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Endometriosis

Endometriosis is a common gynaecological problem that primarily affects women of reproductive age.  It occurs when uterine tissue cells, or endometrium, grow outside of the uterus.  Some more common parts of the body where endometrium can grow in the case of endometriosis include the ovaries, fallopian tubes, outer surface of uterus, pelvic cavity lining, vagina, cervix, vulva, bladder and rectum.

Symptoms

Patients may experience painful cramps in the lower abdomen, back or in the pelvis during menstruation, heavy menstrual bleeding, painful bowel movements, painful urination and infertility or difficulty becoming pregnant.

Causes

The exact cause for endometriosis is not known; however, some research indicates that endometriosis could be a genetic condition, a defect in the immune system, hormonal imbalance, or it could develop as a complication of other surgeries.

Diagnosis

Your gynaecologist will ask you about your general health, your symptoms and perform a pelvic examination to feel for the presence of large cysts or scars. An ultrasound scan may also be performed to look for ovarian cysts.

In some cases, investigative or diagnostic surgery may be performed, such as laparoscopy, so that the pelvic cavity can be visualised, the presence of endometrium assessed, and samples taken for laboratory analysis to confirm that extra-uterine growth is genuinely endometrium.

Treatment

There are several treatment options available to minimise the pain as well as control heavy bleeding.

  • Pain Medication: Over-the-counter pain relievers may be helpful for mild pain. Non-steroidal anti-inflammatory medications may be prescribed by your doctor in cases of severe pain.
  • Hormone Treatment: Hormone treatment is recommended if there is a small growth and mild pain. Hormonal preparations can be taken in the form of pills, shots, and nasal sprays. Birth control pills can help to decrease the amount of menstrual bleeding.
  • Surgery: Surgery is an option for women who have multiple sites of endometriosis, severe pain, or fertility problems. Options include:
    • Laparoscopy: During this surgery, growths and scar tissue are removed or cauterized. This is a minimally invasive technique and does not harm the healthy tissue around the growth.
    • Laparotomy or major abdominal surgery: This involves a larger cut in the abdomen which allows the doctor to reach in and remove the endometrial growth.
    • Hysterectomy: This is a surgery that involves removal of the uterus. Hysterectomy will be done only when there is severe damage to the uterus and the patient does not want to become pregnant in the future.

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