EndoGyn Wiki » endometriosis

What are the symptoms of endometriosis?

informer — Wed, 24 Aug 2011 16:44:26 +0000

Endometriosis is a chronic disease that is difficult to diagnose and to treat. Without treatment, endometriosis gets progressively worse in 65% to 80% of patients. Even with treatment, endometriosis continues to advance in 20% of patients. Cysts and implants may grow and spread to other parts of the pelvis, and in very severe cases, to the urinary or intestinal tracts. Eventually adhesions may form. These are dense, web-like structures of scar tissue that can attach to nearby organs and cause pain, infertility, and intestinal obstruction.

Pelvic Pain

The most common problem for women with endometriosis is pain, which can significantly impair the quality of life. The pain experienced around menstruation (dysmenorrhea) can be so debilitating that up to 25% of women with the condition can be incapacitated for two to six days of each month. In severe cases, regular activities may be curtailed for up to two weeks per month. Sleeping problems have been reported in three quarters of patients, mostly due to pain. Studies suggest that endometriosis is the cause of about 15% of cases of pain in the pelvic region in women. (i.e. the lower trunk of the body.)

Timing of Pain In addition to during menstruation, endometrial pain can occur at other times of the month. A survey published by the Endometriosis Association reported the following findings on the timing of endometrial pain:

71% of women reported pain within two days after their periods started.
47% reported pain in the middle of a cycle. (A sharp pain during ovulation may be due to an endometrial cyst located in the fallopian tube that ruptures as the egg passes through.)
40% reported pain at other times of the month.
20% reported continual pain.
7% said there was no pattern.
Many women with endometriosis experience pain during intercourse.(dyspaerunia)

Location of Pain Nearly all women with endometrial pain experience it in the pelvic area (the lower part of the trunk of the body). The pain is often a severe cramping that occurs on both sides of the pelvis, radiating to the lower back and rectal area and even down the legs. Occasionally, however, pain may also occur in other regions if endometriosis effects other part of the pelvic area, such as the bladder or intestine.

Severity of Pain The severity of the pain also varies widely and does not appear to be related to the extent of the endometriosis itself. In other words, a woman can have very small or few implants and have severe pain, while those with extensive endometriosis may have very few signs of the disorder except for infertility. Large cysts can rupture and cause very severe pain at any time.

Infertility

The medical literature indicates that endometriosis may account for as many as 30% of infertility cases. Some evidence suggests that between 30% and 50% of women with endometriosis are infertile. Often, however, it is difficult to determine if endometriosis is the primary cause of infertility, particularly in women have mild endometriosis. In an attempt to determine the chances for infertility with endometriosis, researchers have come up with a staging system based on findings during diagnostic surgery. [See Staging of Endometriosis.] It should be noted that endometriosis rarely causes an absolute inability to conceive, but, nevertheless, it can contribute to it both

directly and indirectly.

ENDOMETRIAL CYSTS.

Endometrial cysts may directly cause infertility in a number of ways.

If implants occur in the fallopian tubes, they may block the egg's passage.
Implants that occur in the ovaries prevent the release of the egg.
Severe endometriosis can eventually form rigid webs of scar tissue (adhesions) between the uterus, ovaries, and fallopian tubes, thereby preventing the transfer of the egg to the tube.

IMMUNE FACTORS AND THE INFLAMMATORY RESPONSE. Even in early stage endometriosis, investigators have observed increased immune system activity…

What is the endometriosis disease?

informer — Tue, 30 Aug 2011 06:04:41 +0000

Endometriosis is a common condition affecting women. It is a chronic, painful, and often progressive disease in women. The causes of endometriosis are unknown.It has widel variability in symptoms and severity, so diagnosis is at times difficult.Endometrial Implants Endometriosis occurs when cells from the mucus membrane lining the uterus (endometrium) form implants that attach, grow, and function outside the uterus, generally in the pelvic region. Endometrial implants consist of both following cell types:

Gland cells. These cells secrete hormones and other fluids and are normally located in the uterine lining.
Stroma cells. These are the framework cells that build supportive tissue.

Endometrial cells contain receptors that bind to estrogen and progesterone, which promote uterine growth and thickening. During endometriosis these cells become implanted in organs and structures outside the uterus, where these hormonal activities continue to occur, causing bleeding and scarring. Endometrial implants vary widely in size, shape, and color. Over the years, they may diminish in size or disappear or they may grow.

Early implants are usually very small and look like clear pimples.
If they continue to grow they may form flat injured areas (lesions), small nodules, or cysts called endometriomas, which can range from sizes smaller than a pea to larger than a grapefruit.
Implants also vary in color; they may be colorless, red, or very dark brown. These so-called chocolate cysts are endometriomas filled with thick, old, dark brown blood that usually appear on the ovaries.

Location of Implants Implants can form in many areas… Read More

What is conservative surgery for endometriosis?

informer — Tue, 30 Aug 2011 06:04:28 +0000

The goal of conservative surgery is to aggressively remove as many endometrial implants and cysts as possible without causing surgical scarring and subsequent adhesions that could hamper future fertility. The two conservative surgical routes used are either laparoscopy or laparotomy. Improving Fertility. Surgery has been shown to improve infertility rates in women with severe endometriosis (stages III and IV). Some physicians recommend conservative surgery even in early-stage endometriosis, because of the progressive nature of the disorder and there is some evidence that it improves fertility. Fertility can often be restored even if the surgery does not remove all the endometrial implants. However, the best fertility rates in such cases occur in the early postoperative period. They decline over time if implants have not been completely eliminated. Subsequent surgeries become less effective in restoring fertility. Reducing Pain and its Recurrence.Studies report pain reduction after surgery in more than 60% of women. Conservative surgery, however, can miss microscopic implants that may continue to cause pain and other symptoms after the procedure. Laparoscopy is now the gold standard treatment for endometriosis. It is usually done under general anesthetic and involves the following:

The procedure requires making small incisions at the navel and above the pubic bone.
The laparoscope (a hollow tube equipped with camera lenses and a fiber optic light source) is inserted through the incision at the navel (the umbilical incision).
A probe is then inserted through the second incision allowing the physician to directly view the outside surface of the uterus, fallopian tubes, and ovaries.
One or two additional small incisions can be made on either side of the lower abdomen through these incisions.
Surgical instruments or other devices are passed through these accessory incisions to destroy or remove abnormal tissue.
Implants can be removed by excision (surgical removal) using a laser or scissors or by destroying the area with lasers or with electricity (or electrocautery).

Endometriosis: surgical strategies

informer — Wed, 24 Aug 2011 16:48:20 +0000

Endometriosis is a chronic proliferative disorder and needs treatment aggressively to provide relief from its symptoms and arrest progression of the disease. Treatment options include medical or surgical or a combination of both. We offer the option depending on the individual patient needs and desires and most importantly the symptoms and the severity of her disease Our surgical strategy to tackle endometriosis is as follows MANAGEMENT OF ENDOMETRIOMAS MANAGEMENT OF RECTOVAGINAL ENDOMETRIOSIS RESECTION OF ENDOMETRIOTIC BOWEL IMPLANTS HYSTERECTOMY FOR ENDOMETRIOSIS Read more