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Hysterectomy: endometriosis

Endometriosis is the growth of tissue resembling the endometrium in parts of the pelvis where it is not usually seen. This 'stray' tissue grows in an estimated 1-6% of women. It occurs on the ovaries, Fallopian tubes, the outside of the uterus or its supporting ligaments, the bowel, bladder or vagina.6 It occurs in about one in five women with fertility problems, suggesting a significant role in infertility. The tissue behaves like the endometrium in some respects, bleeding at the same time as the usual menstrual period. If the blood cannot easily escape from the body, it may cause irritation or pain and may develop into blood-filled cysts.
Sometimes endometriosis only lasts for a few cycles, but it may also continue throughout reproductive life, getting worse as women enter their thirties and forties. The behaviour of endometriosis in pregnancy is highly variable and it rarely disappears permanently after pregnancy. Published reports indicate that some women continue to have problems due to endometriosis after menopause. It can limit bending, stretching, standing and taking exercise, especially on days of menstrual bleeding. Although it is also associated with infertility, many women with endometriosis become pregnant without difficulty.
Endometriosis is regarded as the most common cause of chronic pain in women aged from fifteen to fifty-five years. This pain is nearly always cyclical, that is, it tends to occur at about the same time in most menstrual cycles. It may be experienced by a woman when she ovulates, menstruates or is about to menstruate. It may also occur when she has sexual intercourse, urinates or passes a bowel motion. It sometimes causes spotting between periods. Although it has much in common with period pain it does not respond to medications, such as anti-prostaglandins, found helpful in that disorder. When Laura sought advice from her doctor about chronic pelvic pain, a number of factors in her history suggested a diagnosis of endometriosis. These included a history of painful periods which had worsened with age, short menstrual cycles with a relatively large number of days of bleeding, and a family history of pelvic pain among her female relatives. Despite this suggestive evidence, Laura's doctor advised her that the diagnosis required a laparoscope entailing a visual inspection of her abdominal organs. He said a number of other procedures might assist in arriving at a diagnosis but he preferred not to perform a biopsy of suspected lesions, a vaginal ultrasound and blood tests until he did the laparoscopy. In fact, the laparoscopy was sufficient to reveal the endometriosis and he and Laura discussed a number of possible treatments, including drug treatment and surgical removal.
The diagnosis of endometriosis usually relies on a laparoscopic examination, a procedure that enables a doctor to examine the contents of the abdomen without making a big opening in. Instead several small incisions are made and a long thin tube specially equipped with thin glass fibres is inserted through one of the incisions. Light travels along the fibres to 'spotlight' internal organs and a periscope-type attachment allows the doctor to see into the abdomen and pelvis. Other instruments used with the laparoscope (hence the need for the other incisions) enable the doctor to make photographic records of the inside of the abdomen, obtain samples (biopsies) of tissue for laboratory analysis and remove abnormal tissue. Using this technique, doctors have learned that the appearance of endometriosis varies markedly. Younger women tend to have clear growths or red lesions, whereas the lesions of older patients tend to be black or yellow-white.
Various theories have been advanced about why endometriosis occurs, but these are hotly disputed. Suffice it to say that no one yet knows if some women are born with a tendency to develop it or if endometrial-type tissue spreads in the body due to some unusual abdominal structure or function.


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