Written by Dr.M.D.Mazumdar, MD
Endometriosis is defined as the presence of functional endometrial tissue at sites other than its normal site inside the uterus.
It is a condition in which bits of the inner lining of the uterus called the 'endometrium' is implanted in areas other than their normal site inside the uterus. It is a common cause for infertility and severe abdominal pain in women of reproductive age.
The endometrium is a spongy tissue that lines the inner muscular cavity of the uterus. It proliferates and thickens at every menstrual cycle and if pregnancy occurs, forms the bed in which the embryo implants and develops.
If pregnancy does not occur, it is shed in the menstrual blood. After the menstrual period is over, the endometrium proliferates again and the cycle is repeated month after month.
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In endometriosis, the bits of endometrial tissue implanted in areas other than in the uterus, also proliferate at the same time as the normal endometrial tissue in the uterus. They also bleed at the time of the menstrual period.
But since these endometrial tissues are present outside the uterus, there is no passage for the blood to escape into the vagina. As a result, the blood collects around the tissues, and in time, forms cyst like areas. These are called 'endometriomas'.
The endometriomas stimulate inflammation in the nearby tissues causing scarring and adhesion of the tissues. They also cause severe pain at the time of menstruation.
Endometriosis can occur anywhere in the body. But endometrial tissue in endometriosis is commonly present in the pelvic organs surrounding the uterus - the peritoneum covering the uterus, the fallopian tubes, the bladder, the rectum, the top of the vagina, the vulva, the intestines and the ligaments connecting the uterus to the abdominal walls on the sides of the body.
The ovary is the commonest site of endometriosis (30 - 40 %), followed by the peritoneum between the back of the uterus and the rectum (Pouch of Douglas).
Endometrial tissue has even been discovered in the tissues of the arms and legs, in the nose, in the umbilicus, in the lungs and also in the kidneys. These sites of occurance are very rare. Nevertheless, if a woman gives a history of bleeding from the nose or from any part of the body which synchronises with the menstrual bleeding, then endometriosis should always be suspected.
When bits of the endometrium is present inside the uterine muscle, it is called 'Adenomyosis'. This is a condition which causes symptoms which may be somewhat different from endometriosis present outside the uterus.
The signs and symptom of Endometriosis is typical of the condition and the diagnosis can often be suspected from a description of these alone. The diagnosis is confirmed by laparoscopy.
Treatment of endometriosis can be medical or surgical with medical treament being the mainstay of the treatment protocol.
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