By Dr. Mapet Gudiel, Ob Gynecologist at Klinika Maharlika in Abu Dhabi
Endometriosis is a condition wherein endometrial tissues which are normally found in the endometrium, the inner lining of the uterus, are found outside the endometrium. It could be adenomyosis, there is thickening of a myometrial surface due to invasion of the endometrial tissues into the myometrium, or endometrial cyst or commonly known as “chocolate cyst”, the enlargement of the ovary due to accumulation of blood coming from ectopic endometrial tissues.
Symptoms
Endometriosis has its characteristic triad of symptoms, meaning if a patient has these 3 symptoms, the number one gynecologic problem that comes to mind is endometriosis.
Dysmenorrhea: It could be mild or several, but the unique characteristic is – if normally you suffer already from dysmenorrhea, it deviates from the usual, like if before if you have mild dysmenorrhea and suddenly it becomes severe or if it is usually experienced during menstruation but now it is felt even before menstruation and persists afterwards.
Dyspareunia: Painful sexual contact which is usually attributed to the unterus being fixed due to the thickening of a myometrial surface or presence of an endometrial cyst.
Infertility: This could be a primary symptom if the patient has never been pregnant. It might also be a symptom if the patient had a child or a few kids but is now having difficulty conceiving a child.
You can contact Klinika Maharlika Abu Dhabi branch at 02 631 0209 and our clinic is located in Al Saif Tower, 3rd floor, Electra Street (back of Al Raha Hospital) in Abu Dhabi.
Causes
To date, there’s no known particular cause for Endometriosis, However, most studies point to the estrogen hormone as the culprit. Gynecologists usually use the “menstrual reflux theory” to explain the pathogenesis of endometriosis.
Menstruation is defined as the shedding/sloughing off of the endometrial lining. A woman’s estrogen hormone is responsible for stimulating the endometrium to thicken. So if there is hormonal imbalance wherein the estrogen is more predominant than the progesterone, the endometrial lining becomes thicker and thus menstruation is heavier.
Normally, during menstruation, all menstrual blood is expelled through the vagina. But for some women predisposed to endometriosis, there are menstrual blood that will reflux and thus leading to invasion of the endometrial tissues to the myometrium, to the fallopian tubes, ovaries, and for some, to the intestines.
Now, when these endometrial tissues are implanted on these areas, each time a patient experiences menstruation, these endometrial tissues will bleed – thus giving rise to more health complications such as adenomyosis, endometrial cysts, and so forth.
Risk factors
There are several risk factors predisposing to endometriosis.
Genetics: If you have a family member who has it, you’re seven to ten times predisposed.
Hormonal Imbalance: Any conditions that promote heavier menstruation like hormonal imbalance particularly in cases where estrogen is excessive – because the more estrogen you have, the thicker the endometrium gets which results to heavier menstruation – thus leading to more chances of menstrual reflux and in patients with uterine myoma.
Immune factors: In some literatures, immune factors have a role and it is also cited that patients who underwent pelvic surgeries like cesarean section wherein endometrial tissues are misplaced during the operation and implanted ectopically.
Diagnosis
The diagnosis of endometriosis is usually made when you already have the clinical suspicion based on the characteristic triad of symptions: dysmenorrhea, dyspareunia and infertility, and you can confirm your diagnosis with a pelvic ultrasound preferably with a transvaginal scan.
In the Philippines, a transvaginal scan especially if done by an OB-GYN sonologist is enough. Here in the UAE, MRI facilities are available.
In some cases, when laparoscopy is done for other purposes, endometriosis can be an incidental finding.
Early detection will save you
If you suspect that you are suffering from endometriosis, you should see to consult with an OB-GYN specialist since this disease is a progressive one – meaning if you are left untreated, it could become worse because as long as you are menstruating, there is menstrual reflux which could lead to more chances for ectopic endometrial tissue implantation. This could ruin your chances of having children.
Likewise, the management of endometriosis is either medical or surgical depending on the severity of the case – so if it is still not that severe, it could be managed medically and you can still lead a normal life because suffering from pain or dysmenorrhea is not an experience to be suffered from by any woman. I used to have a patient who had a severe form of dysmenorrhea that even if she was given Nubain IV, the patient remained in pain.
You can contact Klinika Maharlika Abu Dhabi branch at 02 631 0209 and our clinic is located in Al Saif Tower, 3rd floor, Electra Street (back of Al Raha Hospital) in Abu Dhabi.
