Endometriosis – Signs and Symptoms, Diagnosis, Treatments

A benign but rapidly spreading condition that affects women of reproductive age group. Endometriosis is a disease that is caused due to presence of the endometrial lining, i.e., tissue that lines the inner side of the uterus wall, outside the uterus.

The uterus is lined by three different layers of tissues. The innermost layer is called the endometrium, the middle layer, myometrium, is made up of smooth muscles, and the outer layer is called serosa.

This inner lining tissue is a specialised tissue which is very active and promptly responds to different types of hormones secreted by the ovary and sheds off once the period occurs and readily rebuilds after that. It is a cyclical process and happens every month.

When this endometrial tissue is present in places other than the inner lining, it responds in a similar way, causing pain and bleeding.

 Endometriosis commonly occurs in

• Ovaries
• Fallopian tubes
• Muscle layers of the uterus
• Ligaments that support the uterus
• Peritoneum, lining the whole abdomen and pelvis
• Bladder
• Ureter
• Intestines
• Other uncommon sites: lungs, vagina, previous scar, nerves

Endometriosis occurring in the ovaries is called chocolate cysts.

Signs and symptoms of Endometriosis

• Pain: cyclical, pain before, during and after periods
• Irregular bleeding
• Abdomen distension
• Subfertility: Inability to conceive
• Obstruction to the intestine and urinary tract
• Pain and bleeding while passing urine
• Pain and bleeding while passing motion

Diagnosis of Endometriosis

• History and clinical examination
• USG (Ultrasound of the abdomen and pelvis): If there are chocolate cysts, endometriosis of the muscular uterine wall (adenomyosis), obstruction to the urinary tract causing enlargement of the kidneys.
• MRI & CT in endometriosis of other organs and abdomen
• Laparoscopy: Visualising the abdomen through a telescope & camera, through a hole made on the belly button to check for visible lesions. They appear as dark brown spots because of old blood clots.
• Biopsy of the lesion  
• Endoscopy of Gastrointestinal tract in selected cases

Treatment of Endometriosis  

Once a definitive diagnosis is made. Treatment is aimed at alleviating the most common symptom, that is pain, and treating the underlying cause.

When it comes to relieving pain, commonly used drugs are paracetamol and NSAIDs (non-steroidal anti-inflammatory drugs).

Following methods can be used to treat the cause.  

• Hormonal medications
• Progesterone (tablets and intrauterine devices)
• Combined hormonal contraceptive pills
• Medicine to totally cut off the hormones at the brain level (GnRH: gonadotropin-releasing hormone analogues)

Surgery  

• Removal of chocolate cysts (open or laparoscopic method)
• Removal of ovaries
• Removal of uterus, tubes and ovaries
• Removal of lesions found elsewhere in the body

Conclusion

Though endometriosis is a non-cancerous condition majorly, it has an increased propensity to spread and make adjacent organs to stick together and restrict their movements.

Long-term or chronic ovarian endometriosis has a 2 in 1000 chance of becoming cancer. Endometriosis is another important cause of subfertility. Hence early diagnosis and prompt treatment of pain by consulting a doctor are more essential than taking over-the-counter medications.