Menstrual pain is a condition that usually occurs in
patients who experience menstruation. Menstrual pain is also a sign of
disturbances in the female reproductive organs, including endometriosis.
About Endometriosis
Endometriosis is derived from the word endometrial tissue,
which lines the wall of the uterus. Endometriosis can be interpreted
asendometrial cells move. Endometriosis is the healthof women is characterized
by growth ofendometrial cells outside of the uterus of the bladder. Bladder
uterus endometrium cell covered by a very influential to female hormones.
Usually cells is thickened uterine endometrium during the cycle occurs so that
the female is ready to accept a fertilized ovum and spermatozoid. If an egg is
not fertilized, endometrial cells utolŝennye broke down and quit as menstrual
blood.
Endometriosis is the growth of uterine lining tissue outside
the uterus. This network grew and attached to or referred implants in places
like the ovaries (ovarian), oviduct (fallopian Falloppii), the outer wall of
the uterus, colon, bladder and uterus network that support the uterus, the area
between the vagina and rectum , even in places more distant from the stomach
such as the eyes and lungs, although this is rare.
However, the endometrial lining outside the uterus has no
way out for experienced bleeding every month, so that surrounding layers become
inflamed and swollen.
Endometriosis Symptoms and Signs
Endometriosis Symptoms is variable and unpredictable. The
most common sign is a severe pain in lower abdomen, can be felt at any time and
in constant pain is often unbearable, causing the patient can not do business
as usual. Usually becomes more severe for several days before menstruation and
gets worse until the bleeding is reduced, In endometriosis, uterine tissue
which deviate runs like normal network, thereby causing abnormal bleeding or
cramping feeling very sick and at the time of my period.
The disease is common in infertile women between the ages of
25 -44 years, although it did not rule can also occur in adolescents and
reproductive age, and also occurs in 25-50% of infertile women. Endometriosis
often do not get serious attention from both patients and doctors who examined,
because of pain during menstruation is often regarded as a thing that are
appropriately experienced every month.
In addition there are also various other symptoms such as
pain during intercourse, lower back pain, difficult bowel movements, diarrhea,
or feel pain even bleeds when urinating, bleeding from the anus during bowel
movements are very sick, and also feel pain when exercising, or after a pelvic
exam.
This is because endometrial implants can press organs that
carry the dirt out of the body, such as bladder, colon, and rectum.
However, when we experience the above symptoms, do not
punish us develop endometriosis. Aja can be caused by other things, such as
infection. Therefore, we should immediately go to the doctor and told him what
we experience with a complete and clear.
Levels of Endometriosis:
Stage 1: Defeating superficial, there are spikes at the
surface only.
Stage 2: Spreading until the cul de sac area
Stage 3: Same as stage 2, but with small endometriomas on
the ovary and spread to more.
Stage 4: same as stage 3, but with large endometriosis and
adhesiolysis is very extensive.
Cause of Endometriosis
Until now the doctors do not know the exact reason why the
endometrium grows outside the uterus. So far there are several causes such as
falling below:
The theory of retrograde menstruation (menstrual moving
backwards). Endometrial cells that are released during menstruation moving
backwards into the fallopian tubes and into the pelvis or abdomen, and grows in
the pelvic / abdominal.
The theory of the immune system. Abnormalities of the immune
system causes menstrual network to grow in areas other than the uterus.
The family has a genetic theory of certain factors that
cause the high sensitivity of endometriosis.
While most cases of endometriosis are diagnosed in women
aged around 25-40 years, endometriosis has been reported to also occur in young
women aged 11 years. Endometriosis is rare in postmenopausal women.
Endometriosisis more common in white women than African American women and
Asia. Further study showed that the most common endometriosis also occurs in
women of high, thin with a low body mass index (BMI). Delaying pregnancy until
an older age is also believed to increase the risk of developing endometriosis.
There are several theories that explain why endometrial
implants can be out of the womb. Among them is the possibility of overflow or
spillage of dirty blood to the back of the uterus through the fallopian tubes.
Others say the endometrium is taken to another place through the bloodstream or
lymph channels and could also be because these women are often depressed souls
(stress).
Another possibility is that areas lining the pelvic organs
have primitive cells that can grow into other forms of tissue, such as
endometrial cells. (This process is called coelomic metaplasia).
There is also the possibility that the direct transfer of
endometrial tissue during surgery may be responsible for endometriosis
implants, sometimes seen in a surgical scar (eg, episiotomy or cesarean scar).
Transferring endometrial cells through the bloodstream or lymphatic system is
the most likely explanation for the rare cases of endometriosis that develops
in the brain and other organs far from the pelvis.
Finally, several studies have shown changes in the immune
response in women with endometriosis, which may affect the body's natural
ability to recognize and destroy the misdirected growth of endometrial tissue.
Impact of endometriosis
Impacts that are often found in people with impaired
fertility endometriosis is very difficult to get pregnant (infertile). And an
estimated 50% – 60% of cases of endometriosis will be infertile (sterile). This
is experienced by about 30-40% of women or two times the incidence in the
general population. In the group of infertile women who go to a specialist
almost 93% suffer from endometriosis.
Invasive endometriosis will cause infertility due to
decreased function of the uterus and tubes and ovaries in spreading. But some
theories say that the endometriosis will produce prostaglandins and other
inflammatory material that could interfere with the function of reproductive
organs such as contractions or spasms. Mentioned also in function of the
fallopian tube endometriosis in doing egg retrieval from the ovaries to be
disturbed. It can even damage the epithelial lining of the uterus and cause
implantation failure in fertilization outcome.
Endometriosis can also cause miscarriage in pregnancy. The
exact cause is unknown, but there is the possibility of endometriosis causing
disruption in the state of female hormones that cause poisoning that interfere
with fetal growth. Sometimes women who develop the disease endometriosis can be
several times had a miscarriage.
Endometriosis and cancer risk
Basically, endometriosis is not cancer. Endometriosis is a
type of cyst. However it is very risky if the disease is suffered by someone
who has a history of cancer, especially cervical cancer and women with ovarian
endometriosis appear to have a slightly increased risk for developing several
types of ovarian cancer, known as? Epithelial ovarian cancer (EOC), according
to some research studies. This risk seems highest in women withendometriosis
and primary infertility (those who have never given birth), but the use of
birth control pills / Cotraceptive oral pill (OCP), which is sometimes used in
the treatment of endometriosis, appears to significantly reduce this risk.
The reason the relationship between endometriosis and
epithelial ovarian cancer is not clearly understood. One theory is that
endometriosis implants itself undergoes a transformation to cancer. Another
possibility is that the presence of endometriosis may be associated with other
genetic or environmental factors that also increase women's risk of developing
ovarian cancer.
Examination and endometriosis treatment
For women who often experience the symptoms mentioned above,
you should immediately see a doctor. Through examination of the uterus with a
vaginal ultrasound sonography.
Several types of tests to detect the disease endometriosis:
Laparoscopy
Endometrial biopsy
Ultrasound Rahim
Barium Enema
Abdominal CT scan or MRI
Treatment options for endometriosis:
Drugs that suppress ovarian activity and slow the growth of
endometrial tissue.
Surgery to remove as much as possible endometriosis.
The combination of medicine and surgery.
Hysterectomy, often accompanied by removal of the fallopian
tubes and ovaries.
It must be realized that endometriosis is progressive and
repetitive, so the removal of the uterus (hysterectomy) and both fallopian tubes
are the most likely option to eliminate endemetriosis. However, this action can
not be done on those who still want to have children or not married. So the
right choice to do this is using drugs and therapies.
Medicines that can be used for therapy
Non-steroidal anti-inflammatory drugs (NSAIDs /
non-steroidal anti-inflammatory drugs).
NSAIDs not only reduce pain, but can reduce the bleeding
that occurs. These drugs suppress the production of estrogen by the ovaries by
inhibiting the secretion of hormones from the pituitary gland regulation. As a
result, menstrual periods stop, such as menopause. In severe cases, allows the
use of morphine, but it depends on the doctor's policy.
Side effects of this drug are: hot flashes, vaginal dryness,
irregular vaginal bleeding, mood changes, fatigue, and osteoporosis.
Progesterone or progestin
Progesterone can "resist" the activity of estrogen
and prevent thickening of the endometrium. Progestin is a chemical derivative
of progesterone. Progestin [eg, medroxyprogesterone acetate (Provera, Cycrin,
Amin)], norethindrone acetate, norgestrel acetate (Ovrette) is more powerful
than birth control pills and is recommended for women who can not take birth
control pills.
Avoid any kind of material that is both estrogenic
Oral contraceptives
Oral contraceptive therapy can reduce the pain associated
with endometriosis. The most common combination used is in the form of birth
control pills. Side effects: weight problems, breast tenderness, nausea, and
irregular menstruation.
The other types of drugs used to treat endometrioasis
Oral contraceptives (birth control pills) can suppress pain
up to 75% in patients with endometriosis. Contraceptive pill can be taken
continuously or in accordance with the menstrual cycle and may be discontinued
after 6 to 12 cycles. Side effects that may occur are headache, nausea and
hypertension. These pills are taken in accordance with the rules, without a
placebo pill.
Danazole (steroids) which works by creating an atmosphere of
androgenic, can suppress the growth of endometriosis. But there are side effects
that arise such as hirsutism (excessive hair growth in women with a
distribution like men), acne, etc..
Lupron (GnRH agonist) works by increasing blood levels of
GnRH, LH and FSH levels seingga decreased, but the side effects that may arise
is the appearance of osteoporosis. Can be used only 6 months. The dosage was
11.25 mg for 3 months, then continued once a month for 6 months 3.75 mg.
Aromatase inhibitors are drugs that block estrogen
peroduksi. A new approach for the treatment of endometriosis has involved the
administration of drugs known as aromatase inhibitors [eg, anastrozole
(Arimidex) and letrozole (Femara)]. These drugs act by interrupting local
estrogen formation in endometriosis. They also inhibit estrogen production in
ovaries, brain, and other sources, such as adipose tissue. This study was
conducted to characterize the effectiveness of aromatase inhibitors in the
management of endometriosis. Aromatase inhibitors cause significant bone loss
with prolonged use and can not be used alone without other drugs in
premenopausal women because they stimulate the development of multiple
follicles at ovulation.
Surgery
Conservative surgery, performed if the reproductive organs
are still needed, this action is done by slicing, lifting the endometriosis
tissue itself, and keep pelvic organs in good condition.
Semi-conservative, if ovarian function is still needed.
Radical surgery, if the ovaries uterus and ovaries are
removed completely. performed in patients who experience severe pain and is
resistant to medical (drug), and no longer want to have offspring. But this
radical action also does not guarantee the patient will be relieved of pain
problems.
Surgery is usually done by laparoscopy. Endometrial implants
can be cut by laser or obliterated. If the disease is widespread and aberrant
anatomy, laparotomy (open abdominal wall through a larger incision) may be
required. While surgical treatment can be very effective in reducing pain,
recurrence rates after surgical treatment ofendometriosis has been estimated as
high as 40%. Many doctors recommend for women who have undergone surgery for
endometriosis take oral medication after surgery to help keep relieve symptoms.
Treatment of infertility associated with endometriosis
Endometriosis is more common in the fertile period. However,
their condition will usually not completely prevent pregnancy or become
infertile. Most women with endometriosis will still be able to get pregnant,
especially those with mild to moderate endometriosis. It is estimated that up
to 70% of women with mild and moderate endometriosis will conceive within three
years without special care. Reason for the decline of fertility is not
completely understood, but may be due to both anatomic and hormonal factors.
The presence of endometriosis may involve masses of tissue or scar tissue
(adhesions) within the pelvis that may distort normal anatomical structures,
such as the fallopian tubes, which carry eggs from the ovaries. Alternatively,
endometriosis may affect fertility through the production of hormones and other
substances that have a negative effect on ovulation, fertilization of eggs, and
/ or embryo implantation. Infertility associated with endometriosis are more
common in women with a very severe type of disease. Treatment options for
infertility associated with endometriosis varies, but most physicians believe
that surgical treatment is superior to hormonal or medical treatment for
endometriosis when the objective is to increase fertility. Assisted
reproductive techniques can also be used at the right moment in combination
with surgical therapy. Factors that determine recovery from the disease is
highly dependent patients. This is because there is no treatment that can
completely relieve the patient from severe endometriosis pain. Keep in mind,
initial treatment with laparoscopic surgery is needed to determine the severity
of endometriosisthat can be used as reference in therapy. The existence of the
patient's desire to be free from pain and the desire to have offspring require
consideration for physicians in selecting therapies for patients.
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