Endometriosis is a condition that affects the female reproductive system. It is estimated that up to 10% of women between the ages of 15 and 44 suffer from endometriosis (John Hopkins, 2023). Typically, every month, the endometrium lines the uterus in preparation for a potential pregnancy (fertilized egg). If a fertilized egg does not implant into the endometrium, then it is broken down and shed during a women's menses (monthly period). In the case of endometriosis, the endometrium grows outside the uterus and can involve the ovaries, fallopian tubes, and pelvis (Mayo Clinic, 2018). Regardless of whether inside or outside the uterus, the endometrium is broken down each month. When inside the uterus, the endometrium exits the uterus through the cervix and the vagina. With Endometriosis, there is no exit point for the endometrium and it therefore is trapped (Mayo Clinic, 2018). This can cause tissues to become irritated and therefore scar tissue or adhesions may develop. Adhesions occur when fibrous tissues create bands that cause organs and tissues to stick together (Mayo Clinic, 2018).
The cause of Endometriosis has not conclusively been determined (John Hopkins, 2023). Some possible causes include:
- Retrograde Menstruation- menstrual blood flows backwards through the fallopian tubes
- Transformation of peritoneal cells - hormonal factors cause peritoneal cells to transform into endometrial cells
- Embryonic cell transformation - hormones cause embryonic cells (present in early development) to transform into endometrial like cells and to implant into the pelvis during puberty
- Surgical scar Implantation - endometrial cells may attach to surgical scar after surgeries such as a cesarian section
- Endometrial cell transport - endometrial cells are transported through blood vessels or lymphatic system
- Direct transplantation: after an abdominal surgery, endometrial cells may attach themselves to other parts of the body(Mayo Clinic, 2018)(John Hopkins, 2023)
Locations that Endometriosis can occur include:
- Fallopian tubes
- Ovaries
- Vagina
- Peritoneum
- Bladder and Ureters
- Intestines
- Rectum
- Diaphragm (Cleveland Clinic, 2022)
- age
- family history
- race
- having never given birth
- early age of menarche (start of period)(before 11 years old)
- going through menopause at older age
- short menstrual cycles
- heavy menstrual cycles
- high levels of estrogen
- low BMI
- one or more relative with Endometriosis
- other reproductive tract disorders (Cleveland Clinic, 2022)(Mayo Clinic, 2023)(Healthline, 2021)
- pregnency
- breastfeeding
- healthy weight
- mestrual period starting at a later age (Cleveland Clinic, 2022)
- painful menstrual cramps
- abdominal or back pain during or between periods
- pain during sex
- heavy bleeding during period
- spotting between periods
- infertility
- bloating
- lower back pain
- Painful bowel movements
- diarrhea
- constipation
- nausea (Cleveland Clinic, 2022)(Mayo Clinic, 2023)(Healthline, 2021)
- ultrasound - creates an image of internal organs
- CT scan - creates images of successive planes of the body
- MRI - creates a two dimensional view of internal organs (Mayo Clinic, 2018)(John Hopkins, 2023)
- NSAIDS: can be used for pain relief
- Hormone Therapy: can be used to reduce or eliminate pain through slowing the growth of endometrial lining and preventing implantation of endometrial tissue
- Hormonal Contraceptives: control the hormones involved in endometrial tissue building up
- Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists: these drugs block ovarian stimulating hormones from being produced. With these drugs, endometrial tissue can shrink.
- Progestin therapy: progestin can relieve the signs and symptoms by halting periods and halting endometrial implants from growing. Therapies may be delivered through intrauterine deices, implants or injections
- Aromatase inhibitors: reduce estrogen
- Surgery: endometriosis implants can be removed either laporoscopically or abdominally. A hysterectomy to include the ovaries may also be done.
- Fertility treatment: range from ovary stimulation in order to produce eggs to in vitro fertilization. (Mayo Clinic, 2018)
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