What is endometriosis?

Endometriosis is an abnormal growth of the endometrium outside of the uterus, especially in the pelvic floor and ovaries. The main symptoms of endometriosis are long-term pain and infertility. Backward menstruation is the most common cause, but no one knows why it happens or how it will go away on its own.
In the United States, 6–10% of people have it, and it’s four to five times more common in women who can’t have children. Endometriosis makes you more likely to get coronary heart disease. ¶

Sites of Endometriosis

Common Pelvic sites

• Ovary and ovarian fossa
• Pelvis ligaments
• Uterus
• Fallopian tubes
• Sigmoid colon
• Appendix

Extra-pelvic sites

• Abdominal wall
• Umbilicus
• breast
• gallbladder
• spleen

What are the symptoms of endometriosis?

Common symptoms of endometriosis include:

• Severe pain during menstruation
• Heavy bleeding (having to change a pad or tampon every one to two hours)
• Bloating
• Diarrhea
• Constipation
• Bladder issues
• Pain associated with sexual intercourse
• Infertility.

Pain can also happen at other times of the month or when ovulation is happening.
Endometriosis is hard to figure out exactly how common it is because many women don’t know they have it. Often, it takes a few years between the first signs of disease and the time it is diagnosed (average time of eight or more years). Endometriosis tends to run in families, and most women will have a female relative who has it, though they might not know it because some women don’t talk about problems with their periods.

How to diagnose endometriosis?

Main diagnostic points

These are the top 4 main symptoms for the diagnosis of endometriosis

• Painful menstruation (Dysmenorrhea)
• Painful intercourse (Dyspareunia)
• High-frequency infertility in women
• Abnormal uterine bleeding

If you suspect you may have endometriosis make an appointment with a doctor with sound clinical knowledge of the condition.
Your doctor will perform a physical examination and ask about your symptoms and your menstrual cycle.
Before making a diagnosis of endometriosis it is important to rule out other conditions such as:

• Adenomyosis
• Fibroids (leiomyomas)
• Interstitial cystitis
• Irritable bowel syndrome
• Ovarian cysts
• Pelvic inflammatory disease.

Endometriosis is different from polycystic ovarian disease (PID), ovarian tumors, and uterine myomas. When endometrial tissue gets into the bowel, it can cause blood in the stool, which needs to be distinguished from bowel neoplasm.
Imaging isn’t very helpful and is only useful when a pelvic or adnexal mass is present.
Transvaginal ultrasonography is the best way to look for deeply penetrating endometriosis of the rectum or rectovaginal septum. MRI should only be used to look for rectovaginal or bladder endometriosis when there is some doubt. Endometriosis can only be diagnosed for sure by looking at the histology of lesions taken out during surgery.

Treatment for endometriosis 

Medical treatment

Endometriosis pain can be relieved by medical treatment, which includes a variety of hormonal therapies. But there is no proof that any of these things make it more likely that a woman will get pregnant. Most of these plans are meant to stop ovulation over the course of 4–9 months and lower hormone levels. This stops the cyclical stimulation of endometriotic implants and causes them to shrink.

•  low-dose oral contraceptives
• Oral progestin
  • oral norethindrone acetate and subcutaneous DMPA
• Intrauterine Progestin
  • levonorgestrel intrauterine system
• GnRH agonists
  •   long-acting injectable leuprolide acetate,
•  Danazol is an androgenic medication that has been
  used for the treatment of endometriosis-associated
  pain.
•  Aromatase inhibitors
  • anastrozole or letrozole
• NSAIDs like ibuprofen or naproxen for pain, which can be used with contraceptives for more moderate pain

Surgical Treatment

It works well for both easing pain and making people more likely to get pregnant. Laparoscopic removal of endometrial implants reduces pain by a lot. Ablation of implants and, if needed, removal of ovarian endometriomas can improve fertility, but the chances of getting pregnant after that are inversely related to how bad the disease is.
Total abdominal hysterectomy and bilateral salpingo-ophorectomy are the only ways to treat women with severe pain who don’t want to have children.