Endometriosis is a disease that affects women and their reproductive system. It occurs when the tissue that normally lines inside the uterus, the endometrium, grows outside the uterus. The damaged tissue is usually known as endometriosis patches, implants, nodules, or lesions, and it is found in the pelvic cavity, including on or under the ovaries, on the fallopian tubes, which carry egg cells from the ovaries to the uterus, behind the uterus, on the tissues that hold the uterus in place, on the bowels or bladder, and in rare cases, on the lungs or in other parts of the body.
The main symptoms of endometriosis are pain, which indicate the disease in 75% of the women, and infertility. While other common symptoms include painful, even debilitating, menstrual cramps, which may get worse over time, pain during or after sex, pain in the intestine or lower abdomen, painful bowel movements or painful urination during menstrual periods, heavy menstrual periods, premenstrual spotting or bleeding between periods, painful bladder syndrome, digestive or gastrointestinal symptoms similar to a bowel disorder, as well as fatigue, tiredness, or lack of energy.
Pain as the Main Symptom of Endometriosis
Pain is the main symptom of endometriosis, but reasons, extent, severity, or location is different among the different patients. While the amount of lesions is not the only indicator of pain, researchers have established the existence of numerous factors that contribute to it. These include the hormonal similarity between endometriosis tissue and uterus tissue, inflammation, and chemicals produced by the endometriosis areas that can cause adherence of the pelvic organs and creation of scar tissue, or hormones and chemicals that are released by endometriosis tissue and irritate nearby tissue.
In addition, nodules or bumps in the endometriosis areas that result in lesions on the surface of pelvic organs can also cause pain, as well as nerves in the endometriosis lesions, or patches of endometriosis pressing against nearby nerve cells. Endometriosis-related pain can be severe and interfere with the normal, quotidian activities of the patients. Numerous research projects are focused on understanding how endometriosis is related to pain since it can result in the development of more effective treatments for this specific type of pain.
Treatment of Endometriosis-Related Pain
There is currently no cure for endometriosis, but there are treatments designed to ease endometriosis pain. In order to reduce pain, there are three types of treatment: pain medication, hormone therapy, and surgical treatment. Pain killers are usually recommended to women with minimal or mild endometriosis. The most common types of pain relievers are nonsteroidal anti-inflammatory drugs (NSAIDS) and opioids, which are strong pain drugs that interact directly with the nervous system. However, the effects of pain medication if limited, and when ineffective physicians often recommend one of the two other types of treatment.
Hormone treatment is used in the form of pills, shots or injections, or nasal spray and is based on the hormonal causes for the development of endometriosis. The treatments are meant to stop the production of estrogen in the ovaries, preventing the growth of new adhesions.
The last resort for treating the disease is usually surgery, which has shown significant improvements in controlling endometriosis pain in the short-term. The most common surgical procedure for endometriosis is laparoscopy, a minimally invasive surgery to remove the lesions. Laparotomy has the same purpose, but it is a more extreme procedure that consists of the removal of the uterus and in some cases also the ovaries and fallopian tubes. In addition, there are also the surgery to sever pelvic nerves, a generic name that includes both presacral neurectomy and laparoscopic uterine nerve ablation. However, the American College of Obstetricians and Gynecologists do not include these in its recommendations for the treatment of endometriosis and alerts for the risks of inefficacy.
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