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Endometriosis
Endometriosis is a condition where the inner-most layer of the uterus that is called endometrium, grows outside of the uterus. This tissue outside of the uterus is called endometriosis. Endometriosis can affect any organ system, such as the brain, eye, liver, or urinary tract. However, the most common places where endometriosis occurs are the ovaries, the fallopian tubes, the bowel, and uterine surfaces.
The prevalence is difficult to determine, because symptoms are nonspecific. It is estimated that 12-32% of women with pelvic pain have it, as well as 50% of teenagers undergoing laparoscopy to determine the cause of pelvic pain and evaluation of severe menstrual cramps and 9-50% of women undergoes laparoscopy for infertility.
The cause of endometriosis is not known. The most common theory is called retrograde menstruation theory. According to this theory, during menstrual bleeding, some endometrial tissue flows backwards through the fallopian tubes in to the pelvic and abdominal cavity. Once this tissue lands inside it will grow. There is also evidence that altered immunity plays a role in pathogenesis of endometriosis. Genetic factors influence an individual's risk of developing endometriosis. A first degree relative is 7% more likely to develop endometriosis compared to an unrelated person.
The presenting symptoms are different from one patient to the other. Some patients have few or no symptoms, while the others have pelvic pain, difficulty becoming pregnant, painful intercourse, pain with bowel movement or urination, severe menstrual cramps, abnormal menstrual bleeding, and low back pain.
To diagnose endometriosis for sure, surgery is required to obtain biopsies. However, to treat the condition it is not always necessary to perform surgery. Endometriosis can be treated only based on the patient's signs and symptoms. If treatment does not improve the symptoms within 3-6 months, then surgery is a reasonable next step. There are situations that surgery should be performed to remove the diseased tissue before attempting medical treatment. An example of such a situation is when endometriosis has caused scarring around the ureter.
There are several treatment options available for this condition. The best treatment depends on each individual patient's presentation. Some of those treatments are nonsteroidal anti-inflammatory drugs, hormonal birth control, and other forms of hormone treatment, as well as surgery.
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