but they are not the same condition. Both can cause pain but endometriosis does not always cause heavy bleeding.
You can consult some best doctors at Jaslok Hospital.
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To know more about your specific condition, please visit an Gynecologist in a trusted hospital close to you.