Endometriosis is an extremely common illness, defined as the existence of cells from the lining of the uterus at other sites in the pelvis.

The main route of spread for these “seedlings” is via the fallopian tubes. Deposits find their way to the ovaries, bowel, bladder and the pelvis, forming quite little cysts and scarring that is localized. The seedlings react to the cyclical changes of ovarian hormones, when you’re menstruating so bleeding occurs into the cysts, but the blood cannot avoid. The cysts become distended and sore, and in the ovary may enlarge to 5-6cm (2-3in) in diameter, causing menstrual pain, painful sexual intercourse and generalized pelvic tenderness. Adhesions may form around the cysts, interfering with conception, ovulation and, perhaps.

What Are The Symptoms?

■ Significant or unusual bleeding.
■ Acute stomach and pelvic pain, frequently resulting in painful sex.
■ Acute cramping pain, beginning before the period is due and continuing during menstruation, after which it slowly relieves.
■ Urinary or bowel pain, including diarrhoea.
■ Fertility issues.
If you’re in your late 20s and have not been able to conceive, or if you endure quite debilitating periods or pain deep in your pelvis during sex, you should see your physician when possible. If you’ve never endured from dysmenorrhoea (painful periods) before, it is extremely unlikely to develop in your late 20s without there being a leading reason.

What Might The Doctor Do?

The drugs used to treat endometriosis suppress menstruation and ovulation, thereby allowing the Disorder to regress. The drugs contain the constant use of high-dose oestrogens and/or progestogens or drugs, called GnRH analogues, to curb ovarian-stimulating hormones.

All these treatments are contraceptive. Clinical treatment of endometriosis is typically only offered to girls who aren’t attempting to conceive; it hasn’t been demonstrated to enhance fertility rates. For women wanting to conceive, operative treatment, generally laparoscopic, contains diathermy or laser vaporization of the endometriosis deposits (see box, right) and adhesiolysis (removal of adhesions).

Revolutionary operation with removal of the uterus and ovaries (hysterectomy) may be required in elderly patients with advanced disease who don’t want to have more kids.
NB In vitro fertilization (IVF) should be offered promptly to girls attempting to conceive who’ve dense, extensive adhesions which aren’t amenable to, or recur after, operation.

Self Help

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