Pathophysiology of Endometriosis:

Pathophysiology of Endometriosis – It is a medical condition that occurs when the lining of the uterus, called the endometrium, grows in other places, such as the fallopian tubes, ovaries or along the pelvis.

Endometriosis is the presence of endometrial tissue outside of the uterine cavity, most commonly surrounding the ovaries and fallopian tubes.

Causes for Endometriosis:

The cause of endometriosis is unknown, but researchers have several theories. One theory is that during menstruation, blood with endometrial cells flows back into the fallopian tubes, according to the Mayo Clinic. The cells are rooted there and grow a new lining.

Diagnosis:

  • Biopsy or laparoscopy
  • Magnetic resonance imaging (MRI)
  • Ultrascopy
  • Pelvic Examination

Classification:

  • Minimal – few superficial implants
  • Mild – more and slightly deeper implants
  • Moderate – many deep implants and small tumours on ovaries
  • Severe – many deep implants and large tumours on ovaries

Significance:

  • Untreated endometriosis may lead to
  • Infertility
  • Cancer

Contraindications:

Pregnancy – oral contraceptives.

Check for symptoms:

  • Common symptoms include cyclic midline pain, infertility, inter menstrual bleeding
  • Severe menstrual cramps, unrelieved with NSAIDS
  • Long-term lower-back and pelvic pain
  • Periods lasting longer than 7 days
  • Heavy menstrual bleeding where the pad or tampon needs changing every 1 to 2 hours
  • Bowel and urinary problems including pain, diarrheaconstipation, and bloating
  • Bloody stool or urine
  • Nausea and vomiting
  • Fatigue
  • Pain during intercourse
  • Spotting or bleeding between periods

Prescription contains:

Non Steroidal Anti-Inflammatory Drugs

Drugs to suppress ovarian function.

Counseling on side effects:

Combination estrogen/progestin oral contraceptives:

Ethinyl estradiol -Abdominal swelling, breast tenderness, increased appetite, bleeding, deep venous thrombosis

Progestins:

Levonorgestrel – Irregular uterine bleeding, weight gain

Medroxyprogesterone – bleeding, depression, weight gain

Norethindrone acetate – Irregular uterine bleeding, emotional lability, depression, weight gain

Androgens:

Danazol – Weight gain, acne, lowering of the voice, hirsutism, edema, muscle cramps, breakthrough bleeding

GnRH agonists:

Leuprolide – allergic reactions, bone demineralization.

Risk factors:

  • Genetic predisposition
  • Aging
  • environmental toxins(dioxin)                              

Counseling on diet, exercise, lifestyle management:

  • Adequate rest, regular exercise, low-fat diet, nutritional supplements such as ω3 fatty acids, flax seeds, magnesium, vitamin E, zinc.

Conservative surgery:

Conservative surgery is for women who want to get pregnant or experience severe pain and for whom hormonal treatments aren’t working.

The goal of conservative surgery is to remove or destroy endometrial growths without damaging the reproductive organs.

Laparoscopy, a minimally invasive surgery, is used to both visualize and diagnose, endometriosis. It is also used to remove the endometrial tissue.

Diagnostic laparoscopy. During the procedure, your doctor will inflate your abdomen with gas and make a small cut to insert the laparoscope.

Operative laparoscopy. If your doctor finds endometriosis, she can remove some of the tissue growths during the procedure. She can cut them or burn them off using a laser or another technique.

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