Tuesday, 26 November 2019

[www.keralites.net] Endometriosis

 





    
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Endometriosis


Endometriosis is the development of uterine-lining tissue outside the uterus. Symptoms may include abdominal pain, heavy periods, and infertility. Treatment options include pain relievers, hormones, and surgery.


Endometriosis is usually a long-lasting (chronic) disease. When you have endometriosis, the type of tissue that lines your uterus is also growing outside your uterus. The clumps of tissue (called implants) may have grown on your ovaries or fallopian tubes, the outer wall of the uterus, the intestines, or other organs in the belly. In rare cases they spread to areas beyond the belly.

With each menstrual cycle, the implants go through the same growing, breaking down, and bleeding that the uterine lining (endometrium) goes through. This is why endometriosis pain may start as mild discomfort a few days before the menstrual period and then usually is gone by the time the period ends. But if an implant grows in a sensitive area, it can cause constant pain or pain during certain activities, such as sex, exercise, or bowel movements.

Call a doctor immediately if you develop sudden, severe pelvic pain.

Call a doctor to schedule an appointment if:

  • Your periods have changed from relatively pain-free to painful.
  • Pain interferes with your daily activities.
  • You begin to have pain during intercourse.
  • You have painful urination, blood in your urine, or an inability to control the flow of urine.


  • You have blood in your stool, you develop pain, or you have a significant, unexplained change in your bowel movements

  • You are not able to become pregnant after trying for 12 months.

Watchful waiting

If you have mild pain during your period but have no other symptoms or concerns, you can wait through several menstrual cycles. Then at your next routine visit with your doctor, you can discuss your pain. Home treatment may be all that you need to relieve mild pain.

Who to see

Health professionals who can evaluate endometriosis and help you manage the pain include:

If your case is complicated or your main problem is infertility, you may be referred to:

For diagnosis with laparoscopy or for surgical treatment, you may be referred to a gynecologist.

Endometriosis - Exams and Tests

To see whether your symptoms are caused by endometriosis, your doctor first will:

  • Talk to you about your family and medical history, symptoms, and menstrual periods.
  • Do a pelvic exam. This often includes checking both the vagina and rectum.

If your exam, symptoms, and risk factors strongly suggest that you haveendometriosis, your doctor may suggest that you first try anonsteroidal anti-inflammatory drug (NSAID) and/or hormone therapy before you have other tests. If treatment improves your symptoms after a few months, the diagnosis of endometriosis is more certain.

Laparoscopy

Laparoscopy is a surgical procedure used to diagnose and treat endometriosis. If your doctor recommends a laparoscopy, it will be used to look for and possibly remove implants and scar tissue. But laparoscopy is not always needed. It is usually done when infertilityrequires rapid treatment and probable surgery or when treatment has not relieved pain or infertility.







Tests for ovarian cysts or other problems

If your doctor feels an abnormal mass during the pelvic exam, you may have a cyst on the ovary (ovarian endometrioma) or another problem. You may need a transvaginal ultrasound, a CT scan, or an MRI.














Endometriosis - Treatment Overview

There is no cure for endometriosis, but treatment can help with pain and infertility. Treatment depends on how severe your symptoms are and whether you want to get pregnant. If you have pain only, hormone therapy to lower your body's estrogen levels will shrink the implants and may reduce pain. If you want to become pregnant, having surgery,infertility treatment, or both may help.




Not all women with endometriosis have pain. And endometriosis doesn't always get worse over time. During pregnancy, it usually improves, as it does after menopause. If you have mild pain, have no plans for a future pregnancy, or are near menopause (around age 50), you may not feel a need for treatment. The decision is up to you.




Medicines

If you have pain or bleeding but aren't planning to get pregnant soon,birth control hormones (patch, pills, or ring) or anti-inflammatories (NSAIDs) may be all that you need to control pain. Birth controlhormones are likely to keep endometriosis from getting worse.4 If you have severe symptoms or if birth control hormones and NSAIDs don't work, you might try a stronger hormone therapy.

Besides medicine, you can try other things at home to help with the pain. For example, you can apply heat to your belly, or you can exerciseregularly.

Surgery

If hormone therapy doesn't work or if growths are affecting other organs, surgery is the next step. It removes endometrial growths and scar tissue. This can usually be done through one or more small incisions, using laparoscopy.

Laparoscopy can improve pain and your chance for pregnancy.

In severe cases, removing the uterus and ovaries (hysterectomy and oophorectomy) is an option. This surgery causes early menopause. It is only used when you have no pregnancy plans and have had little relief from other treatments.




Infertility treatment

If you are having trouble becoming pregnant even after surgery, you can consider trying fertility drugs with insemination or in vitro fertilization. To learn more, see the topic Fertility Problems.




Endometriosis - Medications

Medicines can be used to reduce pain and bleeding and, in some cases, to shrink endometriosis growths. For women who are not trying to get pregnant, birth control hormones and anti-inflammatories (NSAIDs)are usually recommended first. They are least likely to cause serious side effects and can be a long-term treatment option.1 But if infertilityfrom endometriosis is your main problem, medicines are generally not used.







Anti-inflammatories (NSAIDs)

Be safe with medicines. Read and follow all instructions on the label.

Hormone therapy

All hormone therapies for endometriosis can cause side effects and pose certain health risks. Some cause especially unpleasant side effects. Before starting a medicine or hormone therapy, review its possible side effects. If they sound less difficult than yourendometriosis symptoms, discuss the therapy with your doctor.

Endometriosis - Surgery

Although surgery doesn't cure endometriosis, it does offer short-term results for most women and long-term relief for a few.

Surgery may be recommended when:

  • Treatment with hormone therapy has not controlled symptoms, and symptoms interfere with daily living.
  • Endometrial implants or scar tissue (adhesions) interferes with the functions of other organs in the belly.
  • Endometriosis causes infertility.

Surgery choices


Endometriosis - Home Treatment

Home treatment may ease the pain of endometriosis. You can try the following things along with your other treatments.

Endometriosis - Other Treatment

To help the stress and pain of endometriosis, you can consider other treatments. Researchers have not yet looked at these therapies forendometriosis. But these treatments have proven benefits for treating other conditions:
















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