Endometriosis: Can it affect beyond pelvis?

Endometrium is the tissue that forms the inner lining of the uterus. The presence and growth of these cells outside the uterine cavity causes the disease condition called endometriosis. The cause and reasons for its growth outside the uterine cavity is unknown. However, the disease per se is a common and painful one. It also has a moderate genetic predisposition. Which means if your mother or sister has suffered from it, there is a likelihood that you would too.

Typically endometriosis affects the ovaries and fallopian tubes, and presents itself as chronic lower abdominal or back pain, painful cycles, infertility or as an incidentally detected ovarian cyst. This is theorised as caused by transplantation and implantation of endometrial cells which are shed during menstrual flow through the fallopian tubes into the abdominal cavity (Sampson’s Theory). However, it fails to completely explain the endometriosis found in other parts of body. There are various other theories postulated. However none of them to this date explains completely the cause of endometriosis completely, and hence Endometriosis remains largely an enigmatic disease.

Extra-pelvic endometriosis: The rare occurrence of Endometriotic lesions outside the pelvic or lower abdominal cavity is generally classified as extra-pelvic endometriosis.

Locations: Though not in huge numbers, endometriosis has been found in every organ system of the women’s body: gastrointestinal (stomach and intestines), nervous system(brain and spine), pulmonary (lungs), urinary tract (bladder), extremities(limbs) and skin.

One of the commonest extra-pelvic location of endometriosis is on the skin, especially on the healing scars of previous pelvic or laparoscopic surgeries. It is called scar endometriosis.

Rarely endometriosis has been detected in males as well.

Diagnosis: The clinical symptoms of endometriosis vary with the organ affected by it. Ranging from cyclical mass/nodules on skin which increases in size and is painful especially during menstrual cycle to epileptic (Catamenial Epilepsy)episodes, if the endometriosis affects the brain.

Endometriosis of the urinary bladder may present as cyclical hematuria(catamenialhematuria) or blood in urine and can be diagnosed and treated by cystoscopy.

Similarly, it can present as blood in sputum or lung cavity, blood in sputum/vomitus, blood in faecal matter, cyclical chest pains, cyclical nasal bleed etc

The diagnosis is made by imaging especially ultrasound, MRI or CT scan and confirmed by biopsy.

Treatment: Once the diagnosis is made, treatment modality is decided based on factors like: location, symptoms, size of lesion etc.

·         Small asymptomatic incidentally detected endometriosis are left untreated and patient is offered follow up.

·         Medical management: various tablets and injections are available to counteract the estrogen requirement of endometriosis.

·         Surgical management: surgical excision, laser or electrical ablation of the lesion are also carried out

·         Combination of medical and surgical management

·         In spite of multiple available modalities of treatment, endometriosis remains one of those disease conditions with very high recurrence risk.

·         Complementary therapies: like vitamin supplementation, Exercises, TENS, acupuncture etc has given mild to moderate symptoms relief to certain patients. Financialexpress.com