Endometriosis Definition And Epidemiology Biology Essay

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It is non-cancerous condition, the tissue that lines the inside of the uterus - grows outside the uterus and attaches to other organs within the abdominal cavity, such as the ovaries, fallopian tubes, bladder, bowel, vagina, rectum, cervix, lungs and skin. however, These tissues are influenced by hormones secreted by ovarian hormone oestrogen, which leads to the growth of this tissue and increase its thickness, and when the level of hormone lows in the body before the menstrual cycle these tissues start bleeding and lead to inflammation and adhesions, and when present in the ovary leading to the formation of cyst called chocolate cyst.( http://www.womenshealth.gov/faq/endometriosis.cfm) Studies have shown that Endometriosis occurs by 10:33% for women in the age of 25: 35. And almost half of the girls who suffer from chronic pelvic pain were diagnosed with endometriosis. And the average age at which the disease is diagnosed it is 27 years, but many women complain of the symptoms of the disease for several years before the diagnosis is made.

Aetiology;

No one knows for sure what causes this disease, but experts have a number of theories:

-Since endometriosis runs in families, it may be carried in the genes, or some families have traits that make them more likely to get it.

-Endometrial tissue may move from the uterus to other body parts through the blood system or lymph system.

-If a woman has a faulty immune system it will fail to find and destroy endometrial tissue growing outside of the uterus. Recent research shows that immune system disorders and certain cancers are more common in women with endometriosis.

-The hormone estrogen appears to promote the growth of endometriosis. So, some research is looking at whether it is a disease of the endocrine system, the body's system of glands, hormones, and other secretions.

-Endometrial tissue has been found in abdominal scars and might have been moved there by mistake during a surgery.

-Small amounts of tissue from when a woman was an embryo might later become endometriosis.

-New research shows a link between dioxin exposure and getting endometriosis. Dioxin is a toxic chemical from the making of pesticides and the burning of wastes. More research is needed to find out whether man-made chemicals cause endometriosis.

-Endometrial tissue may back up into the abdomen through the fallopian tubes during a woman's monthly period. This transplanted tissue could grow outside of the uterus. However, most experts agree that this theory does not entirely explain why endometriosis develops. (http://www.womenshealth.gov/faq/endometriosis.cfm)

Other factors increase the incidence of:

1 - Caffeine.

2 - Obesity.

3 - Aged between 30-44.

Pathophysiology:

To fully understand the long-term complications associated with this disorder, let's briefly review the physiological aspects of the menstrual cycle.

Menstrual Cycle;

During a woman's reproductive years, one of the ovaries releases an egg into the fallopian tubes once a month. It is the ovaries that increase estrogen and progesterone production, which signals the endometrium to grow. This growth prepares the endometrium to support the implantation of a fertilized egg via its rich network of blood vessels and glands. When an egg is not fertilized, it along with endometrium, passes out through the vagina. This passage of endometrial tissue is the monthly menstrual flow.

The Problem;

During menstruation, via some unknown mechanism, endometrial tissue finds its way to other sites and organs in the body, reacting as if they were part of the normal growth pattern. This abnormal growth of tissue can cause severe pain and disrupt normal functioning of vital organs.

Patches of endometriosis also respond to the hormones produced during the menstrual cycle. With the passage of time, the growths of endometriosis may expand by adding extra tissue and blood. The symptoms of endometriosis often get worse. Tissue and blood that is shed into the body can cause inflammation, scar tissue, and pain. As endometrial tissue grows, it can cover or grow into the ovaries and block the fallopian tubes. Trapped blood in the ovaries can form cysts, or closed sacs. It also can cause inflammation and cause the body to form scar tissue and adhesions, tissue that sometimes binds organs together. This scar tissue may cause pelvic pain and make it hard for women to get pregnant. The growths can also cause problems in the intestines and bladder.( http://www.womenshealth.gov/faq/endometriosis.cfm)

While doctors are not quite sure how or why endometriosis occurs, there have been many theories postulated to explain its occurrence;

There are several theories that attempt to explain how endometriosis develops; The most popular theory describes Retrograde menstruation (also known as "reverse menstruation") occurs when blood and endometrial tissue back up into the fallopian tubes and enter the pelvic and abdominal cavities instead of flowing out through the cervix and vagina.. Other theories involve Coelomic metaplasia (normal tissue in the abdominal cavity spontaneously changing to endometriosis), direct implantation of endometrial cells into the abdomen during surgery, and spread of endometrial cells from the inside of the uterus to other locations via blood vessels or lymphatics. Each of these may contribute to endometriosis in different patients. The immune system may allow endometrial cells to establish themselves in other parts of the body and exposure to dioxin and related environmental toxins may also play a role.

Microscopically, endometriotic implants consist of glands and stroma identical to intrauterine endometrium. These tissues contain estrogen and progesterone receptors and thus usually grow, differentiate, and bleed in response to changes in hormone levels during the menstrual cycle.

Clinical signs and symptoms, including red flag symptoms:

Some women have no symptoms at all, while other has severe pain,

The most common symptom noted by women with endometriosis is pelvic pain that is worse just before menstruation, which then improves at the end of the menstrual period.

1- Dysmenorrhoea.

2- Dyspareunia.

3- Bleeding from the rectum during menstruation.

4- Dysuria, if the ectopic tissue nears the bladder.

5- Menorrhagia.

6- The presence of chocolate cysts.

7- Chronic pain in the lower back and pelvis.

8- Constipation or diarrhoea at period time.

9- Intestinal pain.

10- Pain before menstrual cycle.

11- Infertility.

12- Fatigue.

Psychological symptoms:

1- Depression and feeling upset.

2- Lack of sexual desire.

3- The feeling of guilt towards the partner.

Because endometriosis is a chronic disease, it may come on gradually. A woman will want to schedule regular care with a women's care clinician or gynaecology.

If the woman's pain changes dramatically over a short period of time or unexpected symptoms develop, it is reasonable to go to a hospital.

ï‚· In general, call a health care practitioner to investigate new or worsening pain associated with menstruation, sexual activity, or daily activities.

ï‚· Any pain that limits a woman's usual daily activities should be evaluated.

Differential diagnosis and investigations:

Endometriosis cannot be diagnosed with certainty by symptoms and physical examination alone. The healthcare practitioner may consider other conditions such as infections or tumours. Symptoms of endometriosis can be similar to and confused with symptoms of other conditions, such as ovarian cysts, ectopic pregnancy, Pelvic Inflammatory Disease, irritable bowel syndrome, ovarian cancer, fibroid tumours, interstitial cystitis, colon cancer, and appendicitis. (http://www.endo-resolved.com/symptoms.html) Some of these conditions can be very serious, even fatal, if left untreated. In addition, untreated endometriosis can also lead to serious complications, such as infertility. Because of these factors, it is vital that women with symptoms of endometriosis take seek medical care and a definitive diagnosis from a gynaecologist, who is a specialist in women's reproductive health.

The doctor will talk to you about your symptoms and health history. The doctor may also do these tests to check for clues of endometriosis:

1-Pelvic exam; 

Your doctor will perform a pelvic exam to feel for large cysts or scars behind your uterus. Smaller areas of endometriosis are hard to feel.( http://www.womenshealth.gov/faq/endometriosis.cfm)

2-Ultrasound;

Your doctor could perform an ultrasound, an imaging test to see if there are ovarian cysts from endometriosis. During a vaginal ultrasound, the doctor will insert a wand-shaped scanner into your vagina. During an ultrasound of your pelvis, a scanner is moved across your abdomen. ( http://www.womenshealth.gov/faq/endometriosis.cfm)

An ultrasound is performed in cases where other conditions are suspected, such as uterine fibroids, or ectopic pregnancy. Ultrasound can also pick up cysts larger than 1 cm but will miss smaller cysts or small, shallow endometrial implants on the surface of ovaries or on the peritoneum.

3-Laparoscopy;

The most important diagnostic tool for endometriosis.

The only way for your doctor to know for sure that you have endometriosis is to look inside your abdomen to see endometriosis tissue. He or she can do this through a minor surgery called laparoscopy. You will receive general anaesthesia before the surgery. Then, your abdomen is expanded with a gas to make it easy to see your organs. A tiny cut is made in your abdomen and a thin tube with a light is placed inside to see growths from endometriosis. Sometimes doctors can diagnose endometriosis just by seeing the growths. Other times, they need to take a small sample (biopsy) of tissue and study it under a microscope. ( http://www.womenshealth.gov/faq/endometriosis.cfm)

4-Blood test;

Blood tests can be developed that will identify endometriosis by measuring high levels of specific chemical substances released by the implants. Some researchers believe that deep invasive endometriosis may be detected by using a combination of a vaginal examination during menstruation and a blood test for CA-125. This substance is elevated in women with ovarian endometriomas (cysts) and deep endometriosis. Higher levels of CA-125 occur in many other diseases, including ovarian cancer, so results using this test alone do not provide enough information for a definitive diagnosis of endometriosis. It may, however, be useful for indicating the need for more invasive tests in women who are infertile and for monitoring the effectiveness of treatments in women with severe endometriosis.

5-MRI;

Is another common imaging test that can produce a picture of the inside of your body. And

Can reveal the presence of blood cyst, tissue migrants scattered in the intestine and bladder and the presence of adhesions around the ovary.

6- A barium enema;

 For women who are experiencing rectal bleeding, to rule out the possibility of gastrointestinal ailments or diseases such as colon cancer. It involves x-rays of the colon using a contrast medium (barium), which is introduced into the rectum by enema and is visible on the x-rays. The barium fills the colon, and areas of abnormalities can be seen.

Orthodox Medical treatment:

There is no cure for endometriosis disease; treatment is to relief the symptoms of the disease.

1 - Home care:

If a woman increases her level of physical activity daily, the amount of pain associated with endometriosis may decrease. Researchers are uncertain as to the cause of this relationship and have noted that increased exercise does not reduce pain in all women.

2-Medication treatment:

Treatment for endometriosis often depends on whether the patient's goal is to relieve pain, improve fertility, or both.

To halt or slow the progression of endometriosis, the doctor will start by prescribing medication

The primary therapy initially recommended for the pain of endometriosis is a no steroidal anti-inflammatory drug (NSAID) such as ibuprofen (Motrin or Advil) or naproxen sodium (Aleve).

If NSAIDs are not sufficient for pain control, her doctor may prescribe stronger medications, even including opioid (narcotic) drugs. Care should be taken when using these drugs due to the possibility for abuse and addiction.

Hormones treatment:

1 - Oral contraceptive pills (OCPs, estrogen and progesterone in combination, birth control pills) are also sometimes used to treat endometriosis in women who also desire contraception. Weight gain, breast

Tenderness, nausea, and irregular bleeding may be mild side effects.

2- Androgens hormone is called Danazol is a synthetic drug that stimulates high levels of androgens (male type hormones) and low estrogen levels by interfering with ovulation and ovarian

Production of estrogen. This drug is effective for pain relief and shrinkage of endometriosis implants, but has a high incidence of side effects including: weight gain,

edema, decreased breast size, acne, oily skin, hirsutism, deepening of the voice, headache, hot flashes, changes in libido, and mood changes.

All of these changes except for voice changes are reversible, but the return to normal may take many months (http://www.medicinenet.com/endometriosis/page4.htm)

3- Gonadotropin-releasing hormone analogs (GnRH analogs) have been effectively used to relieve pain and reduce the size of endometriosis implants. These drugs suppressestrogen production by the ovaries by inhibiting the secretion of regulatory hormones from the pituitary gland. As a result, menstrual periods stop, mimicking menopause. Nasal and injection forms of GnRH agonists are available. They have side effects such as symptoms of menopause such as vaginal dryness, hot flushes and mood

Changes, it is possible also loss of calcium from the bones, but returns to normal after treatment. (http://www.medicinenet.com/endometriosis/page4.htm)

4-Progestogen: the oral pills or needles for long periods and high doses of the hormone to stop the menstrual cycle, and the interruption of the menstrual cycle, the uterine endothelial tissue located in the non

Natural place to stop the bleeding and gradually shrink and die.

Drugs of Progesterone ( Medroxy Progesterone Acetate _ Norethindrone Acetate )

These medicines may cause side effects similar to the effects of the pre- menstrual cycle, such as water retention, mood swings, and the most common is sudden sporadic bleeding, weight gain,

Bloating, irregular uterine bleeding, breast tenderness and depression.

3-Surgical treatment:

Surgery is recommended only if medications fail.

1-Total Hysterectomy:

To remove the large tissue or to remove adhesions.

A more extensive surgery than laparoscopy where the doctor needs to work in a relatively large open in the abdomen.

The processes are used in cases of advanced disease and when there are very severe symptoms, or women do not want to have more children.

After the eradication of the ovaries, uterus, sometimes the doctor describes the hormone therapy and this helps to control menopause symptoms that occur as a result of early loss of the ovaries.

2- Abdominal telescope:

It is a simple surgery that uses a small telescope through a small abdominal incision to remove all the tissue lining migrants' by laser, or thermal or electric cauterization. And this process is used when a woman of childbearing age and wish to have children.

3- Combination treatment:

Doctor combining drug treatment and surgical treatment, allowing the patient to take advantage of two treatments

the doctor can prescribe for the patient doses of treatment for a period of two or three months and are followed by surgical treatment and thus controls the disease with medications, and reduce the spread before serving it surgically and can help the patient to give birth.

4-Infertility treatment;

If this disease is the main cause of infertility, the treatment is by surgery followed by either directly or after several months of medication to stimulate ovulation in addition to IVI.

In case the impact of the disease to a great degree of blockage of the fallopian tubes, treatment is by IVF.

The pregnancy is the absence of menstruation, so the pregnancy is the kind of treatment as the disease enters hibernation in pregnancy and lactation.

Natural Medicine:

I think that some of the natural medicine, vitamins and healthy food to help control some symptoms of the disease and its spread and reduce the severity of the disease. And the natural medicine Complementary treatments beside the Orthodox medical treatment. These are the most well known natural or alternative treatments. There are many other alternative therapies available, but all of them have one single aim, and that is to assist the body to heal itself. The natural treatments which appear to be having the best results for the treatment of Endometriosis are

1- Eliminating dairy, meat products and saturated fats from your diet, avoiding caffeine, sugar and excessive salt, and consuming fresh fruits, vegetables and other high fiber foods. (Note: Women who suffer from endometriosis should avoid soy products due to the presence of mild estrogens.) 

2- Supplementing the diet with B-complex vitamins (50 to 100 milligrams). B-vitamins assist the liver in converting excess estrogen into weaker forms.

3- Using supplemental vitamin C and bioflavonoids to strengthen blood capillaries and reduce bleeding and cramps (1,000 to 4,000 milligrams of vitamin C daily). 

4- Using herbs such as white willow bark and meadowsweet to reduce pain, fever, cramps and inflammation of endometrial tissue. Other herbs like false unicorn, black cohosh, anise, fennel and blessed thistle may offer help due to their ability to balance the hormonal system. Lark recommends 100 milligrams of any of the above individual supplements. 

Many cases of endometriosis can be treated with herbs, but to successful treatment will take many months such as-evening primrose oil and ginger, Horsetail and Red raspberry reduces bleeding and is thought to strengthen the uterus. Taking Echinacea root is a good and this herb does not only improve immunity, but also helps repair connective tissues and fibres. Castor oil packs are also very helpful in treating endometriosis. Castor oil packs in hot or cold sitz baths with a few drops of lavender or chamomile essential oil (in the hot bath only) to increase circulation and improve the function of the immune system in the pelvic area. Some young women with endometriosis take other supplements such as vitamin E, zinc, selenium, , magnesium, Calcium, essential oils (such as flax, and fish oils), and acidophilus, but there are no published scientific studies that prove that extra supplements improve endometriosis symptoms. It is important to remember that some herbs (such as ginseng) can actually interfere with medications that treat endometriosis because they contain plant-estrogen. It is always best to talk with your health care provider first before taking any over-the-counter herbs

5- Increasing the consumption of essential fatty acids (EFAs), which contain hormone-like substances called prostaglandins. Prostaglandins may help relax muscles and blood vessels, thus preventing cramping. EFAs are found in nuts, seeds, salmon and trout and various dietary supplements such as flaxseed oil and evening primrose oil.

Other alternatives used to manage endometrial symptoms and pain include acupuncture, acupressure, naturopathy, aromatherapy, transcutaneous electrical nerve stimulation (TENS), meditation, biofeedback, massage therapy, meditative exercises such as yoga and tai chi, and sex therapy via a qualified practitioner,

Acupuncture;

The acupuncture points commonly used in the treatment of endometriosis can be located on the ears, abdomen, wrists, feet, legs, and back. Needles are usually retained for 20 to 45 minutes. The treatment of endometriosis with acupuncture usually requires a commitment of enough time to rebalance the body's systems. This will vary from one woman to another, and will be dependant on the severity of the disease.( http://www.endo-resolved.com/acupuncture.html)

Naturopathy;

The endometriosis program in Naturopathy will consider diet, lifestyle, cleansing and hormone balancing herbs, as well as herbs for pain relief and external preparations to clear toxicity in the abdominal area. (http://www.endo-resolved.com/acupuncture.html)

Aromatherapy;

The chemical properties of different essential oils can aid digestion, assist with sleep problems, boost the immune system, support the reproductive system, and help rebalance the hormone system. (http://www.endo-resolved.com/acupuncture.html)

Prognosis:

Hormone therapy and pelvic laparoscopy cannot cure endometriosis. However, it can partially or completely relieve symptoms in many patients for a number of years.

Removing the uterus (hysterectomy), both ovaries and tubes give the best chance of a cure for endometriosis. You may need hormone replacement therapy after your ovaries are removed. Rarely endometriosis can come back, even after a hysterectomy.

Endometriosis may result in infertility, but not in every patient, and especially if the endometriosis is mild. Laparoscopic surgery may help improve fertility. The chance of success depends on the severity of the endometriosis. If the first surgery does not aid in getting pregnant, repeating the laparoscopy is unlikely to help. Patients should consider further infertility treatments.

Endometriosis can lead to problems getting pregnant (infertility). Other complications include:

Chronic or long-term pelvic pain that interferes with social and work activities

Large cysts in the pelvis (called endometriomas) that may break open (rupture)

Other complications are rare. In a few cases, endometriosis implants may cause blockages of the gastrointestinal or urinary tracts.

Very rarely, cancer may develop in the areas of endometriosis after menopause. ( http://www.nlm.nih.gov/medlineplus/ency/article/000915.htm)

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