Endometriosis Symptoms and Treatments

Endometriosis is a peculiar cell layer lining within the uterus, named as ‘endometrium’, of which is built-up after end of menstruation to provide an environment for pregnancy, and in the case of non-pregnancy it is discharged as a menstrual bleeding due to lack of sufficient hormonal support.
This cell layer is located only inside of the uterus.
Presence of these cells elsewhere than uterus is defined as “endometriosis” disease.
This instance is frequently seen in ovaries, rectouterine excavation (pouch of Douglas), between outer surfaces of the uterus or intestines, on the intestines, over or around the tubes or over cervical ligaments and bladder, or surfaces of peritoneum.

Endometriosis focuses experience same changes which hormones causes throughout menstrual period and bleeding and discharge will seen in these cells during this menstrual period. Inflammatory defensive cells oriented towards restraining the bleeding within ventral cavity will surround the endometriosis focuses. A process causes by inflammation will begin in this area. During recovery, cohesions will occur in surrounding cells and this continues repetitively in every menstrual period.

Many factors such as transportation of egg within endometriosis tubes, defect in fertilization function, nidation of fertilized embryo within uterus could cause infertility. In women, apart from infertility, also painful intercourse (dyspareunia), painful menstruation (dysmenorrhoea) and chronic inguinal pain (pelvic pain) also can cause endometriosis.

Besides when endometriotic focuses are present within ovary, every month they cause a bleeding similar to endometrium by the effect of hormones, in other words will cause ovarian cysts named as “endometrioma”.

Endometriosis causes different complaints on people. Some could damage genital organs, pelvic cavity and adjacent organs (such as intestines, urinary bladder) which are almost undistinguishable than the cancer. Sometimes, it can be seen as a cystic disease or small focuses and it can be predicted for every human.

As the symptoms will not be so intense in severe and endemic endometriosis, in mild cases the complaints can be serious and unbearable.

Endometriosis is a wide seen disease than expected.

Endometriosis is seen 3-5 percent of all women, and this rate increases to 40 percent in couples having trouble to get pregnant.

Although it is known that endometriosis do not have genetical origin, it is remarkable that it is a disease indicates familial tendency.

How endometriosis occurs?

The factors causing an endometriosis are still not known. Some theories asserted in this matter.
Broadly accepted one is; in women have genetical tendency, the structural changes seen in specific surfaces or tissues within abdominal region, movement of endometrium tissue into abdominal cavity through tubes during menstrual period which facilitates this change and occurrence of new endometriosis focuses.
It is also stated that a weakness in immune system of person having immunological background can cause endometriosis.

How it is diagnosed?

Important complaints of women arousing suspicion are painful menstruation (dysmenorrhoea), painful intercourse (dyspareunia) and infertility.
Especially, menstrual pains occur and increasing in due course after first years of menstruation is a sign of endometriosis.
Defining the endometriosis with an examination is so hard. Determining focuses located in the tissue between vagina and rectum can be the presence of endometriosis.
Endometriosis diagnosis could not be made with ultrasound examinations. In this manner, only endometrioma (chocolate cysts), an ovary cyst developed due to endometriosis can be seen.

Final diagnosis in endometriosis can be only be made by directly seeing it with laparoscopy.
Endometrioma (Chocolate cysts)
Chocolate cysts are formed when a membrane layer which coated intra-uterine and called as “endometrium” occurs and being encysted by bleeding in every menstrual period.

In every menstrual period, the blood which lies within the bleeding cyst for a long time then congeals and dissolves, and becomes a liquid of which its colour and viscosity resembles a chocolate. For this reason these are called as “chocolate cyst”.
Chocolate cysts, together with a disease called “endometriosis shows adhesiveness inside the body. Occurrence of chocolate cysts shows that endometriosis is acute.
A diagnosis can be made by observing intense granular cystic masses within ovary during ultrasound.
In the ultrasound, an ovary cyst endometrioma (chocolate cyst) having one septum and two sectional is seen. (Adjacent picture, endometrioma, chocolate cyst)Generally these patients see a doctor with infertility, painful menstruation, pain during intercourse and too much menstruation complaints.
In distinctive diagnosis of endometriomas, there are mucinous cancers developed within ovaries.

Endometriomas Treatment

Treatment of endometriomas is to extract cysts with a surgical operation. Generally laparoscopy methods are used in these surgical operations.

In the adjacent picture you can see a chocolate cysts extracted with an operation.
50 percent of patients, of which their chocolate cysts are extracted, can become pregnant without any treatment.
The cysts smaller than 4 cm can be observed or some medicine treatments can be applied.
Relation between Endometriosis and Infertility
In the case of acute endometriosis, it is obvious that the obstructions occur within the tubes due to impairment of anatomic relation between reproductive organs causes infertility.

On which rate and in what way the minimal and intermediate endometriosis causes infertility is a question of debate. But the absolute reality is endometriosis often accompanies infertility.
But, it is not easy to create a cause-effect relation between these two tables that are generally seen together. As the existence of endometriosis is seen in 21-48 percent of laparoscopies realized due to infertility, in laparoscopies realized due to another reason (such as tubal ligation) this rate decreases to 1.3-5%.
Another interesting finding is that in vaccination treatments realized by a donated sperm (another donor) due to acute male factor infertility, pregnancy chance of women having endometriosis is much more less.

Surgical Treatment in Endometriosis

Seriousness of the disease, woman’s infertility history, desire for pregnancy and her age determines the manner and intensity of the treatment. Unfortunately, in 30 percent of the patients, extracting the woman’s uterus can not release the pain.

First surgery in patients having defective tube-ovary relationship is effective but repetitive attempts are much more inefficient in treating the fertility.
Frequently seen surgical operations realized by laparoscopy are; cutting adhesive parts surrounding ovary-tube-uterus, endometriotic lesions, extraction of ovarian cysts, and destruction of lesions, cauterization or vaporization.

“Laparoscopic Uterosacral Nerve Ablation” (LUNA) operation by laparoscopy is very effective especially to release the pain seen between menstruations and 85 percent of recovery can be achieved for these kinds of complaints.
In extreme acute pains, the incoming nerves to this area will be removed with an operation named as “presacral neurectomy”.
Endometriomas within ovaries will be removed by peeling with its membrane. Otherwise in a short time the cyst will occur again. In cases which cyst wall could not be removed wholly, remaining cyst capsule should be destroyed by argon beam, Co2 laser or electricity.

Medical Treatment in Endometriosis

The purpose in medical treatment is to repress the eggs, to stop menstruation for a long time and regression of the disease. For this, birth control pills or placebo medicine creates menopause status (Danazol, Lucrin, Synarel, Zoladex, Decapeptyl, Suprefact) called as “GnRH analogue” are used.
Besides with GnRH analogues, medicine named as “danazol” is used for a long time in treatment.

Unfortunately focuses are once again can be seen when both GnRh analogues and Danazol are discontinued in treatment. So these medicines can only be used in specific cases.

As a result, for patients of infertility treatment, a decision should be made on whether endometriosis treatment should be applied or not, by determining the anatomy formed after surgical treatment is suitable for ovulation induction & intrauterine insemination (IUI, vaccination), and risk of ectopic pregnancy. Fertility potential of the patients should be re-evaluated and the treatment should be adapted to patient’s needs.

Treatment steps in Endometriosis:

• 1. Observing whether pregnancy occurs or not (Acceptance approach)
• 2. Surgical (Operational) Laparoscopy
• 3. Ovulation induction & intrauterine insemination (vaccination)
• 4. In Vitro Fertilization

In endometriosis cases, best protection method is the birth control pills. Since, birth control pills are remedial especially on persons having acute inguinal pain and dysmenorrhoea (painful menstruation) by repressing the endometriotic focuses.