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Endometriosis is an often painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis.

Endometriosis lead to women experiencing pain, especially during their menstrual cycle. It is a very common condition with 1 in 10 women experiencing it but often goes undiagnosed as women believe that experiencing very painful periods is normal which is not.

Women of reproductive age suffer from endometriosis. This age begins at teenagers to women in their 40s and it usually comes with painful and heavy periods. It can also be genetic. If the pain is severe to a point of it interfering with daily activities or requires to take painkillers excessively, it is not normal and could be endometriosis.

Endometriosis is usually diagnosed on laparoscopy (operation looking with the camera inside of the stomach) and treated with hormones or surgery. It most commonly involves uterus, ovaries, fallopian tubes, rectum and bladder also. During Endometriosis, the displaced endometrial cells stick to pelvic walls and the surfaces of pelvic organs as mention above. They continue to grow, thicken and bleed throughout the menstrual cycle.

Endometriosis is diagnosed based on history, clinical examination, detailed pelvic ultrasound, occasionally MRI / CT scan.

In some cases, laparoscopy is necessary to diagnose and assess the severity of endometriosis.

Although the exact cause of endometriosis is unknown, some possible explanations include:
– Retrograde Menstrual
– Fetal development
– Embryonic cell transformation
– Surgical scar implantation
– Genetics
– Immune system disorder

The symptoms of endometriosis can vary from patient to patient, the severity of pain can be mild to severe and does not always indicate the degree of the condition.

The basic symptoms of endometriosis is pelvic pain, often associated with menstrual period. Female with endometriosis typically have sever menstrual pain compare to normal pain. Other common symptoms:

  • Excessive bleeding
  • Infertility
  • Pain while having a sex
  • Pain while urination
  • Pain passing stool

Symptoms are likely to be cyclical as it is a chronic condition. Beyond the physical, it can also interfere with psychological wellbeing.

Treatment will vary from patient to patient and is often determined by the patient’s priorities. For instance, in the case of a woman who is planning to conceive soon, hormonal treatments would not be advisable as they either act as a contraceptive or halt the menstrual cycle.

Treatment should be decided considering patient history and below factors:

  • Age
  • Severity of her symptoms and disease
  • The desire to have children, and when
  • Previous treatment
  • Purpose of treatment – pain relief or fertility
  • Risk and Side effects of drugs
  • Intended duration of treatment

The treatment options are:

  • Surgery
  • Hormonal treatment
  • Pain management

Hormonal treatments are used to act on the endometriosis and stop its growth. They either put the woman into a state of pseudo-pregnancy or pseudo-menopause. (Pseudo means simulated or artificial – both states are reversed when the patient has stopped taking the hormones.)

In addition, testosterone derivatives are occasionally used to mimic the male hormonal state; these drugs are generally synthetic hormones. While not all of the hormonal drugs used to treat endometriosis are licensed as a contraceptive, they all have a contraceptive effect, so are not used if the patient is trying to conceive. Please note: only the oral contraceptive pill and the Mirena IUS are licensed as contraceptives, so barrier methods of contraception (e.g. condoms) should be used if using other treatments as an extra precaution.

All of the hormonal drugs carry side effects and are equally effective as treatments for endometriosis, so it’s often the side effects that will dictate the choice of drug.

Drugs used that mimic pregnancy:

  • Combined oral contraceptive pill
  • Progestagens
  • Mirena IUS

Pregnancy is characterised by higher levels of progesterone, thus taking progestagens (the synthetic form of progesterone) mimics the state of pregnancy. During pregnancy, the endometrium is thin and also inactive.

Drugs that mimic menopause:

  • GnRH analogues

GnRH analogues are a form of the naturally occurring GnRH, which is produced in a part of the brain called the hypothalamus. GnRH analogues stop the production of the hormones FSH and LH. The ovaries switch off and temporarily stop producing eggs and the hormone oestrogen.

Male hormone drugs – testosterone derivatives:

  • Danazol and Gestrinone

Danazol and Gestrinone are derivatives of the male hormone, testosterone. They lower oestrogen levels which directly switches off the growth of the endometrium (lining of the womb).

COCPs are tablets containing synthetic oestrogen and progestagen (female hormones). The combination of these hormones in the pill is similar to that in pregnancy, causing the menstrual cycle to stop, hence the symptoms of endometriosis being reduced.

The pill is commonly used to treat endometriosis before a definite diagnosis as most women who take it do not suffer from side effects. It can also be taken safely for many years. The pill can be taken continuously (without a monthly break) to avoid bleeding.

Although there is limited data on its use to treat endometriosis, there are few studies that have assessed the pill’s effectiveness. One particular review compared the use of the pill to Zoladex over six months. The Luprodex relieved dysmenorrhoea (painful menstruation) more effectively because it stops periods, but there were no differences between the two treatments for dyspareunia (painful sex) and non-menstrual pain. Based on the side effects of each treatment it was concluded that the pill may be preferable as an overall treatment and has the advantage that it can be safely continued long-term until menopause in fit and healthy, non-smoking women.

As a treatment for endometriosis, surgery can be used to alleviate pain by removing the endometriosis, dividing adhesions or removing cysts. Surgery is also used to diagnose the disease and can be used to improve fertility.