Endometriosis is when lining of uterus which is called endometrium grows outside of uterus and cause cramping, heavy bleeding like symptoms. The endometrium acts like regular Uterine tissue during the menstrual cycle, it starts breaking down and bleed at the end of the cycle , but this blood has nowhere to go but in surrounding of Uterus due to whole area around uterus gets inflamed.
As no obvious cause has been known since yet for Endometriosis, there are certain theories for Endometriosis to be happen which are as follows –
1) Problems with menstrual flow –
When blood enters the fallopian tubes and pelvis instead of leaving the body in the usual way is called Retrograde menstruation.
2) Embryonic cell growth –
At times embryonic cells lining the abdomen and pelvis develop into endometrial tissue within those cavities.
3) Foetal Development –
Endometriosis can be present in a developing Uterus.
4) Surgical scar –
Endometrial cells can move during a procedure such as a hysterectomy or C-section.
5) Endometrial cells transport –
The lymphatic system transports endometrial cells to various parts of the body.
6) Genetics –
There may be an inherited component.
7) Hormones –
It is stimulated by the Hormone estrogen.
8) Immune system –
Problem with the immune system can prevent the destruction of extra uterine endometrial tissue.
1) Back pain during Menstrual cycle.
2) Painful intercourse.
3) Unusual or heavy bleeding in menstrual cycle.
4) Pain when pooing or peeing , especially during the periods.
5) Severe menstrual cramps.
6) Blood in stool or urine.
7) Diarrhoea or constipation.
8) Difficulty in conceiving.
9) Fatigue all the time.
1) Superficial peritoneal lesion –
This is most common type of lesion. Here lesions appear on thin lining of pelvic cavity which is named as peritoneum.
2) Endometrioma ( ovarian lesion) –
These lesions appear deep in ovaries called chocolate cysts characterised by dark in colour and fluid filled. These lesions don’t respond good to treatment.
3) Deeply infiltrating Endometriosis –
This type of Endometriosis is having prevalence of 1-5%. It grows under peritoneum and can involve organs near Uterus.
1) Stage 1 (Minimal) –
In this stage uterus have a few small lesions but no scar tissue.
2) Stage 2 (Mild) –
Here Uterus have more lesions but no scar tissue.
3) Stage 3 (Moderate) –
In this stage lesions may be deep and they start surrounding ovaries or fallopian tubes.
4) Stage 4 ( Severe) –
At this stage lesions becomes more in number and size of cyst in ovaries also become larger. Patient may have scar tissue around ovaries and fallopian tubes or between Uterus and lower part of the intestines. This stage has no symptoms at all.
Risk factors –
1) Age –
It is common in age 30-40 yrs.
2) Nulliparous –
Never given birth a child.
3) Genetics –
One or more relatives having the same condition.
4) Medical History –
Having a pelvic infection , Uterine abnormalities or condition which prevents expulsion of menstrual blood.
5) Menstrual History –
Menses lasting more than 7 days or menstrual cycle of less than 27 days.
6) Caffeine , alcohol consumption and lack of exercise.
1) Pelvic Examination
2) Imaging test like CT scan and MRI.
Surgery is the option but only in that condition when other treatments do not work.
Some other treatment options include –
1) Pain medication –
Non steroidal anti-inflammatory drugs such as Ibuprofen works in painful menstruation.
2) Hormones –
Treatment may be with hormonal therapies such as hormonal Birth Control pills ,GnRH agonists and antagonists like Medroxyprogesterone or Danzol. Use of IUD also may be recommended.
3) Fertility Treatment –
Pregnancy may be recommended via IVF.
4) Ayurvedic Treatment –
Shaman chikitsa for Ama pachan and Shodhan chikitsa to pacify Vata especially Apan Vata are important in Endometriosis treatment.
Ayurvedic herbs such as Haritaki , Sonamukhi are more powerful in reversing the Apana Vata movement from upwards to downwards to stop Retrograde menstruation.
Specific astringent herb such as Turmeric reduces inflammation and provides relief from pain.
2) Ovarian cyst
4) Scar tissue and adhesion development
5) Increased risk of ovarian cancer or adenocarcinoma
6) Intestinal and bladder complications.
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