REPROSAIT 4 U

The tissue that lines the interior of the uterus is called the endometrium.

Endometriosis is the growth of endometrial tissue (from the lining of the uterus) in places outside of the uterus, such as the ovaries, fallopian tubes and bowel.

Endometriosis can cause numerous symptoms, including painful periods and pain with sex, fertility problems, pelvic and ovulation pain, pain in the lower back and thighs, and bowel and bladder symptoms.
Treatment options include :

1. SURGERY
2. HORMONE TRATMENT and
3. COMPLEMENTARY THERAPIES
   

Diagnosis can be difficult

Diagnosing endometriosis can be difficult, especially in the early stages of disease. The only way to diagnose the disease is to look inside the pelvic cavity, using a special instrument called a laparoscope. Diagnosis may be delayed if the woman assumes her degree of pain is normal and so doesn’t see her doctor. A diagnosis may also be delayed if the doctor is not familiar with the range of symptoms associated with endometriosis. If you have bad period pain, you should see your doctor.

Treatment options

The treatment options for endometriosis include:

1. Observation with no medical intervention
2. Hormone treatment
3. Surgery
4. Combined treatment
5. Complementary therapies.

Observation with no medical intervention

In mild cases of endometriosis, it may be possible to simply monitor the condition with regular visits to your doctor or gynaecologist. Antiprostaglandin medications (non-steroidal anti-inflammatory drugs such as ibuprofen and mefenamic acid) can help to control any associated pain.
If symptoms progress, talk over the medical options with your health care provider before making a final decision. Remember that a mild condition can become moderate to severe. Removal of adhesions through surgery is the most effective treatment to lessen the chances of recurrence.

Hormone treatment

Each month, a woman’s uterine lining is prompted by the hormone oestrogen to thicken in preparation for possible pregnancy. During menstruation, the hormone progesterone causes the plump uterine lining to shed. The misplaced endometrial cells in other areas of the body also respond to oestrogen and progesterone. Hormone therapy can sometimes be an effective way to manage the symptoms of endometriosis.
Options for hormone therapy include:

• GESTRINONE – is a synthetic hormone that causes the endometriosis to become inactive and waste away. Side effects of gestrinone include weight gain, acne, depression, mood swings, hot flushes and loss of libido (sex drive).
• DYDROGESTERONE– a synthesised version of the hormone progesterone, which helps to dry up the stray endometrial cells. Ovulation may still occur. Side effects of dydrogesterone can include depression, tender breasts, weight gain, fatigue, nausea, headaches and dizziness.
• MEDROXYPROGESTERON ACETATE– another synthesised version of the hormone progesterone. Most women taking medroxyprogesterone acetate will stop ovulating and menstruating. Other side effects include weight gain, bloating, irregular vaginal bleeding, depression, sweating, headaches, acne, nausea, fatigue and tender breasts.
• GnRH AGONIST– gonadotrophin-releasing hormones help to govern the menstrual cycle. GnRH agonists are drugs that stop the ovaries from producing as much oestrogen by reducing the hormones produced by the pituitary gland (follicle stimulating hormone and luteinising hormone). Without oestrogen, the misplaced endometrial cells are unable to grow. Side effects of GnRH agonists include menopausal symptoms such as thinning of the bones, hot flushes, dry vagina, headaches, depression, loss of libido and night sweats. These symptoms can be relieved, while still maintaining the benefit of the treatment, by adding back oestrogen and progesterone.
• The oral CONTRACEPTIVE PILL– the pill is frequently used to achieve long-term suppression of endometriosis. It can be used to stop the disease progressing in women with mild disease or to stop the disease from recurring following surgical or hormonal treatment.
• DANAZOLE– this mild form of the male hormone testosterone reduces the amount of oestrogen produced by the ovaries to around the same level as occurs during menopause. Without oestrogen, the stray endometrial cells can’t grow and, therefore, shrink and disappear during the treatment. Danazol is now rarely used to treat endometriosis due to its serious side effects, which can include weight gain, bloating, fluid retention, acne, smaller breasts, increase in muscle mass, increased facial and body hair, muscle cramps, mood swings, voice deepening and clitoral enlargement. Danazol can also cause gastrointestinal upsets, depression and liver disease.
These treatments can have side effects, so make sure you are well informed about them before you and your doctor decide on your treatment.

Surgery

The different types of surgery include:

• LAPAROSCOPIC SURGERY– a slender tube is inserted into the abdominal cavity via a small incision (also known as ‘keyhole’ surgery). Endometrial implants, cysts and adhesions are then removed by cutting out (excision), burning (cauterisation) or vapourising (ablation) them. Cutting out is the most effective of these methods. You should seek an expert in advanced laparoscopic surgery to conduct your procedure. Some doctors can perform surgery, including the removal of the ovaries or removal of endometriosis from the bowel, laparoscopically.
• LAPAROTOMY (open surgery) – a surgical incision into the abdominal cavity to cut out or burn tissue or remove cysts (with the advent of laparoscopic surgery, this procedure is now rarely necessary).
• BOWEL RESECTION – may be necessary if the bowel has developed endometriosis adhesions.
• HYSTERECTOMY – the uterus is removed, along with endometrial implants, cysts and adhesions. In some cases, the fallopian tubes and ovaries will also be removed. Unfortunately, hysterectomy does not always cure endometriosis.

Combined treatment

In some cases, a woman will benefit from undergoing hormone therapy as well as surgery. Hormone therapy may be offered before or after the surgery, depending on the circumstances.

Complementary therapies

Some women find complementary therapies to be helpful. Always tell your doctor about the kinds of complementary therapies you are using or considering. Options include:

1. Acupuncture
2. Chinese medicine
3. Herbal therapy
4. Homeopathy.

Pregnancy is not a cure

Some people believe that endometriosis can be cured by pregnancy. This isn’t the case. The symptoms may improve for some women, but worsen in others. For those women who experience an end to all symptoms during pregnancy, the relief may only be short lived. Unfortunately, for some women, the endometriosis will recur.

The tissue that lines the inside of the uterus is called the endometrium. Endometriosis is the growth of endometrial tissue in places outside the uterus, such as the ovaries, uterus, bowel and lining of the pelvic cavity.

The causes of endometriosis remain unknown, but researchers have uncovered a number of possible causes and risk factors.

Endometriosis can cause numerous symptoms, including :

1. Painful periods (DYSMENORRHOEA)
2. Pain with sex (DYSPAREUNIA) ,
3. Fertility problems,
4. Pelvic and ovulation pain,
5. Pain in the lower back and thighs, and
6. Bowel and bladder symptoms.
   

Usually, endometriosis causes pain around the time of the period, but some women experience almost constant pain. If you have bad period pain, you should see your doctor.

Stray endometrial cells respond to hormones

The endometrium responds to the sex hormones oestrogen and progesterone. In women with endometriosis, the stray endometrial cells in the pelvic cavity also respond to these hormones.
During ovulation, oestrogen prompts the uterine lining – and the misplaced endometrial cells – to thicken. However, the misplaced endometrial cells cannot leave the body via menstruation; they simply bleed a little, causing inflammation and pain, and then heal. Over time, this may create scar tissue. Affected organs, such as the ovaries and bowel, may stick together. This can cause chronic pain and bowel symptoms. Sometimes, it can cause fertility problems if the scar tissue (adhesions) stops the released egg from getting to the fallopian tube.

Genetic susceptibility

Studies indicate that some women are genetically predisposed to developing endometriosis. According to researchers from the University of Queensland, endometriosis runs in families, which means the genetic susceptibility is inherited.
Australian researchers have found that women who have a sister with the disease are 2.3 times more likely to have the disease than women in the general community. The increased likelihood of developing the disease is not just confined to the daughters and sisters of women with the disease but also affects their cousins.
Possible causes
Some of the theories on what causes endometriosis include:

1. Retrograde menstruation
2. Immune system malfunction
3. Genetic factors.

Retrograde menstruation

Retrograde menstruation is also known as ‘backward menstruation’. The lining of the uterus is shed during the period. In almost all women, some of the menstrual fluid flows backwards into the fallopian tubes instead of leaving the body through the vagina.
Since the fallopian tubes are open-ended (they are not joined to the ovaries, but open nearby), menstrual fluid can drip into the pelvic cavity. It is suspected that, in women who experience endometriosis, the endometrial tissue contained in the menstrual fluid sticks to whatever structures it lands on (such as the ovaries) and starts to grow.

Immune system malfunction

Retrograde menstruation occurs in almost all women, but only 3–10 per cent of menstruating women develop endometriosis. One theory suggests that the immune systems of some women allow endometriosis to develop by failing to control or stop the growth of endometrial tissue outside the uterus.

The genetic factor

It seems that genetic susceptibility plays a significant role in the development of endometriosis – but how? Some researchers suspect that some families carry faulty genes that allow abnormal cells to survive and grow in the pelvic cavity.

Risk factors

Apart from genetic susceptibility, some of the suspected risk factors include:

• MENSTRUAL CYCLE FACTORS– some evidence suggests that women with endometriosis are more likely to have started their periods at an early age. Other factors related to the menstrual cycle that may predispose a woman to endometriosis include heavy or painful periods, short menstrual cycles (less than 27 days) and long periods (more than one week).
• ALLERGIES – such as food, eczema and hay fever.
• OBESITY
• EXPOSURE TO TOXINS – persistent environmental pollutants, such as dioxins, are suspected of contributing to the development of endometriosis. Animal experiments have indicated such an effect, but at levels of exposure higher than those currently seen in humans.

Reducing your endometriosis risk

Factors that may help reduce your risk of endometriosis include:

• AEROBIC EXCERCISE of five hours per week – studies show a 50 per cent reduction in the risk of recurrence
• CHILDBEARING – reduces the risk of recurrence by about 50 per cent.
• The CONTRACEPTIVE PILL – this prevents ovulation, during which there is a surge of oestrogen production and spill into the pelvis.

Endometriosis is a condition in which endometrium, the tissue that normally lines the womb (uterus), grows in locations outside the uterus.

Endometriosis may cause adhesions (fibrous scar tissue) on the uterus.

The uterus can become stuck to the ovaries, fallopian tubes and bowel.
The pain of endometriosis can be so bad that it stops you from going to work or school. Usually, it causes pain around the time of your period but for some women the pain is almost constant. If you need treatment, you may need emotional as well as physical support.

Symptoms

The symptoms of endometriosis include:

• Painful periods
• Pain with sex
• Pelvic pain
• Ovulation pain
• Pain in the lower back and thighs
• Bowel symptoms
• Bladder symptoms
• Reduced fertility
• Nausea and lethargy
• Pre-menstrual tension (PMT).

Many women think that painful periods are normal. If you have bad period pain, you should see your doctor.

Diagnosis

Tests that are used to help diagnose endometriosis include:

• LAPAROSCOPY– surgical procedure performed under general anaesthetic, where a medical instrument with a video camera attached is used to examine your pelvic organs.
• ULTRASOUND – a vaginal or abdominal instrument that uses sound waves to create a video image of your pelvic organs.
• COLONOSCOPY– a medical instrument with a video camera attached that is used to examine your bowel. This is done if it is thought that the endometriosis could also be affecting your bowel. You would be sedated for the procedure.

Endometriosis may not show up during an internal pelvic examination. Your doctor may need to refer you to a gynaecologist if you have endometriosis.

Treatment

Endometriosis can be treated medically (with drugs or medicine) or with surgery. Sometimes both medicine and surgery are used. Some women also benefit from natural therapies.
Drug therapy
Medications that are used to help treat endometriosis include:

• Anti-inflammatory medications
• Pain killers (Mersyndol is often used)
• Hormonal treatments, which suppress ovulation and menstruation and may have side effects. There are different categories of these such as GnRH agonists (Zoladex, Synarel), androgenic steroids (Danocrine, Azol, Dimetriose), progestogens (Provera, Duphaston, Primolut) and the oral contraceptive pill.

Surgery

Surgical methods used to treat endometriosis include:

• LAPAROSCOPIC SURGERY– performed to diagnose and treat endometriosis. Laser surgery may be used to remove the adhesions. This is done to reduce pain and improve the chances of you becoming pregnant.
• LAPAROTOMY – to cut out or burn tissue or remove cysts.
• BOWEL RESECTION – may be necessary if the bowel has developed endometriosis adhesions.
• HYSTERECTOMY(removal of the uterus) – may be an option if endometriosis is significantly impacting on your quality of life and other treatments have not worked.

If your ovaries are removed during a hysterectomy, you will need to discuss hormone replacement with your doctor.

Complementary therapies

There are many different forms of complementary therapies that can be used to treat endometriosis. Most therapies may be used in conjunction with Western medicine or instead of surgery and drug therapy.

Examples of different therapies include:

• Herbal medicine
• Homeopathy
• Traditional Chinese medicine
• Nutritional therapies
• Massage
• Yoga.

Adenomyosis

Known as "Endometriosis of the uterus," Adenomyosis is benign and does not cause cancer. Most commonly, the disease affects the back wall (posterior side) of the uterus. The endometrial cells penetrate deep into the uterine muscle (myometrium). When this occurs, the uterus is enlarged usually more than twice the normal size and very hard. The disease may be localized with well-defined borders or diffuse, meaning having no limits or borders. When this localized disease is found it is called adenomyoma. These adenomyomas can be located at different depths of the uterine muscle and can penetrate into the uterine cavity, becoming submucosal tumors

How common is Adenomyosis?

This disease can only be diagnosed with 100% certainty by doing a biopsy of the uterine muscle. Depending on the various reported studies published, it has been noted to occur in 8-62% of women who have had hysterectomies. 12% of women with Adenomyosis have also had Endometriosis in other sites such as the pelvic wall, ovaries, fallopian tubes etc. The highest incidence is seen in women in their mid to upper forties, and though this disease may cause infertility, it often appears in women who have already had children.

What are the symptoms of Adenomyosis?

As with Endometriosis, patients with Adenomyosis may not show any symptoms (asymptommatic). However, women most commonly experience excessive, heavy or prolonged menstrual bleeding and painful periods (dysmenorrhea). The amount of bleeding and cramps is usually associated with the degree of disease involvement and depth of penetration into the uterine walls. Extensive involvement of the uterine muscle can also interfere with the normal contractility of the muscle which then leads to excessive bleeding.

How is Adenomyosis diagnosed?

An exact diagnosis is often difficult to establish pre-operatively because abnormal patterns of bleeding (dysfunctional bleeding) and fibroid tumors can result in similar symptom patterns. Sometimes during a D&C procedure to remove intra-uterine polyps or small fibroid tumors, tissue is removed enabling a pathologist to make the diagnosis.

Pelvic Exam Findings

Pelvic exam findings can reveal a normal, or only slightly enlarged uterus to a very firm tender uterus enlarged to twice the normal size.

MRI- Magnetic Resonance Imaging

At times, this can distinguish adenomyomas from fibroid tumors, but again, experienced physicians and radiologists possessing extensive training are required.

MRI provides better diagnostic capability due to the increased spatial and contrast resolution, and to not being limited by the presence of bowel gas or calcified uterine fibroids (as is ultrasound). In particular, MR is better able to differentiate adenomyosis from multiple small uterine fibroids. The uterus will have a thickened junctional zone with diminished signal on both T1 and T2 weighted sequences due to susceptibility effects of iron deposition due to chronic microhemorrhage. A thickness of the junctional zone greater than 10 to 12 mm (depending on who you read) is diagnostic of adenomyosis (<8 mm is normal). Interspersed within the thickened, hypointense signal of the junctional zone, one will often see foci of hyperintensity (brightness) on the T2 weighted scans representing small cystically dilatated glands or more acute sites of microhemorrhage.

MR can be used to classify adenomyosis based on the depth of penetration of the ectopic endometrium into the myometrium.

Transvaginal Ultrasound

Extensive recent work has been completed with this test, but the amount of false positive results is still high.

Tissue Diagnosis

Tissue diagnosis in some form remains the only definitive method for diagnosing Adenomyosis. If the diagnosis is suspected pre-operatively, then a laparoscopy and a long needle biopsy can be performed, whereby a needle is inserted into the back of the uterus to collect a tissue sample for pathological testing. It may also be diagnosed when fibroid tumors are removed .

Can Adenomyosis be treated without surgery?

Some studies have shown that there is a relationship between Adenomyosis and hormone imbalance, most commonly an excess of estrogen. Progesterone therapy, either in the natural or synthetic form has been known to help, but shows very little long term benefits. A medication called Danazol may be helpful in treating the pain and decreasing the size of the uterus but long term positive results are poor. Although gonadotropin-releasing hormone agonists such as Lupron have been found to reduce uterine symptoms of adenomyosis during treatment, the symptoms return quickly after the medicine wears off.

How can Female Alternative Surgery help Adenomyosis?

Most commonly, hysterectomy has been the mainstay of treatment. Traditional medicine states that since most women with Adenomyosis are beyond child-bearing age, the uterus is no longer relevant. At the Institute, we want to give women every opportunity to retain their female organs even if fertility is not a concern. Our surgical approach is first to make a diagnosis. For women who still wish to conceive, we try to remove the Adenomyosis using laser technology (CO2 Yag and Argon) which preserves the endometrial cavity but treats the remaining deep uterine muscle disease. In the case of women who are not concerned with fertility but want to preserve their organs, our approach is to remove as much of the affected tissue and, if necessary, decrease the size of the endometrial cavity. We treat the remaining uterine muscle with a deep tissue laser technique. Post surgical results have shown that pain almost always disappears and menstrual flow and volume decrease.