Today we will be talking about ENDOMETRIOSIS.

We shall have this discussion under the following headings;

▫️Definition of Endometriosis
▫️Causes of Endometriosis
▫️Types of Endometriosis
▫️Symptoms and complications of Endometriosis.
▫️Treatment of Endometriosis.
▫️Endometriosis and Infertility.

▫️DEFINITION OF ENDOMETRIOSIS:
Endometriosis happens when tissue that is similar to the tissue that lines the uterus grows outside of the uterus.

This tissue acts as regular uterine tissue does during your period; this means it will break apart and bleed at the end of the cycle. But this blood has nowhere to go unlike the one in the uterus that flows out as menses. Surrounding areas where this happens may become inflamed or swollen leading to scar tissue and lesions.

▫️CAUSES OF ENDOMETRIOSIS:

The causes of endometriosis is not clearly known, however there are some theories;

● Retrograde Menstruation:
Some experts think menstrual blood that contains endometrial cells may pass back through the fallopian tubes and into the pelvic cavity, where the cells stick to organs. This is called retrograde menstruation.

● Genetic causes: genes can play a role. If your mom or sister has endometriosis, you’re more likely to get it. Research shows that it tends to get worse from one generation to the next. So we can say endometriosis can be “inherited”.

● Immune disorders: Some people with endometriosis also have immune system disorders. It is suspected that there’s a link. This can lead to transformation of certain cells eg peritoneal cells, making them become like endometrial cells.

● Hormonal disorders: Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial-like cell implants during puberty leading to endometriosis.

● Surgical scar implantation: After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.

●Endometrial cell transport: The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body. This is not usually common though.

▫️TYPES OF ENDOMETRIOSIS:

There are four (4) stages of Endometriosis and this classification is based on the quantity of endometrial tissue present at a site;

•Stage 1 or minimal Endometriosis: Here there are a few small implants or small wounds or lesions found on organs or the tissue lining the pelvis or abdomen with little to no scar tissue. Commonest tissue affected here is the peritoneum

•Stage 2 or mild endometriosis: Here there are more implants than in stage 1. They’re also deeper in the tissue, and there may be some scar tissue. Commonest organ affected here is the ovary.

•Stage 3 or moderate Endometriosis: Here there are many deep implants. There may also be small cysts on one or both ovaries known as chocolate cysts, and thick bands of scar tissue called adhesions.

•Stage 4 or severe endometriosis: This is the most widespread form. There are many deep implants and thick adhesions. There are also large cysts on one or both ovaries. Organs affected here include the bowels, ovaries, fallopian tubes, rectum and pelvic floor.

There is no known reason why some people have more severe cases than others. The disease doesn’t always go from one stage to the next. If left untreated, it can remain the same over time, or it may get worse or better.

▫️SYMPTOMS OF ENDOMETRIOSIS:

Endometriosis can be asymptomatic, meaning an affected person may not have any symptoms.

When symptoms occur, they can include:

•Back pain during period
•Severe menstrual cramps
•Pain when pooping or utinating, especially during period
• Unusual or heavy bleeding during periods
• Blood in stool or urine
•Diarrhea or constipation
•Painful sex
•Fatigue that won’t go away
•Difficulty getting pregnant

Complications of Endometriosis:

✔️Severe endometriosis pain can affect your quality of life.
✔️Some people struggle with anxiety or depression as a result of endometriosis.
✔️Endometriosis may raise the risk of ovarian cancer or another cancer called endometriosis-associated adenocarcinoma.

▫️TREATMENT OF ENDOMETRIOSIS:
Endometriosis has no cure. However it can be managed

•medically
•surgically
•And by lifestyle modifications

● Medical Management:
▫️Pain medications eg NSAIDs are given to help control the pain.
▫️Hormonal Therapy which lowers amount of estrogen produced by the body, stopping the periods and reducing the ability of the lesions to bleed. This then reduces the inflammation, scarring and cyst formation. Hormonal drugs used include birth control pills (oral contraceptives), Gonadotropin agonists and antagonists and progesterone.

● Surgical Management:
Surgery might be recommend surgery to take out as much of the affected tissue as possible. This usually happens in severe form like stage 4.
In some cases, surgery helps symptoms. A laparotomy can be done. Also laparascopy can be done using laser to remove the tissues. Pain sometimes comes back after surgery.

● Lifestyle Modifications:

Lifestyle Changes for Endometriosis which can help ameliorate the condition includes:

•Warm baths
• Hot water bottles, and heating pads which can give quick relief from the pain.
• Right diet: Research has shown a link between endometriosis and diets that are low in fruits and vegetables and high in red meat. Some experts think the high amount of fat in meat like beef encourages your body to produce chemicals called prostaglandins, which may lead to more estrogen production. This extra estrogen could be what causes excess endometrial tissue to grow.

So add more fresh fruits and vegetables by making them the heart of your meals. Stocking your refrigerator with pre-washed and cut fruit and vegetables can help you eat more of both. Foods rich in omega-3 fatty acids is also helpful
• Avoid alcohol, caffeine and soda.
• Exercise regularly. This improves blood flow which reduces stress, estrogen levels and by extension cause lighter periods. This can improve the symptoms over time. Exercise also releases endorphins which naturally reduces pain.
• Stress management can also reduce the symptoms of Endometriosis. Stress management mechanisms like meditation, deep breathing, self care, relaxation can be practised.

Diagnosis of Endometriosis:

Diagnosis of endometriosis is usually clinical. The doctor might suspect endometriosis based on symptoms presented with. To confirm it, they can do tests including:

•Pelvic examination
•Imaging tests eg ultrasound, CT scan, or an MRI can make detailed pictures of your organs.
•Laparoscopy. This is usually the only way to be totally certain that one has endometriosis.
•Biopsy where a sample of tissue, often during a laparoscopy, is taken and a specialist looks at it under a microscope to confirm the diagnosis.

ENDOMETRIOSIS AND INFERTILITY

This is our major concern in today’s discussion.

Endometriosis is a leading cause of infertility. Nearly 2 of every 5 people who can’t get pregnant have it.

•If endometriosis interferes with the reproductive organs, ability to get pregnant can become an issue.

•When endometrial tissue wraps around the ovaries, it can block the eggs from releasing.
The tissue can block sperm from making its way up the fallopian tubes.
•It can stop a fertilized egg from sliding down the tubes to the uterus.

A surgeon can fix those problems, but endometriosis can make it hard for one to conceive in other ways;

•It can change the body’s hormonal chemistry.
•It can cause the body’s immune system to attack an embryo.
•It can affect the layer of tissue lining the uterus where the egg implants itself.

A doctor can surgically remove the endometrial tissue. This clears the way for the sperm to fertilize the egg.

If surgery isn’t an option, one might consider intrauterine insemination (IUI), which involves putting a partner’s sperm directly into the woman’s uterus.

The doctor may suggest pairing IUI with “controlled ovarian hyperstimulation,” which means using medicine to help your ovaries put out more eggs. People who use this technique are more likely to conceive than those who don’t get help.

In vitro fertilization (IVF) is another option. It can raise chances of conceiving.

In all, being aware of the condition can lead to quick diagnosis as it will make those affected to seek help faster. This then leads to better outcomes.

If you suspect that you or anyone you know may have endometriosis, seek help now.