Adults
What is Endometriosis?
Endometriosis is a chronic disease where endometrial-like tissue (similar to the type that lines your uterus) grows outside of the uterus and other organs in your abdomen, and causes inflammation, scarring, damage to nearby structures, intense pain and even infertility.
Symptoms of Endometriosis
Chronic Pelvic Pain
Deep pelvic pain inside during intercourse. This typically occurs with deeper penetration, and certain positions may be more painful. Pain may also occur after sex and last hours to days
Painful Intercouse
Depression
Daily Function: Endometriosis can affect the ability to go to work or perform at your best due to pain. Many patients report
difficulties with attendance, work productivity, or even day-to-day activities
Mood Change: Mood problems can develop due to endometriosis with 29% of patients reporting anxiety or depression
History of noncyclic pelvic pain for at least six months. Pain becomes more frequent, and often daily, and may begin to affect other nearby organs
About 30-50% of patients experience infertility, and women with infertility have a 6 to 8 times higher risk of having endometriosis than fertile women
Infertility
Menstrual Cramps
Heavy Menstruation
Recurrent, crampy, pelvic pain occurring just before or during menses and lasting two to three days; pain may radiate into the lower back and thighs, and may be associated with nausea, fatigue, bloating, and general malaise
Patients with endometriosis may have very heavy periods starting when they are teenagers
Endometriosis growing on or around the bladder can cause pain. Sometimes endometriosis will cause the muscles in the pelvis to become irritable, and this can also cause bladder pain
Painful Urination
Constipation and/or Diarrhea
Irritable bowel symptoms can be caused by endometriosis growing on the bowel or the nerves nearby. Not all cases of IBS are caused by endometriosis, however
Diagnostic of Endometriosis
Pelvic Exam
Doctors bimanually exam the uterus, ovaries, and fallopian tubes and use the speculum to visualize the vaginal walls and cervix
Ultrasound
Doctors use high-frequency sound waves to create images of the reproductive tissue and organs inside of the body
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Magnetic Resonance Imaging (MRI)
Doctors use a magnetic field and radio waves to create detailed images of the reproductive tissue and organs inside of the body
Laparoscopy
Diagnostic ability
Cost
Operator dependence
for deep endometriosis
for peritoneal endometriosis
highly operator-dependent
low cost
for deep endometriosis
for peritoneal endometriosis
highly operator-dependent
medium cost
for deep endometriosis
for peritoneal endometriosis
highly operator-dependent
high cost
for deep endometriosis
highly operator-dependent
extremely high cost
(But may lead to improvement in symptoms)
Endometriotic implants morphology
Black and blue lesions are common for ADULTS.
Lesions that are shown on the left are more common in ADOLESCENTS, though they occur in ADULTS. It includes red flame, white, yellow-brown lesions, subtle lesions appear to be clear, shiny peritoneal vesicles etc.
Treatment
Medical Treatment (Hormone or Non-hormone)
Description: Different types of birth control to stop periods, and pain medications to manage symptoms
Advantage: Cheap, low risk, may control symptoms
Disadvantage: Does not get rid of endometriosis, cannot get pregnant while using
Examples: Pills, patch, vaginal ring, injections, and IUD
Non-hormone Treatment
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen sodium. They are the first-line treatment followed by combined oral contraceptives. NSAIDs are appropriate to use for a short term course to see if it relieves the symptoms preoperatively. However, if the symptoms remain unchanged or become worsened, it is encouraged for patients to seek other medical treatment, preferably surgical excision or a short term course of hormonal contraceptives.
Hormone Treatment
Hormonal contraceptives: Hormonal contraceptives such as birth control pills, patches and vaginal rings are less invasive and can also prevent pregnancy. However, it could result in a late diagnosis.
Levonorgesterel IUD: Levonorgesterel IUD delivers daily progesterone to the body and lasts for over five years. This is another hormonal treatment option for adolescent patients other than OCPs. Levonorgestrel causes degeneration of the uterine lining and endometriosis.
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Progestins: Progestins such as depo medroxyprogesterone acetate (DMPA) are limited due to a correlation of the drug with lower bone mineral density. Thus, according to NICE this drug could be used as contraceptive in cases where all the other methods have failed.
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GnRH analogs: They are usually used as a treatment after surgical confirmation of the disease. Their use is limited in short periods of time since they pose a great danger due to bone density loss. After 17 years of age where the bone structure is established, GnRHa treatment may be considered, if all the other possible treatments have failed to improve the patient’s quality of life.
Description: Laparoscopic surgery to remove endometriotic tissue, and normalize
or improve the anatomy
Advantage: Can both improve fertility and alleviate pain.
Disadvantage: Endometriosis often comes back, and surgery may lead to scar tissue
Surgery
Risk Factors
＜ 12 years
Earlier age at first period
Body Type
Thinner People
Reproductive history
Infertility
Shorter menstrual cycles
＜ 26 days
Diet
· Higher risk for those eating highly processed foods (lower risk in vegetarians)
· Anti-inflammatory diets MAY decrease the risk
LGBTQIA Hub
It has been studied that LGBTQIA community can still have symptoms of endometriosis. But do not worry, there are specialists outside for help. Also, some treatments can still be considered for LGBTQIA community. To know more information, you can visit this website https://www.endofound.org/lgbtqia
Citation
1.Zondervan, Krina T, Christian M Becker, Kaori Koga, Stacey A Missmer, Robert N Taylor, and Paola Viganò. 2018. "Endometriosis." Nature reviews. Disease primers 4 (1): 9-33.
2.Bulletti, Carlo, Maria Elisabetta Coccia, Silvia Battistoni, and Andrea Borini. 2010. "Endometriosis and infertility." Journal of assisted reproduction and genetics 27 (8): 441-447.
3.Dunselman, G.A, N Vermeulen, C Becker, C Calhaz-Jorge, T D'Hooghe, B. De Bie, O Heikinheimo, et al. 2014. "ESHRE guideline: management of women with endometriosis." Human Reproduction 29 (3): 400-412.
4.Fourquet, Jessica, M.P.H, Lorna, M.P.H Báez, Michelle, M.P.H Figueroa, R. Iván, M.S., M.D Iriarte, and Idhaliz, Ph.D Flores. 2011. "Quantification of the impact of endometriosis symptoms on health-related quality of life and work productivity." Fertility and Sterility 96 (1): 107-112.
5.Friedl, F, D Riedl, S Fessler, L Wildt, M Walter, R Richter, G Schüßler, and B Böttcher. 2015. "Impact of endometriosis on quality of life, anxiety, and depression: an Austrian perspective." Archives of gynecology and obstetrics 292 (6): 1393-1399.
6. Osayande, Amimi S., MD, and Suarna, MD Mehulic. 2014. "Diagnosis and Initial Management of Dysmenorrhea." American Family Physician 89 (5): 341-346.