Endometriosis, Definition, Signs and Symptoms, Causes and Treatment.

Endometriosis Implants scarring

Definition:
       Endometriosis is the abnormal growth of the endometrial cells (Cells present in the inner layer of the uterus) outside the uterus.

When will this abnormal Growth of cells become harmful?
The Abnormal cells will divide and grow under the influence of hormones during the menstrual cycle. But in the menstrual phase of the cycle, the cells of Endometriosis shed off. These cells attach themselves the tissue outside the uterus and are called endometriosis implants. Common sites of endometriosis implants are ovaries, bladder, and intestine. Cells may attach themselves in vagina or cervix. In rare condition, these cells may implant themselves in the liver and brain.
Endometrial implants, while they can cause problems are benign.
Endometrial Implants become harmful or uncomfortable in the following condition

1. In case of deeper implants. deeper implants may stimulate nerve endings. The pain usually occurs just before menstruation when the cells start shedding and implanting.
2. The endometriosis implants can secrete some substance in the blood which can cause discomfort and pain.
3. Scarring of the tissue because of implantation process may cause pain.
4. The endometriosis cells can block the cervix or uterine tubes. hence can't allow the sperms to reach egg which results in infertility.

Signs and symptoms:

Most women who have endometriosis often have no symptoms. but in some cases, symptoms do appear. following are the common signs and symptoms of endometriosis.

the circled portion shows endometriosis on
posterior vaginal fornix.
The dark spots are nabothian cysts.

• Pain (usually pelvic). Pain start just before or during menstruation and lessens after menstruation.
• Infertility
• Painful intercourse.
• Pain during defecation.
• Pain during Urination.

Other rare symptoms.

• Blood in urine
• diarrhea and constipation
• heavy Irregular menstrual bleeding
• lower back pain.

Causes:

• The actual cause is unknown. But some scientists suggest that retrograde menstrual flow can be a possible cause. Retrograde menstrual flow means the flow of menstrual fluid towards the uterine tubes. This can cause abnormal implantation of endometrial cells and endometriosis.
• Direct transfer of endometrial tissue during surgery (e.g cesarean section) may be a cause.
• Lymphatic flow containing endometrial cells can cause endometriosis.
• An immune deficiency that is a deficiency of the immune system to recognize the abnormal growth of the endometrium.

Treatment Options:

The goals of endometriosis treatment are to relieve pain and enhance fertility. 

1. Endometriosis can be treated by surgery.
2. NSAIDs. Non-steroidal anti-inflammatory drugs for pain relief.
3. GnRH antagonist: Gonadotropin releasing hormone antagonists decrease the estrogen production from the ovaries and thus reduce the growth of endometriosis. ( endometriosis cells require estrogen to grow and divide)
4. Oral contraceptives: Sometimes used for the treatment.
5. Progestins. e.g norgestral, recommended for women who can't take birth control pill
6. Danazol (Danocrine): it is a drug that increases androgen levels. androgen is a male hormone and produces male characteristics. if pain is not relieved by other therapy than this is used. about 80 percent women get pain relief. 
7. Aromatase inhibitor. (letrozole) Aroamtase is an enzyme required for estrogen synthesis. its inhibition causes low levels of estrogens and thus less chances of endometriosis growth.