Taylor D
Geralyn Caplan
April 4, 2010
Pathology Paper
Endometriosis
Endometriosis is a condition in the female body that causes the tissues in the lining of the uterus to grow in other areas of the body. Often times this causes pain to the female, it can cause irregular bleeding, and sometimes infertility. The growth of this tissue will most likely be found in the pelvic area and the lining of the pelvis, outside the uterus, on the ovaries, bowel, rectum, and bladder. However, endometriosis is not limited to these specific areas of the body; it can occur in other areas as well (health.com, 2010). It is important that women learn to recognize the signs and symptoms of endometriosis, understand the risk factors, and understand the treatment options for this disease.
The risk factors for endometriosis include a number of things. Endometriosis can occur in women of any type or background, and it seems to occur more in women with high-achieving careers that suffer from personal and career stress, because stress can throw off the hormone balance in women (Lark, 1995). Although endometriosis occurs in women of any type, it will occur primarily in Caucasian women. Also, endometriosis seems to exist in women whose mothers or sisters have had the disease. Eight to ten percent of women with endometriosis have mothers or sisters who have also had the disease (Lark, 1995).
The symptoms of endometriosis vary from woman to woman. While some women experience no symptoms, others experience the most common symptom with endometriosis which is disabling pain. "Approximately 60 percent of women with endometriosis suffer from progressively worsening menstrual cramps" (Lark, 1995). Severe cramps can occur for as long as two weeks before menstruation, and could continue throughout menstruation. In addition, cramps caused by endometriosis might not respond to the usual medication, such as anti-inflammatory pills and birth control medications, taken to ease the pain during the menstrual cycle (Lark, 1995).
Not only can pain be experienced during menstruation, women often experience pelvic pain as well. This pain could be caused due to not only the stimulation of and bleeding from endometriosis implants, but also to the adhesions and pelvic scarring and inflammation that the implants will leave over time (Lark, 1995). If endometriosis has gone unnoticed and has advanced, then women with advanced cases of endometriosis who have gone into surgery will most likely have thick scar tissue that can deform or even destroy a female's normal structure of the ovaries, ligaments, bowels, and other pelvic structures (Lark, 1995). Women may also experience pain during ovulation due to implants on the ovaries bleeding just slightly. This will cause irritation of the nerve endings in the pelvic cavity, which could lead to pelvic pain that lasts around two days (Lark, 1995).
If a woman suspects that she might have endometriosis, she should make a gynecological appointment immediately. If endometriosis is suspected, then a gynecologist will perform one of the following tests: laparoscopy or imaging tests. However, the first thing that must always be done is a physical examination, which will include a physician looking and feeling for abnormalities that would be associated with endometriosis (endo-resolved.com, 2010). A gynecologist might suspect endometriosis if a woman has tenderness in her pelvic region, enlarged ovaries, a tipped-back uterus, lesions on the vagina, or surgical scars; a gynecologist also might suspect endometriosis if there are thickened areas around the uterus during a pelvic examination (Parker, 1997).
After the physical examination, if endometriosis is suspected, then a laparoscopy would be performed. "A laparoscopy is an exploratory procedure that allows the physician to see inside the pelvic region to observe and check for endometrial growths" (endo-resolved.com, 2010). During the procedure, a physician would make an incision near the naval and then a laparoscope would be inserted into the abdomen. Usually endometriosis is fairly easy to spot once inside the abdomen, but sometimes endometrial lesions can be mistaken for different conditions. Because of this, lesions should be surgically removed and examined under a microscope to determine whether the condition is actually endometriosis (endo-resolved.com, 2010).
Another test that might be performed is an imaging test (such as a pelvic ultrasound or magnetic resonance imaging). These could be used to see individual endometrial lesions. However, these tests cannot determine the severity of the disease, and the implants cannot be found easily by using these methods. Some things that physicians would look for during a pelvic ultrasound include: solid masses, irregular cystic spaces, enlargement of the uterine wall, and loss of definition of pelvic organs (Bisset, et al, 2002).
If it is discovered that a woman has endometriosis, then the treatment for endometriosis will be based on the severity of the symptoms, severity of the disease, and age. A physician might also consider what the woman or couple’s goals are and decide treatment based on the woman/couple’s goals. For instance, if a woman experiences no pain because of endometriosis, and she (or the couple) plan on not having a family, then more than likely no treatment will be provided because there is no need for it. However, for women who do experience pain, and for women and couples that do desire to have a family one day, treatment for the woman is crucial (Perry, 2007).
Some treatment options are for endometriosis includes medications to control the pain, medication to stop the endometriosis from getting worse, surgery to remove endometriosis, or in the worst cases, a hysterectomy. For women with mild cases who do not desire children, all that is required of them is that they agree to have regular exams every 6-12 months so that the doctor can be sure that the disease is not progressing. These women can manage symptoms by using exercise and relaxation techniques, non-steroidal anti-inflammatory drugs (NSAIDs) (like ibuprofen, Advil and Aleve). They might even use prescription painkillers if their pain worsens (health.com, 2010).
Another treatment option is stopping the menstrual cycle and creating a state which resembles pregnancy. This is called pseudo pregnancy, and it helps to prevent the disease from getting worse. A pseudo pregnancy is accomplished by using birth control pills. A woman would take birth control continuously for 6-9 months before the medicine was stopped so that she could have her menstrual cycle (Lark, 1995). Birth control treatment will relieve most symptoms of endometriosis; however, it cannot prevent scaring from the disease. This treatment also will not reverse any damage that has already occurred in the body (Lark, 1995).
Some physicians may prescribe medicines to women with endometriosis that stop the ovaries from producing estrogen. Medicines such as these are called gonadotropin agonist drugs, and they are very similar to the gonadotropin-releasing hormone. These medications are given like nasal spray or injection and they inhibit the hypothalamus-pituitary-ovarian feedback loop. Gonadotropin agonist drugs are effective for endometriosis because they shrink endometrial implants and fibroids (Lark, 1995).
The last treatment option for endometriosis is surgery. “Surgery is an option for women who have severe pain that does not improve with hormone treatment, or who want to become pregnant either now or in the future” (health.com, 2010). A pelvic laparoscopy would be used to remove the endometriosis from the affected area. For women who do not desire to one day have children, a hysterectomy would be performed. Although a hysterectomy sounds like a nightmare for some women, a hysterectomy actually gives the best chance for a cure from endometriosis. Some women might need hormone replacement therapy, but usually endometriosis will not return to the body after a woman has received a hysterectomy (health.com, 2010).
The most severe cases of endometriosis will result in infertility. This is one of the reasons why endometriosis is such a devastating disease for women. Infertility does not occur in every case, especially if the endometriosis is mild. Laparoscopic surgery can help to improve fertility, but the chance of success depends on the severity of the endometriosis. If the surgery does not work, and the woman still cannot conceive, then repeating the surgery a second time will not aid in helping the woman to conceive and she should consider different fertility options (health.com, 2010).
It is important that women pay attention to their bodies and what their bodies might be saying. If a woman notices re-occurring pain during, before, and after her period, then she should contact her doctor immediately. Endometriosis is a serious disease for those women who wish to one day have a family because if endometriosis is noticed too late, then it may be too late for the woman to have the family that she has dreamed about. There are many treatment options for the disease, and it is worth seeing a doctor if a woman notices changes in her body. There are always risk factors with treatment options, but the risk factors are worth having the body free of a disease that could ultimately result in the prevention of conceiving children.
Bibliography
Bisset, R. A. L, Khan, A. N., Thomas, N.B. (2002). Differential Diagnosis in Obstetric and Gynecologic Ultrasound. China: RDC Tech Group.
Lark, Susan M. (1995). Fibroid Tumors & Endometriosis: Self Help Book. Berkely, California: Celestial Arts.
Lowdermilk, Perry. (2007). Maternity and Women’s Healthcare. China: Jeff Paterson
Parker, William H. (1997). A Gynecologist’s Second Opinion: The Questions and Answers You Need to Know to Take Charge of Your Health. New York: Penguin Group.
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