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Endometriosis : Pevalence, symptoms, treatment
By Rifaat Al-Nasser, Jordan News
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Endometriosis is a gynecological condition that affects
girls and women of reproductive age. According to the World Health Organization (WHO), endometriosis is thought to affect 10 percent of the female population
within this age demographic. اضافة اعلان
Unfortunately, data on endometriosis is extremely limited. To date, there has only been one study conducted in Jordan that assessed the national prevalence of this condition. Furthermore, the study is inherently flawed as it relied on self-reporting and was not verified by medical records.
The prevalence of endometriosis in Jordan, as reported by this study, was found to be 2.5 percent, considerably lower than the international average, which gives cause for concern that patients might go undiagnosed.
What is endometriosis?
The endometrium is the lining of the uterus which, during the course of a regular menstrual cycle, builds up and thickens. If the woman does not become pregnant, the endometrium sheds and results in regular monthly bleeding known as menstruation. In endometriosis, tissue that is similar to the endometrium grows in areas outside the uterus. Most commonly, these tissues will form on other reproductive organs (e.g., ovaries and Fallopian tubes) or in the abdominal cavity. In rare instances, these tissues may be found in areas well beyond the pelvic area. This endometrial-like tissue responds to hormonal changes as normal endometrium tissue does. Unfortunately, because these tissues are outside the uterus, when it is time to shed, the blood and tissues have nowhere to exit and become trapped in the pelvic and abdominal area.
Causes of endometriosis
The exact cause of endometriosis is unknown, but there are many theories. One of the oldest and most popular is a condition known as retrograde menstruation. Retrograde menstruation is a process in which the blood flows back through the Fallopian tubes during menstruation, instead of leaving through the vagina. These endometrial cells stick to the pelvic wall and are no longer considered true endometrium tissue, but still behave as such. Some research suggest that retrograde menstruation is responsible for 90 percent of cases of endometriosis.
The induction theory proposes that hormones transform the inner lining of the abdomen into endometrial-like cells. Some suggest that blood vessels or the lymphatic system may also transport endometrial cells to other parts of the body, which may explain the rare instances of endometriosis occurring in areas outside the pelvic region.
Finally, another theory suggests that surgeries, such as a hysterectomy or a cesarean section, may implant endometrial cells in the abdominal cavity.
Risk factors
There are several factors that put a woman at higher risk of developing endometriosis, although genes tend to be the predominating factor. Those with a first-degree relative (i.e., parents or siblings) who suffers from endometriosis are 4-7 times more likely to develop it themselves. Those who have never given birth before the age of 30 are also at higher risk.
The prevalence of endometriosis in Jordan, as reported by this study, was found to be 2.5 percent, considerably lower than the international average, which gives cause for concern that patients might go undiagnosed.
Other conditions that cause abnormalities with the menstrual cycle also place women at a higher risk of developing endometriosis. Examples include starting menstruation at an early age, going through menopause at a later age, having short menstrual cycles (less than 27 days), or heavy menstrual periods that last longer than 7 days.
Complications
The most common complication of endometriosis is infertility. On average, up to 50 percent of women with endometriosis suffer from infertility because the additional tissue obstructs the reproductive tract, making it difficult for the sperm to reach the egg. The condition may also affect fertility in more indirect ways, such as damaging the egg or sperm. As a result, medication will not improve fertility and surgical intervention may help, but there is no guarantee.
Many women with mild to moderate endometriosis can still conceive and carry to term. For those with fertility issues, treatments such as IVF (in vitro fertilization) might help. Even if infertility is not a complication experienced, managing chronic pain can come with its own set of issues. Chronic pain may take a toll on psychological health, and conditions such as depression and anxiety may present themselves.
Research into the risk of cancer for those with endometriosis is on going. The general consensus seems to be that there is no increased risk. However, some argue that there is an increased risk of developing certain cancers, such as ovarian and endometriosis-associated adenocarcinoma. These cancers are never less rare, and the risk is still ultimately low.
Screening and what to expect
There are currently no guidelines regarding regular screening for endometriosis. Generally, diagnostic investigation only begins when the patient reports symptoms that may be indicative of endometriosis. As such, it is important to be aware of the symptoms in order to know when you should see your doctor.
Screening for endometriosis is non-invasive or minimally invasive and can be performed by your gynecologist during regular check-ups. One screening method is a pelvic exam, which may help identify cysts on the reproductive organs or scar tissue that is caused by endometriosis. Doctors may also perform an ultrasound exam in order to create images of the inside of your body. These exams do not identify endometriosis itself, but helps detect and identify cysts that are associated with endometriosis, known as endometriomas. Those suspected of having endometriosis may need to undergo magnetic resonance imaging and laparoscopy. An MRI produces detailed images of organs and tissue, which can help with diagnosing and surgical planning.
In some cases, especially in more severe cases, laparoscopy may be needed. Laparoscopy is a minimally invasive surgical procedure done under anesthesia that involves a small incision near the navel and uses a camera known as a laparoscope. With this procedure, doctors are able to gather information on the location and extent of endometriosis. With proper surgical planning, the endometriosis may also be treated by the same procedure.
Read more Health
Unfortunately, data on endometriosis is extremely limited. To date, there has only been one study conducted in Jordan that assessed the national prevalence of this condition. Furthermore, the study is inherently flawed as it relied on self-reporting and was not verified by medical records.
The prevalence of endometriosis in Jordan, as reported by this study, was found to be 2.5 percent, considerably lower than the international average, which gives cause for concern that patients might go undiagnosed.
What is endometriosis?
The endometrium is the lining of the uterus which, during the course of a regular menstrual cycle, builds up and thickens. If the woman does not become pregnant, the endometrium sheds and results in regular monthly bleeding known as menstruation. In endometriosis, tissue that is similar to the endometrium grows in areas outside the uterus. Most commonly, these tissues will form on other reproductive organs (e.g., ovaries and Fallopian tubes) or in the abdominal cavity. In rare instances, these tissues may be found in areas well beyond the pelvic area. This endometrial-like tissue responds to hormonal changes as normal endometrium tissue does. Unfortunately, because these tissues are outside the uterus, when it is time to shed, the blood and tissues have nowhere to exit and become trapped in the pelvic and abdominal area.
Retrograde menstruation is a process in which the blood flows back through the Fallopian tubes during menstruation, instead of leaving through the vagina.
Causes of endometriosis
The exact cause of endometriosis is unknown, but there are many theories. One of the oldest and most popular is a condition known as retrograde menstruation. Retrograde menstruation is a process in which the blood flows back through the Fallopian tubes during menstruation, instead of leaving through the vagina. These endometrial cells stick to the pelvic wall and are no longer considered true endometrium tissue, but still behave as such. Some research suggest that retrograde menstruation is responsible for 90 percent of cases of endometriosis.
The induction theory proposes that hormones transform the inner lining of the abdomen into endometrial-like cells. Some suggest that blood vessels or the lymphatic system may also transport endometrial cells to other parts of the body, which may explain the rare instances of endometriosis occurring in areas outside the pelvic region.
Finally, another theory suggests that surgeries, such as a hysterectomy or a cesarean section, may implant endometrial cells in the abdominal cavity.
Risk factors
There are several factors that put a woman at higher risk of developing endometriosis, although genes tend to be the predominating factor. Those with a first-degree relative (i.e., parents or siblings) who suffers from endometriosis are 4-7 times more likely to develop it themselves. Those who have never given birth before the age of 30 are also at higher risk.
The prevalence of endometriosis in Jordan, as reported by this study, was found to be 2.5 percent, considerably lower than the international average, which gives cause for concern that patients might go undiagnosed.
Other conditions that cause abnormalities with the menstrual cycle also place women at a higher risk of developing endometriosis. Examples include starting menstruation at an early age, going through menopause at a later age, having short menstrual cycles (less than 27 days), or heavy menstrual periods that last longer than 7 days.
Complications
The most common complication of endometriosis is infertility. On average, up to 50 percent of women with endometriosis suffer from infertility because the additional tissue obstructs the reproductive tract, making it difficult for the sperm to reach the egg. The condition may also affect fertility in more indirect ways, such as damaging the egg or sperm. As a result, medication will not improve fertility and surgical intervention may help, but there is no guarantee.
Many women with mild to moderate endometriosis can still conceive and carry to term. For those with fertility issues, treatments such as IVF (in vitro fertilization) might help. Even if infertility is not a complication experienced, managing chronic pain can come with its own set of issues. Chronic pain may take a toll on psychological health, and conditions such as depression and anxiety may present themselves.
Research into the risk of cancer for those with endometriosis is on going. The general consensus seems to be that there is no increased risk. However, some argue that there is an increased risk of developing certain cancers, such as ovarian and endometriosis-associated adenocarcinoma. These cancers are never less rare, and the risk is still ultimately low.
Screening and what to expect
There are currently no guidelines regarding regular screening for endometriosis. Generally, diagnostic investigation only begins when the patient reports symptoms that may be indicative of endometriosis. As such, it is important to be aware of the symptoms in order to know when you should see your doctor.
Screening for endometriosis is non-invasive or minimally invasive and can be performed by your gynecologist during regular check-ups. One screening method is a pelvic exam, which may help identify cysts on the reproductive organs or scar tissue that is caused by endometriosis. Doctors may also perform an ultrasound exam in order to create images of the inside of your body. These exams do not identify endometriosis itself, but helps detect and identify cysts that are associated with endometriosis, known as endometriomas. Those suspected of having endometriosis may need to undergo magnetic resonance imaging and laparoscopy. An MRI produces detailed images of organs and tissue, which can help with diagnosing and surgical planning.
Screening for endometriosis is non-invasive or minimally invasive and can be performed by your gynecologist during regular check-ups.
In some cases, especially in more severe cases, laparoscopy may be needed. Laparoscopy is a minimally invasive surgical procedure done under anesthesia that involves a small incision near the navel and uses a camera known as a laparoscope. With this procedure, doctors are able to gather information on the location and extent of endometriosis. With proper surgical planning, the endometriosis may also be treated by the same procedure.
Read more Health
