Endometriosis develops when endometrial-like mucosal cells normally found in the endometrial lining of the uterus begin growing and functioning in other areas or organs of the body. Under the microscope, endometriosis almost always contains the glands and stroma of normal endometrial cells found in the uterus, but it has other features that are very different; that’s why its cells are described as similar to or endometrial-like.
How does endometriosis occur?
Despite microscopic differences, endometriotic growths can respond to the monthly fluctuations of female sex hormones, just as normal uterine endometrial cells do in reproductive-aged women and girls. Because of this, endometriosis growths can bleed, shed, and proliferate in concert with a woman’s monthly menstrual and/or ovulatory cycle. This is why the pain usually becomes most acute around menstruation and/or ovulation.
In the broadest terms, many researchers hypothesize that the body’s immune system recognizes that these endometriotic growths are not growing where they should and therefore launches an immune response in order to destroy them. (Others believe that the immune system does not recognize them until it’s too late). As a result of this continued battle between endometriosis and your body’s immune system, the cytokine-prostaglandin response, inflammation, and other immune system factors appear to become chronically dysregulated.
Endometriosis is a very difficult condition to diagnose and thus occasionally it can take a long time for patients to be referred to hospital specialists. Many patients will suffer with pelvic pain for over 6 years before the required tests are carried out.
Mr Amer Raza has a carefully planned series of investigations and assessments available to diagnose the extent of endometriosis and these can be carried out in a timely fashion without delay.
Some of these tests are summarized below. The order of these tests may vary with every patient, and you may not require every test performing.
History taking and examination A full and thorough history will be taken to understand the extent and type of disease process. This is the most important part of the assessment. This will be followed by a gentle examination, including a pelvic assessment and possibly speculum to palpate any endometriotic nodules, bowel adhesions or masses.
Endometriosis and pelvic pain are commonly misunderstood and mistreated. Successful treatment of endometriosis and pelvic pain requires addressing several essential issues in two basic categories; (1) correctly performed surgical removal of the endometriosis implants and (2) treatment of co-conditions and/or underlying conditions often associated with endometriosis. Unfortunately many patients with endometriosis are not having either of these areas treated correctly. There is a lot of un-necessary pain and suffering as a result of the inadequate diagnosis and treatment of endometriosis.
Currently, the standard approach used by the majority of general OB/GYN’s for surgical treatment of endometriosis is ineffective and out of date. coagulation or burning of endometriotic lesions is the most common surgical approach, which results in only a partial destruction of the disease. The remaining disease not removed at surgery continues to grow with return of symptoms quickly (months to a year or two). In contrast,Wide excision of Endometriotic implants used by Mr Raza. This technique ensures the excision of all endometriotic lesions at the margins of normal tissue. The inadequate surgery often results in patients undergoing multiple ineffective surgeries. There is no medical cure for endometriosis. It must be completely removed surgically with true wide excision.
The medical treatment can be used and justified in few instances.One of its role is in the Pre-surgical treatment of ovarian endometrioma. The Hormonal treatment can help to reduce the size of endometrioma which reduces the surgical harm to the ovaries. The Hormonal medical treatment is also justified after the operation to stop the periods so to allow more time for the excision wounds to heal. Third indication id for those patients who want to delay operation or have quite mild disease hence prefer to have medical treatment.
Mr Raza will have detailed discussion about the pros and cons of this treatment to formulate a final plan of care. There is lot of research being carried out to use various other drugs but none of them have been the answer for this problem.
Laparoscopic removal of endometrial implants remains the key part of management. The critical part of this approach remains the complete removal of endometriosis from the peritoneal cavity, ovaries, bowel and bladder. The endometriosis can lead to adherence of various structures in the abdomen. Most symptoms are secondary to this adhesive disease. The peritoneal involvement of endometriosis leads to pelvic pains and period pains. If endometriosis involved the bowel, then painful defecation, irritable bowel and bloating are the main symptoms. The bladder endometriosis leads to painful urination along with increased urine frequency. There could be number of other organ involvement giving rising to relevant symptoms. The treatment options will be to remove this adhesive disease in its entirety to have the symptoms relief.
If the endometriosis is of severe nature, then multidisciplinary approach is adopted involving all the specialities such as colorectal surgeon, urologist to make a final plan of care.
The endometriosis also effect fertility by its adhesive nature and effecting the fallopian tibes and ovaries. Surgery helps to restore the normal anatomy hence helping with functionality .
A thorough excisional technique helps to remove the visible and adjacent invisible (microscopic) endometriosis. This is the most effective approach to treat this problem.