- Symptoms and Signs
What is endometriosis?
The endometrium is the inner lining of the uterus, which changes throughout the menstrual cycle, shedding during menstrual periods. Endometriosis is the presence of normal endometrial tissue abnormally implanted in locations other than the inner wall of the uterus.
The abnormally located endometrial tissue (endometrial implant) nevertheless responds to natural cyclic hormonal fluctuations in much the same way as the tissue located in the uterus. The result is, thickening, hormone secretion and cyclic sloughing of menstrual material. Thus, the symptoms of endometriosis depend on the cyclic production of menstrual hormones as well as where it has spread.
Typically, the abnormal sites of endometrium implants are in the pelvis:
- Fallopian tubes
- Soft tissue
More unusual sites include:
What are the symptoms and signs of endometriosis?
Almost a third of women with endometriosis do not have any symptoms. When symptoms are present, they depend on the site where endometrial implant has occurred. A common complaint is pain in the pelvic region, which varies with the menstrual cycle. The main symptoms include:
- Pain during menstrual periods (dysmenorrhea)
- Heavy or irregular bleeding
- Pain in the pelvic region
- Lower abdominal or back pain
- Pain or discomfort during intercourse (dyspareunia)
- Pain on passing feces (dyschezia), often with cycles of diarrhea and constipation
- Bloating, nausea, and vomiting
- Pain in the groin
- Pain on passing urine and/or increased urine frequency
- Pain during exercise
- Blood in sputum
- Seizures that change in severity with the menstrual cycle
How is endometriosis diagnosed?
The diagnosis of endometriosis is based on a detailed history, including the symptoms mentioned above, physical examination, and investigations.
Usually, the findings on physical examination are subtle. The most common finding is pain on applying pressure in the pelvic area.
Diagnostic examinations include:
What are the risk factors for developing endometriosis?
Risk factors for endometriosis include the following:
What is the treatment for endometriosis?
Although there is no permanent cure available, several treatment options exist.
Management with medication
The following drugs form the mainstay of pharmacologic care:
- Combination oral contraceptive pills
- Progestational agents
- Gonadotropin-releasing hormone analogs
- Conservative: when the reproductive potential of the patient is retained
- Semiconservative: when reproductive ability is eliminated, but the function of ovaries is preserved
- Radical: when the uterus and ovaries are removed (hysterectomy)
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Endometriosis implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They also can be found in the vagina, cervix, and bladder. Endometriosis may not produce any symptoms, but when it does the most common symptom is pelvic pain that worsens just prior to menstruation and improves at the end of the menstrual period. Other symptoms of endometriosis include pain during sex, pain with pelvic examinations, cramping or pain during bowel movements or urination, and infertility.
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