ENDOMETRIOSIS AND INFERTILITY (part 1)

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In the last edition, we considered Lifestyle and its impact on our fertility. This week we would be looking at the medical condition called “Endometriosis”

For the girl child puberty sets in from 10-14 years and is characterized by the monthly menstrual cycle. For some women the menstrual cycle seems to be a night mare because it is marked by excruciating pain. Some female who experience this pain have a positive family history, which means that their mother may have experienced similar pain at some point of her reproductive years. While most times the cause of this pain may go undetected, infertility may be the reason for further investigation in the future where endometriosis, a major cause of excruciating pain around one’s menstruation period is now diagnosed.

What is Endometriosis?

It is a condition in which the endometrium (the layer of tissue that normally covers the inside of the womb) grows outside of it. The reproductive organs most affected are the ovaries, fallopian tubes and tissues around the uterus and ovaries, however in rear cases it might also occur in other part of the body.

Incidence of Endometriosis

Globally it was estimated in 2015 that endometriosis affects about 10.8 million women. Another source also states that about 6-10% of women are affected.  Endometriosis is most common with women in their thirties and forties; however it can begin in girls as early as 8years. Exact numbers of women suffering from Endometriosis in Nigeria have not been compiled.

Degree of Endometriosis

Endometriosis may be mild, moderate or severe. Women with Mild to Moderate Endometriosis, have more difficulty in getting pregnant than those without. There are inflamed regions that vary in color from red to blue to black, due to the monthly accumulation of blood from the excess womb tissue. In Severe Endometriosis, fibrous adhesions on various inner portions of the abdomen are seen and depending on the severity the condition can be visualized using ultrasound and better diagnosis are made by carrying out a laparoscopy (a procedure where a thin camera called a laparoscope is inserted into the abdomen through a small incision near the navel).  These inflamed regions and adhesions can block the fallopian tube or the ends of the tube thereby blocking the exit of the egg ready for fertilization by a single sperm and this may cause infertility.  Along with the physical pains associated with endometriosis, there is also social and psychological turmoil which increases the social isolation and depression faced.

What organs can be affected by Endometriosis?

Endometriosis occurs usually at internal organs surrounding the womb such as the ovaries, fallopian tube but can be seen at the bladder, vagina, and old surgical scars in the abdominal region. The endometrial implants vary in color from clear to red, brown to black due to the monthly accumulation of menstrual blood.  The implants can bleed during menstruation, increasing the pains felt. Pain is more intense around the menstruation and during the early days of the flow. Endometriosis can be mistaken for appendicitis in its acute intensity, midline stomach pain, or even pains during urination or stooling.

 

What are the signs and symptoms of Endometriosis?

  • Dysmenorrhea, Pains in the lower abdomen (stomach), the pelvis, midline stomach pains, one week before to two weeks after the period.
  • Pains during urination or during stooling.
  • Dyspareunia (Pains during intercourse)
  • Menstrual alterations.
  • Stomach bloating,
  • Rectal bleeding.

 

 

What are the causes / Risk factor for Endometriosis?

 

The cause of endometriosis is poorly understood, but it is believed that there is an outward movement of the cells/tissues lining the inside of the womb to other part of the body. One of the theories that try to explain endometriosis is the retrograde menstruation which simply says that endometriosis may occur due to backflow of menses through the fallopian tube to other part of the abdomen. Endometrial tissues may also migrate during Caesarean Section to other parts like the cervix, vagina, and ovary.

Risk factors include having a family history of the condition, in which case it may be genetic. Genetics can play a key role as daughters and sisters of Endometriosis sufferers are at a 6 fold risk of developing endometriosis too.

Other factors include:

  • Most women who have not yet had children (nulliparous)
  • Prolonged exposure to estrogen e.g. late commencement of menopause
  •  Early start of menstruation (menarche)
  • Obstruction of menstrual outflow examples are women with Mullerian anomalies

The areas affected by endometriosis, bleed each month and eventually results in inflammation and scarring. The growth due to endometriosis is not cancerous. Pain that is felt is believed to be caused locally by increased prostaglandins due to the extra tissue of the womb.  The ovary may become extremely tender becoming cystic and even rupture with dramatic and urgent emergency surgical needs.  Laparoscopic investigation can reveal the extent of the disorder.