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Endometriosis

Endometriosis is a gynecological condition in which the cells that usually line the uterus grow in other parts of the body. It's a very common condition and is estimated to occur in 6-10% of women. The exact number is unknown, because many women never show symptoms, or show only mild symptoms and think little of it. It's even more common in those with IBD and other conditions.

Endometriosis can occur almost anywhere in the body. It most commonly involves the ovaries, bowel, or tissue lining the pelvis. The symptoms can vary greatly depending on where it's located. The severity of symptoms can also vary greatly, and often does not correlate to the severity of the disorder.

Contents


Symptoms

  • Severe menstrual cramps
  • Pain with bowel movements or urination (most likely to occur during menstruation)
  • Heavy periods
  • Bleeding between periods
  • Fatigue
  • Pain during or after intercourse
  • Pain in the lower back and pelvis (most likely during menstruation, but can occur at any time)
  • Infertility (but infertility does NOT always occur - many women with endometriosis can have children and have healthy pregnancies, and symptoms often lessen after having a child)

Common symptoms associated with endometriosis affecting the bowel are:
  • Diarrhea
  • Constipation (diarrhea and constipation can alternate)
  • Rectal bleeding
  • Intestinal cramping
  • Nausea and/or vomiting
  • Painful bowel movements
  • Rectal pain

Common symptoms associated with the urinary tract are:
  • Painful or burning urination
  • Blood in urine
  • Tenderness around the kidneys
  • Urinary frequency, retention, or urgency
  • Hypertension

Common symptoms associated with the lung and chest cavity are:
  • Coughing up blood, particularly during menstruation
  • Accumulation of air or gas in the chest cavity
  • Constricting chest and/or shoulder pain
  • Shortness of breath

Endometriosis can also occur on the skin, causing visible, painful nodules that may bleed during menstruation. It can affect the sciatic nerve, causing hip pain or discomfort that radiates from the buttock down the leg.

Diagnosis

Endometriosis is often misdiagnosed as ovarian cysts, fibroids, IBS, IBD, ovarian cancer, STDs, pelvis inflammatory disease, adenomyosis, and other conditions.

Endometriosis is usually diagnosed through laparoscopic surgery. Unless the disorder is severe, it's unlikely to show up on an ultrasound or MRI. Laparoscopy is minor and usually performed on an out-patient basis. In order to avoid the surgery, it's common to try to control the symptoms with birth control before a definite diagnosis is made.

Treatment

  • Birth control - decreases the amount of menstrual flow and prevents overgrowth of the tissue that lines the uterus; symptoms will return when the birth control is stopped.
  • GnRH agonists and antagonists - reduce the amount of estrogen in a woman's body and stops the menstrual cycle; when the medication is stopped, periods and the ability to get pregnant return, although endometriosis symptoms may not return for months or years.
  • Progestins - hormone that works against the effects of estrogen; it stops a woman's periods but can cause irregular vaginal bleeding. The birth control shot Depo-Provera is a progestin.
  • Danazol - a weak male hormone that lowers the levels of estrogen and progesterone; it also stops a woman's period or makes it more infrequent. This treatment has side effects such as oily skin, weight gain, shrinking breasts, and facial hair growth, cannot be used with other hormones, and does not prevent pregnancy, so is often used as a last resort.
  • Laparoscopy - endometrial growths and scar tissue can be removed during this procedure. As it's a minor surgery, recovery is quick.
  • Laparotomy - involves a larger cut than a laparoscopy, but allows the doctor to remove growths in the pelvis or abdomen.
  • Hysterectomy - a surgery in which the uterus is removed. The ovaries may also be removed to help ensure that endometriosis will not return. This is only done as a last resort.

References


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