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About endometriosis

By endometriosis that kind of cells or tissue normally found inside the uterus (womb) in the inner lining (endometrium) are spread also in other areas outside the womb.

This misplaced tissue have more or less the same structure as the endometrium inside the womb with a basal stroma mostly made of connective tissue, with an epitelial cover and with glands pt glandular cells imbedded in that tissue.

The misplaced tissue most often occur at the outside of the uterus and ovaries, but can occur at any part of the inner peritoneal wall or any organ surface, especially on the lower abdominal area.

' Endometriosis can also spread to insides of internal organ, to scars in the skin and to places like the nose.

That wrongly placed tissue react against the female hormones in the same way as tissue inside the womb during the menstrual cycle: Most of the epitelial lining get disintegrated, there wil then be bleeding and then regrowth of tissue. These reactions can also cause scarring and further spread of tissue outside the uterus and they can cause adhesions. Endometriosis can also spread downwards into the vagina.

When endometriosis has pread to the internal of organ tissue, the bleeding will cause the endometriosis to form a cyst. Endometriosis spread to the nose will cause nosebleads during the menstrual periods.


Causes of endometriosis

Endometriosis seems to be directly caused by blood from menstruation that contain cells from the mucosa of the uterus, endometrial cells, are pushed up through the fallopian tubes and out between other organs.This is possible because the connection between the ovaries and the fallopean tube leading down to the uterus is an open funnel, and not a closed channel.

But this is probably a frequent event and occur by many women without causing endometriosis. For the cells to spread further they must also have a higher motility.

Such a higher motility is especially required in the cases where the endometriosis spread far awy, as to scars in tje skin and to the nose.

The cause of this higher motility is not well known.

The ultimate causes of endometriosis is therefore not known surely, but there are speculations about various possible causes.

Women with endometriosis seem to have endometrial cells that have a higher mobility than normal, and that the disease spread by endometrial cells moving around and setling in wrong places.

There seem to be a hereditary component, so that some women are born with more mobile endometrial cells than others.

Environmental toxins may give an imballance in the body that make endometrial cells move more around. Such toxins are PCBs, DDT and Dioxin, and hormon-like compunds, so called Xenoestrogens.

Liver diorders that make it difficult for the liver to remove estrogens from the body may cause a hormonal imballance that make the cells move more freely around.

An auto-immune condition may trigger endometrial cells to move more freely around and settle at wrong places.


Symptoms of endometriosis

Because of these reactions, the tissue in wrong places produce symptoms, especially during menstruation. The spread of these misplaced cells can be small or extensive but there is no clear connection between the amount of spread and the symptoms.

The most common symptom is pain of various kind: Dysmenhorrea - intenily painful menstrual cramps in the pelvic region and lower back, often getting worse as years pass. Chronic pain in the pelvis, stomach area or lower back. Dyspareunia - pain during sex. Dyschetzia - pain during bowel movement. Dysuria - increased urgency to pee, frequent urination and pain wnen urinating.

Nausea, voimiting and diarrhoea are frequently experinced by women with endometriosis.

Women with endometriosis often have heavy menstrual bleding and prolonged menstruation.


Complications of endometriosis

A cyst can be formed in the misplaced tissue and that cyst can rupture causing an accute abdominal situation.

Women with endometriosis are often infertile, but it is not certain if the endometriosis causes infertility or these two conditions have a common cause.


Diagnosis of endometriosis

Often one performs a suggestive diagnosis of endometriosis based on the symptoms, and then starts treatment to see if that works. If the treatment works, endometriosis is the most probable cause of the symptoms.

Endometriosis can sometimes be diagnosed by ultrasound or by NMR imaging, but often surgery with biopsy taking is the only secure way of making the diagnosis. Such a surgery is done by a laparoscope inserted through a tiny opening made in the abdominal wall.


Treatment of endometriosis

One treats endometriosis usually by alleviating symptoms and with measures to hinder progression.

NSAIDS (non-steroid anti-inflammatory drugs) are common therpeutic measures to controle pain and hinder progression.

Contraceptive agents are often used because they hinder the reactions during menstruation.

For more severe cases one uses steroid substances or other substances that counteract the production or effects of the hormone estrogen. Sometimes Progesterone or progestins are used to counteract estrogen and inhibits the growth of the endometrium.

Sometimes one performs surgery to remove the most extensive lesions, but usually one will not take away all the misplaced tissue in order to preserve fertlity.

Only seldome are the uterus and ovaries together with all misplaced tissue removed by surgery, and even such an extensive surgery will not garantee that the condition will not come back to some extend.

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