Endometriosis
is a condition found in women of menstruating age. It can cause
pain (see Dysmenorrhoea), dyspareunia (pain on intercourse)
and, in some cases, infertility (see Infertility female). The
lining of the fertile woman's uterus, the endometrium, bleeds
once a month if the ovum she has produced, mid-cycle, has not
been fertilised. This is menstruation. In endometriosis a situation
exists where endometrial cells are found, not just within the
inside of the uterus, but on other parts of the female organs
such as the ovaries and the fallopian tubes, sometimes in the
vagina, the cervix and even the wall of the abdominal cavity.
Nobody knows, for sure, the reason for this displacement of
cells. It is not cancer. The cells are perfectly normal, just
in the wrong place. And like the cells lining the uterus, they
do bleed every month. This means that at the time of the periods
there is also bleeding around the ovaries, tubes etc. This would
be no problem except that blood in the body cavity (as opposed
to within the blood vessels where it is no problem) is an irritant
setting up inflammation and adhesions. The classical finding
on investigation of endometriosis is the presence of "chocolate cysts" on the ovary, chocolate being the dark brown colour of old blood. Thus, when a woman with endometriosis menstruates, she also bleeds a small amount internally. Although the actual blood loss is not significant the pain caused certainly is. The woman, therefore has severe dysmenorrhoea during the period and, often, for some days afterward, if not almost continually. The scarring and adhesions can cause chronic pain and, sometimes, the fallopian tubes and ovaries are sufficiently affected as to cause infertility. Endometriosis, by its very nature, gives no problems during pregnancy and after the menopause.
Endometriosis is a common cause of dysmenorrhoea (see Dymenorrhoea) and, if suspected, referral to a gynaecologist is usually made. The diagnosis is usually confirmed by laparoscopy where a periscope-like instrument is put into the abdominal cavity and the pelvic organs examined - for chocolate cysts etc. For the symptoms, painkillers are usually required. One medication widely used is danazol which has an affect on the pituitary gland changing the hormone levels in the body, in this case reducing the oestrogens and progesterones and increasing the androgens. In severe cases of endometriosis surgery may be necessary to divide adhesions etc and in some cases where pain is chronic and severe, pelvic organs such as the tubes and ovaries have to be removed. |
