Health Talk: An advertising supplement to The Morning Journal
Over the past several years I have had patients come to me saying they were diagnosed with endometriosis. Some of them have had surgery ranging from laparoscopy (inspection of the pelvic under general anesthesia through small incisions in the abdominal wall), to hysterectomy with or without removal of the ovaries. When the surgical pathology report or the operation report can be obtained I have quite often found that they had adenomyosis instead of endometriosis. The two conditions are different in their characteristics and management.
Endometriosis is the presence or growth of tissue similar to the inner lining of the uterus in places other than the cavity of the uterus.
Adenomyosis is the growth of the inner lining of the uterus into the muscle of the uterus. Adenomyosis has been called internal endometriosis in the past but this can be confusing because they are separate conditions.
The frequency of endometriosis is hard to estimate because many patients with endometriosis have no symptoms and their endometriosis is found incidentally during surgery for other conditions.
The cause of endometriosis is uncertain. The suggested causes include reverse menstruation-that is reverse flow of menstrual tissue into the pelvis during menstruation, passage of menstrual tissue through the blood vessels to other parts of the body, and spontaneous change of the pelvic tissues into endometrial tissue. Immune changes, hormonal influences, and genetic tendencies have also been suggested.
The classic symptom of endometriosis is pelvic pain which is worse around the time of the menses and can be incapacitating.
Endometriosis is most commonly diagnosed during the menstrual years but about 5% of women with endometriosis are diagnosed after menopause, presumably their endometriosis is stimulated by estrogen treatment.
The severity of the symptoms often does not reflect the amount of endometriosis present.
Women with extensive endometriosis may have no symptoms; whereas, those with minimal implants of endometriosis may have incapacitating pain. Endometriosis can be present in a cesarean section scar or an episiotomy scar from implantation of endometrial tissue during cesarean section or vaginal birth.
Women who have relatives with endometriosis have an increased incidence of endometriosis compared with those who do not.
The most common site affected by endometriosis is the ovaries but it may be found anywhere in the pelvis including the bowel. Rarely, it can be found in areas far removed from the pelvis like the lungs, arms and legs. A definitive diagnosis is made by laparoscopy.
The treatment of endometriosis can be medical or surgical or both. Medical treatment involves stopping the periods with continuous hormonal contraception. Alternatively, the anti-estrogen (gonadotropin-releasing hormone) can be given monthly for 6 to 9 months. Surgery involves removal of the endometriosis implants and may require a hysterectomy’ and removal of both ovaries in some cases. Surgical treatment can be combined with hormonal treatment to enhance the results.
In adenomyosis, for some reason the barrier between the lining of the uterus (the endometrium) and the muscle of the uterus is broken and the endometrial glands grow into the muscle of the uterus. The uterus becomes uniformly enlarged and soft. It is not a cancerous condition neither is endometriosis.
Most women with adenomyosis have no symptoms. The classic symptoms of adenomyosis when present are menstrual pain, heavy menses and pain during sexual relations. The findings of a bulky soft tender uterus on examination and characteristic findings on ultrasound or MRI can help make the diagnoses.
Hormonal contraceptives and Ibuprofen help with the heavy periods and pain as may the hormone releasing IUD Mirena. Hysterectomy is the definitive treatment for adenomyosis when child birth is no longer a desire.
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