Endometriosis

Endometriosis is a condition in which bits of the tissue similar to the lining of the uterus (endometrium) grow in other parts of the body. Like the uterine lining, this tissue builds up and sheds in response to monthly hormonal cycles. The blood discarded from these implants falls onto nearby organs, causing swelling and inflammation which lead to scar tissue and adhesions. Endometriosis is estimated to affect 7% percent of women of childbearing age in theUnited States. It is most common between the ages 25-40. Pregnancy may slow the progress of endometriosis. A woman's risk of endometriosis is increased ifher female relatives have endometriosis or her periods last longer than a week with an interval of less than 27 days between them.

Endometrial implants are often found on the pelvic organs--the ovaries, uterus, fallopian tubes, and in the cavity behind the uterus. Occasionally, they grow in more distant parts of the body. Implants appear as small bumps on thesurfaces of the organs and supporting ligaments. Ovarian cysts (endometriomas), ranging from pea to grapefruit size, may form around endometrial tissue. Endometriosis usually advances slowly, over many years. Doctors rank cases from minimal to severe based on the number and size of the endometrial implants,their appearance and location, and the extent of the scar tissue and adhesions in the area of the growths. The cause of endometriosis is unknown. While many women with endometriosis experience severe weakness, others have the disease without knowing it. There is no relation between the severity of the symptoms and the extent of the disease. The most common symptoms are: menstrual pain, pain during sex, abnormal bleeding, and infertility. There is a strong association between endometriosis and infertility.

If a doctor suspects endometriosis, he/she will do a pelvic exam to try to feel implants. Often this does not provide strong evidence of endometriosis. The only way to make a definitive diagnosis is through minor surgery called a laparoscopy. A laparoscope, a slender scope with a light on the end, isinserted into the woman's abdomen through a small cut near her belly button.This allows the doctor to examine the internal organs. Often, a sample of tissue is taken for laboratory examination. Endometriosis is sometimes discovered when a woman has abdominal surgery for another reason. Imaging tests suchas ultrasound,computed tomography scan (CT scan), or magnetic resonance imaging (MRI) offer more information but don't help with the initialdiagnosis. A blood test to determine the level of the blood protein CA125 can predict a recurrence of the disease. How endometriosis is treated depends on the woman's symptoms, her age, the extent of the disease, and her preferences. It cannot be fully resolved without surgery. Treatment focuses on managing the pain, preserving fertility, and delaying the progress of the condition.Over-the-counter pain relievers such as aspirin and acetaminophen (Tylenol) are used for mild cramping and menstrual pain. Prescription-strength and over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn), are also effective. Narcotics are occasionally used for severe pain. Hormonal therapies effectively relieve endometriosis but they are also contraceptives. Oral contraceptivestrick the body into thinking it's pregnant, reducing pain and temporarily withering endometrial implants. Danazol (Danocrine) and gestrinone are synthetic male hormones that lower estrogen levels, prevent menstruation, and shrinkendometrial tissues, but they lead to weight gain and menopause-like symptoms, and cause some women to develop masculine characteristics. Progestins suchas Medroxyprogesterone (Depo-Provera) and related drugs minimize painand stop the condition's progress, but are rarely used because of side effects. Gonadotropin-releasing hormone (GnHR) agonists limit pain and prevent thegrowth of endometrial implants, but they can cause menopause symptoms and possible bone loss. Removing the uterus, ovaries, and fallopian tubes is the only permanent way to eliminate endometriosis. This is an extreme measure that means that a woman cannot have children and forces her body into menopause. Endometrial implants can be removed with laparoscopic laser surgery. For womenwith minimal endometriosis, this is usually successful in reducing pain and slowing the condition's progress. It may also help infertile women increase their chances of becoming pregnant. Although severe endometriosis should not beself-treated, many women help their condition through alternative therapiessuch as taking vitamin B complex with vitamins C, E, and the minerals calcium, magnesium, and selenium; a macrobiotic diet or a less extreme diet that cuts out sugar, salt, and processed foods; mind-body therapies such as relaxation and visualization, acupuncture; and biofeedback; and treatment withchiropractors or homeopathic doctors. Most women with endometriosis have minimal symptoms and do well. Symptoms come back in about 40% of women over the five years following treatment. There is no proven way to prevent endometriosis.

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