A B C D E F G H I J K L M N O P R S T U V W

ENDOMETRIOSIS

What is Endometriosis ?

The cells which line the inside of the womb are called endometrial cells. The whole lining is termed the endometrium. The cells respond to hormone changes in the menstrual cycle which make them grow. They are shed, together with blood, during a period. Endometriosis occurs when endometrial cells collect and grow outside the cavity of the womb. They may grow on the ovaries, over the bladder and on the bowel. Sometimes they grow in the muscle of the womb. This type of endometriosis is called adenomyosis. Rarely endometriosis grows in scars on the abdomen or where the stitches were after having a baby. Very rarely indeed endometriosis grows even further away from the womb, for example, the lungs. These abnormally situated endometrial cells still respond to hormones. They will grow under the influence of oestrogen and they will bleed. The blood cannot escape and forms little blood blisters. To start with these may be pinhead size. They may grow to become the size of a tennis ball. The bleeding is only very little but may cause pain with a period and intercourse. It may cause adhesions around the ovaries and tubes and reduce fertility.

How does Endometriosis occur ?

How endometriosis develops is a bit of a mystery. It may be that endometrial cells spill backwards down the tubes at a period. They then implant on the ovaries or other tissue and grow. When the womb is opened at an operation such as a Caesarean, endometrial cells may be shed in the scar. Endometrial cells may reach the lungs very rarely through the bloodstream. Alternatively, it may be that they are really cells belonging to the site where they are found but in some way change their behaviour to resemble endometrial cells.

Why does Endometriosis occur ?

We do not know why some women get endometriosis and not others. We do know that it is commoner in women who have no children. It is found in about 20% of women investigated for infertility but is also found in some women with no symptoms at all. Endometriosis can make women less fertile. Endometriosis is commoner in the later reproductive years. It is never a problem before periods begin, and rarely after the menopause. It is not caused by using any specific form of contraception.

Treatment Involved for Endometriosis

Endometriosis is usually treated only when there is pain or infertility. It is diagnosed by inspecting the womb and ovaries under anaesthetic using a laparoscope. An ultrasound scan (using sound waves to make a type of radar picture) may help detect endometriosis in the ovaries. DRUG TREATMENT This is aimed at stopping periods. If there is no period then the endometrial cells will not bleed. If periods are suppressed the endometriosis may die out. Pregnancy is one of the best treatments because it stops periods naturally. The drugs that are used all stop periods if used correctly. The contraceptive pill may be given continuously with no breaks. Danazol, Provera and other progesterone types of hormone may be used. These are all given by mouth. Drugs called GnRH (gonadotrophin-releasing hormone) analogues are also used but can only be taken as a nasal spray or by injection. The length of treatment is usually 6 months although treatment with GnRH analogues may be as effective if used for only 3 months in some cases. If treatment with GnRH is continued for more than 6 months hormone replacement treatment will usually be given at the same time to prevent thinning of the bones (osteoporosis). All these treatments relieve pain equally well so the choice of which drugs to use will depend on which causes the fewest side-effects for a particular woman. If a woman wishes to avoid using hormone treatment or is trying to conceive anti-inflammatory pain killing drugs like ibuprofen may be an effective way to control the symptoms. SURGERY Endometriosis can be treated at laparoscopy (telescopic examination through the navel). Small areas can be eradicated electrically or with lasers. Adhesions round the tubes and ovaries can be cut away. If there is a lot of endometriosis it may need a full abdominal operation to remove larger blood cysts. Endometriosis in scars is usually excised. Drug treatment is often given before surgery to make the operation easier. Given after surgery, drugs may reduce the risk of recurrence. If all else fails and there is intractable pain, a hysterectomy together with removal of the ovaries may be recommended. The doctor is more likely to suggest a hysterectomy for you if adenomyosis is present. If the ovaries are removed, hormone replacement therapy may be recommended. Drug treatment does not seem to improve fertility although surgical treatment may do so if the endometriosis is not too extensive.

During Treatment for Endometriosis

Some women feel bloated and put on weight when their periods are stopped. The skin may become more greasy and acne may develop. Occasionally facial hair may increase. If treatment is being given because of painful periods the improvement should be immediate. Painful intercourse should be improving in 2 or 3 months. Pregnancy should be avoided whilst taking hormone treatment. If the oral contraceptive pill is being used this will also prevent pregnancy. If other hormone treatments are used additional contraception such as condoms should be used. Women with a fertility problem should be seen regularly in the fertility clinic. If GnRH analogues are used, there may be side-effects of hot flushes and dryness of the vagina. Treatment with hormone replacement therapy may be given at the same time to reduce these side effects. The advice the doctor gives will depend on age and the severity of the endometriosis. Patients may find it helpful to contact a local patient support group.

After Treatment for Endometriosis

Endometriosis may recur after treatment. About two thirds of women will remain free of symptoms 5 years after drug treatment for small amounts of endometriosis but only a quarter of women with more severe disease will remain symptom free. We do not have ideal treatments because the cause is not fully understood. If infertility is the problem one should try to conceive as soon as treatment is completed.