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Endometriosis is an abnormality of the female reproductive tract in which endometrial tissue is found in other parts of the female body. Although most women with endometriosis are between 30 – 40 years old, it has been observed in younger women as well. It is estimated that 40% of women suffering with endometriosis will experience infertility to some extend. It is not clear how endometriosis affects fertility in a woman.
The primary cause seems to be the scarring, blockage or adhesions in the tubes. It is possible that these adhesions prevent the egg from meeting with the sperm for fertilisation, or they obstruct the fertilized egg to move on towards the uterus resulting, sometimes, in ectopic pregnancy.
Another theory relates mild endometriosis and infertility with an autoimmune reaction. It is believed that endometrial tissue found anywhere else outside the uterus is viewed as foreign by the body resulting in an immune defence reaction, which may affect both eggs and sperm.
Moreover, it is believed that women with endometriosis have a larger quantity of peritoneal fluid and higher levels of prostaglandin. The high levels of prostaglandins may influence the normal function of the Fallopian tubes, preventing, in this way, the transfer of the egg and sperm to the uterus.
Many women, often but not always, may present one or more of the following symptoms: Dysmenorrhea (pain during menstruation), dyspareunia (pain during intercourse), cycle disorder, vaginal bleeding. Thirty per cent (30%) of the women with endometriosis have no symptoms other than infertility.
The diagnosis of endometriosis entails a combination of tests including: a detailed medical history of the symptoms and the menstrual cycle of the patient, gynaecological examination, laparoscopy for the observation of the pelvis, the ovaries and the tubes. Endometriosis should not be excluded without laparoscopy. In some cases, endometrial tissue in the ovaries may also be detected by ultrasound.
With mild endometriosis no scarring is present in the ovaries and the tubes, although a few endometrial tissue is found on the ovaries and scattered lesions in the pelvic area.
In moderate endometriosis, endometrial tissue is to be found on one or both ovaries as well as adhesions.
In severe endometriosis cases, endometrial tissue is found in large areas on both the ovaries and adhesions that bind the ovaries or the tubes. In some cases large quantities of endometrial tissue are found on the intestines and the urinary tract. The level of CA – 125 in blood is increased in some women with endometriosis. Testing of CA-125 is also useful in monitoring endometriosis after surgical or medical treatment.
Endometriosis treatment has two aims in women that wish to get pregnant:
Treatment of endometriosis comprises unblocking the tubes and the removal of adhesions as well as the endometrial tissue through laparoscopy or laparotomy. During laparoscopy a small incision is done on the lower part of the abdomen and, through microsurgery or LASER surgery, all adhesions are removed and the pelvic organs are restored to their normal condition. Laparotomy is a fairly major surgery that requires 2 – 3 weeks for full recovery.
Some doctors combine surgery with hormonal treatment for the repression of the endometrial implants. These drugs prevent ovulation before surgery. Two hormonal drugs are used for the treatment of endometriosis. An old regime included the continuous administration of contraceptive pills for 9 – 12 months preventing menstruation or ovulation. Other treatments involve Danazol and GnRH agonists. Danazol was introduced in 1971 but is not in use today. It is a synthetic male hormone, which interferes with the release of FSH, and LH hormones in the pituitary gland resulting in menstruation cessation. Treatment with GnRH agonists is the most frequent one for reducing the FSH, LH and oestrogen hormones levels resulting in the absence of ovulation and menstruation. Treatment with GnRH agonists involves a monthly or every three months injection for 4 – 9 months.
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