When endometrial tissue that usually grows inside the uterus, starts growing outside uterus, it is called Endometriosis. Pain during or before periods, pain during intercourse, pain while urinating or bowel movements, heavy bleeding, infertility are some of the symptoms of endometriosis.

Treatment of endometriosis usually depends on the following factors:

Age of female
Severity of symptoms
Duration of the symptoms
Future plans for children/ fertility
Associated pathologies
Accordingly the doctor might choose any of the treatment options like:

Medication for Pain: If the symptoms are mild, then the doctor will prescribe some pain  relieving medications like Nonsteroidal anti-inflammatory drugs (e.g. Diclofenac) or anti-spasmodics(e.g.drotaverine)
Hormone Therapy: Hormone therapy is effective, but once you stop them, your symptoms may recur. Some of the hormone therapies include: 
Hormonal Contraceptive pills: Useful in controlling the hormones that are responsible for endometrial tissue growing outside the uterine cavity.
Medroxyprogesterone: This helps to counter effect estrogen hormone which is responsible for endometrial tissue growth.
Gonadotropin-releasing hormone (GnRH) agonists: Gonadotropin hormones that stimulate ovaries are blocked by these. They bring down oestrogen levels and hence symptoms. It can cause absence of menstruation in some females which is reversible.
Danazol: It is synthetic androgen, suppresses growth of endometrial tissue temporarily.  However, Danazol may not be a favourable option because of its side effects. Females should avoid pregnancy while on this drug.
Dienogest: This newer progesterone molecule, which does not have major side effects and is apporved for use in endometriosis.
Other medications like selective progesterone receptor modulators, immunomodulators, anti angiogenic factors are being evaluated.
Conservative surgery: If you are trying to conceive, then surgical excision or ablation of endometrial tissue is one treatment option.Suboptimal surgery with conservation of maximum ovarian tissue is considered suitable in such cases.
Hysterectomy: In severe endometriosis cases where female has completed her family, hysterectomy is offered wherein the uterus, cervix & if required ovaries can be removed.

Endometriosis - Ways To Manage It Well!

What is Endometrium?

The uterus is where the fetus grows and develops. It has three linings- the outermost lining, the middle layer and the innermost lining. The innermost layer is called Endometrium. The endometrium is made of mucosal tissues.

How the endometrium changes and what is its function?

Before ovulation, when an egg is released, the functional layer of the endometrium undergoes a change. Vascularization takes place i.e. a buildup of blood vessels and tissues that thickens the endometrium in anticipation of implantation of a fertilized egg. If conception does not take place, the tissues and cells are shed from the endometrium lining. This is when a woman gets her period.

When conception does take place, the fertilized egg attaches itself to the endometrium. The endometrium also supports the placenta, which provides the fetus with oxygen and nutrition.

What is the ideal thickness of the endometrium?

In pre-menopausal women, the thickness of the endometrium should be-

  Between 2-4 millimetres during menstruation,
  5-7 millimetres at the onset of the early proliferative phase
  Around 11 millimetres during the late proliferative phase
  16 millimetres during the secretory phase



What is a poor/thin endometrium?

If the endometrium lining does not meet standard thickness and is not conducive to implantation, it is called a poor endometrium.

Causes behind thin endometrium

There could be many reasons that can lead to a poor endometrial layer-

  Inadequate secretion of estrogen
  Insufficient blood flow
  Prolonged use of birth control pills
  Substandard quality of endometrial tissues
  Presence of fibroids (small uterine tumours)
  Amenorrhea (unnatural periods/ excess bleeding or too little bleeding)
  Intrauterine adhesions (scar tissues form between the layers of the uterus and glue them together)
  Pelvic inflammatory disease
  Use of clomiphene

What are the symptoms of poor endometrium?

  Infertility (inability to conceive)
  miscarriage
  Irregular menstruation
  Painful periods
  Inadequate bleeding during menstruation

Treatment for poor endometrium

  Since the most common cause of poor endometrium is insufficient estrogen, doctors prescribe estrogen pills that can raise estrogen levels.
  If poor endometrium is the result of poor blood flow, an Ultrasonography Test will reveal that. Then doctors prescribe Vitamin E pills and L-arginine amino acid pills to thicken the endometrium layer.
  Regular exercising increases blood flow to the uterus
  Acupuncture is a very effective stress buster. Chronic stress could lead to a shrunk uterine wall. Acupuncture can allay the stress and promote the health of the uterus.
  Intrauterine adhesions can be extracted through surgery.
  Natural remedy (through natural therapy) includes asparagus, royal jelly, cover and they help in thickening the endometrium layer.
  Granulocyte Colony Stimulating Factor if injected into the body raises endometrial thickness and combats infertility.

Only an endometrium of normal thickness can support a pregnancy. If the lining is not thick enough medical intervention may be necessary.

Poor Endometrium - Can It Be Treated?

There can be a number of reasons that lead to infertility in women. Endometriosis is one of them. It is a benign condition where the endometrium, which includes the tissues that form the lining inside the uterus, grows outside the uterus. Apart from infertility, it may also cause pelvic pain in women.

There are no such symptoms of endometriosis apart from pelvic pain and it cannot be detected without surgery. Thus, it is very difficult to diagnose this disease and state how common it is. However, research says that the prevalence of this disease in women in their reproductive age is between 3 to 10 per cent.
It is found that endometriosis sometimes leads to infertility. Here is how:

Abdominal Adhesions and Infertility
Normally, the endometriosis implants develop in the abdomen. Then the body surrounds them with connective tissues. The reason for doing so is isolating the implants, so that they cannot harm your body.
Now, sometimes these adhesions can create a blockage in the opening of the fallopian tube or may also pinch off the fallopian tube. This will result in obstruction in the fertilisation of egg and the sperm and thus fertilization will not take place; so there are no chances of conceiving. These obstructions when diagnosed can be treated with surgery.

Secretions from implants
Endometrium plays a vital role in conception where the tissues secrete a wide variety of hormones and nutrients. Now, the endometrial implant also functions in the same way and secretes those hormones. The difference is that it does not deposit them in the lumen of the womb, and it is released in the abdominal cavity. In these substances, there may be some hormones that are responsible for infertility.

Prostaglandins
Prostaglandins are other hormones that are secreted by the endometrium normally. It helps in a lot of body processes that include various stages of menstrual cycle and pregnancy. This hormone is required for a lot of functions such as ovulation, sperm mobility, and regression of corpus luteum, immune interaction, menstrual cramps and contraction of the uterus at birth.

Just like the endometrium, the implants also secrete these hormones. And, the problem that is caused by the implant secreted prostaglandin hormone is that they are released in the abdomen and not in the womb. Moreover, they are not secreted at the right time, thus sending a wrong message to the brain.

A woman with a few days of pregnancy may face a miscarriage because the ovary will get a signal to start the menstrual cycle, and the womb lining where the egg is implanted will be expelled.

How Endometriosis Leads to Infertility and Miscarriages?

When tissues that usually grow inside the uterus, start growing outside the organ, it is called endometriosis. Painful periods, pain during sex, pain while urinating or bowel movements, extreme bleeding, fatigue, infertility, diarrhea, bloating and nausea are some of the symptoms of endometriosis.

Treating endometriosis usually depends on the following factors

Age
Severity of symptoms
Severity of the disease
Future plans for children
Depending on these the doctor might opt for any of the following treatments

Medication for Pain: If the symptoms are mild, then the doctor will prescribe some pain killers like Nonsteroidal anti-inflammatory drugs. 
Hormone Therapy: Hormone therapy is effective, but once you stop them, your symptoms may come back. Some of the hormone therapies include: 
Hormonal Contraceptives: Birth control pills, vaginal rings and patches are useful in controlling the hormones that are responsible for tissue build-up outside the uterine cavity. 
Medroxyprogesterone: This drug stops menstruation, which in turn stops the tissue build-up and put an end to all the symptoms. But on the other hand, gaining weight, low bone production and depression are some of the common effects of this drug. 
Gonadotropin-releasing hormone (Gn-RH) antagonists and agonists: Hormones that stimulate ovaries are blocked by these. They bring down oestrogen levels and hence prevent menstruation. 
Danazol: This drug prevents menstruation and symptoms of endometriosis by blocking the hormones that stimulate the ovaries. However, Danazol may not be a favourable option because of its side effects. The drug should be avoided during pregnancy.
Conservative Surgery: If you are trying to get pregnant, but you already suffer from endometriosis, then removing endometriosis surgically is a viable solution. Your uterus and ovaries will be preserved, which might increase your chances of becoming pregnant. Even suffering from severe pain might find relief from conservative surgery. 
Hysterectomy: In extreme cases, the only way to deal with the symptoms is to completely remove the uterus, ovaries and cervix. Since a hysterectomy means you cannot have children, it is kept as the last option for women in their reproductive age.

Management of Endometriosis

Endometriosis is a condition in which the endometrial cells lining the inside wall of the uterus begin to grow outside the uterus. In a majority of the cases, the growth is on the ovaries, the Fallopian tubes, or the tissues around the uterus. In rare cases, it occurs in other body parts. Normally, women in the age group of 30 to 40 years are prone to developing this condition and genetics is believed to be the reason behind this disorder. It is a serious medical condition if it causes discomfort to the woman.

Signs and Symptoms:  The signs and symptoms of endometriosis include chronic pelvic pain, pain during menstruation, urination, and intercourse, longer periods, bleeding between menstrual cycle, bloody urine or stool, and urinary and bowel problems.

Treatment methods:  In many cases, endometriosis goes undiagnosed and it can only be diagnosed through biopsy. If the biopsy confirms endometriosis, then it can be treated in the following ways:

Hormonal treatment: Hormonal treatment includes birth control pills, placement of the intrauterine device, Gonadotropin-releasing hormone, and Danazol or Medroxyprogesterone (Depo-Provera).
Pain medication: Pain killers with anti-inflammatory properties are prescribed to those who suffer from painful menstruation.
Surgery: This is the last treatment option and only advised to those who did not find relief from medicines and hormonal treatment. Surgeons try to remove the areas affected by endometriosis but in severe cases, the ovaries might need to be removed completely.
Complications: It is important to treat endometriosis on time as delay can lead to complications. The complications arising out of endometriosis include the following:

Infertility: The scarring and distortions caused in the reproductive organs due to endometriosis and the endometriotic cysts can make a woman infertile.
Scarring: The bleeding and the inflammation caused by endometriosis leads to scarring of the tissues of ovaries.
Ovarian cysts: Sometimes, the abnormal growth of endometrial cells outside the uterus spreads to the ovaries and starts growing over there, leading to cysts.
Prevention: As it been mentioned before, in many cases, endometriosis goes undiagnosed but it can be prevented or its symptoms managed effectively if one is cautious. One should do the following:

Exercise regularly: Exercise increases immunity and also reduces the level of estrogens, which slows down the progression of endometriosis. It also provides relief from pain.
Eat nutritious diet: A diet rich in vitamin and minerals ensures good health of the reproductive organs and a fine immune system. This helps to fight the symptom of endometriosis and keeps the disorder in check.
Endometriosis is known to affect a large number of women and since the early symptoms are mild or confusing, most of the time they go undetected. Nevertheless, a woman can avoid it and the complications arising out of it by being mindful of the symptoms. They should also undergo a regular pelvic exam and follow the instructions of their gynecologist. This would ensure timely detection of the disorder and if this is ensured, the management also becomes easy.

Suffering From Endometriosis - What Are Its Treatment Options?

Endometriosis is a condition where the endometrial tissue lining the womb, grows outside the urethral lining. This can cause severe pelvic pain and a host of other complications, if it is not treated on time. 

Here is everything you need to know about this ailment.


- symptoms: owing to the location of this tissue and its painful protrusion through the lining or walls of the womb, one of the earliest and most painful symptoms experienced may include severe cramps and pain during the menstrual cycle. Also, the patient will experience pain in the lower abdomen region about a week before the onset of the cycle. Heavy bleeding as well as infertility may be experienced in such cases too. Sexual intercourse will also give rise to pain in the region, while discomfort will be felt during the bowel movements. Pain in the lower back will also be experienced throughout the menstruation period. 


- stages: there are several stages of this disease and its progression, each of which will require a different form of treatment. These four stages usually depend on the location, size, depth and number of the endometrial implants within the body of the patient.


- minimal stages: in this stage, usually there will be small wounds and lesions as well as shallow implants on the ovaries. Inflammation in the pelvic cavity can also be felt in this stage.


- mild stage: in this stage, there will also be light lesions and shallow implants which will spread over the ovaries as well as the pelvic lining.


- moderate stage: in this stage, the implants will dig deeper into the ovaries and the pelvic lining, which will result in the growth of even more lesions.


- severe stage: as the name suggests, in this stage the patient will experience deep implants along with lesions in the bowels and the fallopian tubes.


- treatment: there are varied forms of this treatment including pain relief medication for minimal to mild stage patients. Also, hormonal therapy with the help of supplements may be prescribed. Hormonal contraceptives may also be used. In such cases, medication like danazol, medroxyprogesterone, 

Gonadotripin releasing hormone agonists, and other such elements may be prescribed. Conservative surgery and radical surgery may follow, depending on the severity of the condition. Laparoscopy is the preferred form of treatment in such cases. A hysterectomy can be conducted as a final resort where the surgeon will remove the cervix as well as the uterus of the patient. This will make pregnancy impossible for the patient, thereafter. To stem estrogen production, the ovaries will also be removed. 


One must discuss all risks and complications before going in for a certain form of treatment for this ailment.

Symptoms, Stages and Treatment of Endometriosis

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