Endometriosis: Difference between revisions
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#<u>'''Anti Inflammatories'''</u>''' (NSAIDS) '''- Over the counter or prescribed NSAIDS work by decreasing the pain and amount of inflammation in the region of disease caused by displaced endometrial tissue or scaring. NSAIDS also decrease pain associated with menstrual bleeding by blocking the protein prostoglandin.<ref name="webmd">Endometriosis Health Center. WebMD. July 28, 2009. Available at: http://women.webmd.com/endometriosis/endometriosis-medications. Accessed March 7, 2010.</ref> | #<u>'''Anti Inflammatories'''</u>''' (NSAIDS) '''- Over the counter or prescribed NSAIDS work by decreasing the pain and amount of inflammation in the region of disease caused by displaced endometrial tissue or scaring. NSAIDS also decrease pain associated with menstrual bleeding by blocking the protein prostoglandin.<ref name="webmd">Endometriosis Health Center. WebMD. July 28, 2009. Available at: http://women.webmd.com/endometriosis/endometriosis-medications. Accessed March 7, 2010.</ref> | ||
< | '''Prescription NSAIDS<ref name="webmd" />''' | ||
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| '''Generic Name''' | | '''Generic Name''' | ||
| '''Brand Name''' | | '''Brand Name''' | ||
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| ibuprofen | | '''celecoxib''' | ||
| | | '''Celebrex''' | ||
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| '''ibuprofen''' | |||
| '''Motrin''' | |||
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| '''ketoprofen''' | |||
| | |||
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| '''naproxen sodium''' | |||
| '''Anaprox''' | |||
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| | | '''piroxicam''' | ||
| | | '''Feldene''' | ||
|- | |- | ||
| | | '''sulindac''' | ||
| | | '''Clinoril''' | ||
'''Over the counter NSAIDS'''<ref name="webmd" /><br> | |||
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| '''Generic Name''' | | '''Generic Name''' | ||
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| ibuprofen | | ibuprofen | ||
| Motrin | | Advil, Motrin | ||
|- | |- | ||
| naproxen sodium | | naproxen sodium | ||
| | | Aleve | ||
|- | |- | ||
| | | asprin | ||
| | | Bayer, Bufferin | ||
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2. '''<u>Birthcontrol Horomones</u>'''- creates horomone levels in the body similar to those during pregnacy. This may slow or cesase the growth of endometrial implants, and stop the shedding and discharge of menstrual fluid which will lead to a decrease in pain.<ref name="webmd" /> This treatment may be used in the form of a pill, patch or ring and has been shown to have the least amount of side affects.<ref name="webmd" /> | |||
2. '''<u>Birthcontrol Horomones</u>'''- creates horomone levels in the body similar to those during pregnacy. This may slow or cesase the growth of endometrial implants, and stop the shedding and discharge of menstrual fluid which will lead to a decrease in pain.<ref name="webmd" /> This treatment may be used in the form of a pill, patch or ring and has been shown to have the least amount of side affects.<ref name="webmd" /> | |||
''' <br><br>''' | ''' <br><br>''' |
Revision as of 03:27, 8 April 2010
Original Editors - Rebecca Clark from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Definition/Description[edit | edit source]
Endometriosis is a female reproductive disorder which affects the lining of the uterus, otherwise known as the endometrium.[1] This estrogen-dependent disorder is defined by the presence of endometrial tissue outside of the uterus and becomes apparent after the start of menses.[2]
In a typical monthly menstrual cycle, endometrial cells lining the uterine walls are stimulated through a release of horomones and multiply in order to provide an ideal environment for egg fertiliztion.[3] If fertilization of the egg does not occur, the uterus sloughs off the lining of blood (endometrial tissue) and menstrual flow occurs for 3 to 5 days.[2]
When affected by endometriosis, endometrial tissue is misplaced outside the uterus in various places. Despite the location of the tissue, the same monthly menstrual cycle occurs.[1] The misplaced tissue engorges with blood, as it would in the uterine lining. Since this blood has no course to drain out of the vagina it remains where it is resulting in "chocolate cysts" wherever endometrial cells are located.[2] In addition to cysts, trapped blood may lead to scar tissue, adhesions and irritation of the surrounding tissue which causing pelvic pain and fertility problems.[1]
Blood deposits or ectopic implantation may occur anywhere in the body but most commonly affects the ovaries, fallopian tubes, broad ligaments, bladder, pelvic musculature, perineum, vulva, vagina, or intestines.[2][1] It has been discovered that endometrial tissue has the ablility to migrate through the body, and in less common cases has been found in the abdominal cavity, kidneys, small bowel, appendix, diaphragm, pleura, bone and even the brain.[2]
Prevalence[edit | edit source]
The incidence of Endometriosis has been on the rise in Western countries for the last 40 to 50 years.[2] Although there are statistics in the literature, the true prevelence of endometriosis is unknown because many women remain asymptomatic.[4] It has been reported that endometriosis occurs in a wide range of 7%- 60% of all women.[2] Further Reports in 2008 revealed that endometriosis occurs in 7%-10% of women in the general population, 2%-50% of women suffering from infertility, and 71%-87% of women with chronic menstrual pain.[5] Unlike many common disorders, there have been no correlations between endometriosis and specific populations. Endometriosis has been shown to affect women of all race, cultures, ethinic origins, socioeconomic status, and geographic backgrounds.[2]
Characteristics/Clinical Presentation[edit | edit source]
Generally, endometriosis becomes apparent soon after menses begins in early teen years, and symptoms continue until menopause. Although any woman of child bearing age is at risk of developing Endometriosis, it is more common in those who have postponed pregnancy.[2]
Endometriosis has been shown to vary in its degree of severity. In order to gage level of severity, the American Society of Reproductive Medicine has developed five stages of classification: I (minimal), II (mild), III (moderate), IV (severe), V (extensive).[2] Despite these classifications, symptoms do not always correlate with disease severity. Many women with severe endometriosis have little pain or remain asymptomatic, while some with minimal or mild classification may experience intense symptoms affecting quality of life.[2] It is likely that if gone untreated, sypmtoms will progress and worsen over time.[1]
Common Sign and Symptoms[2][1][6]
- Abdominal pain, fatigue and mood change beginning 1-2 days before menstration and continuing for duration
- Constant/intermittent, or cyclical pelvic and/or low back pain (unilateral or bilateral)
- Infertility - often first diagnosed in women who are seeking treatment for infertility
- History of ectopic pregnancy or miscarriage
- Dysmenorrhea (painful menstration) - commonly identified as the chief complaint if implants are located over the uterosacral ligaments
- Dyspareunia (painful intercourse) - local adhesions may be irritated by penile penetration
- Painful defication - adhesions may be present over the large bowel. As fecal matter moves through the intestines these adhesions can be stretched causing local irritation.
- Low-grade fever
- diarrhea, constipation, rectal bleeding
- referred pain to the low back/sacral groin, posterior leg, upper abdomen, or lower abdominal.suprapubic areas
- menorrhagia/menometrorrhagia - excessive or occasional heavy periods may be experienced, along with bleeding between periods
Less Common Signs and Symptoms[4]
- Chest pain/hemoptysis - due to endometrial implants in the lungs
- Headache/seizures - due to endometrial implants in the brain
Associated Co-morbidities[edit | edit source]
- Several health problems have been shown to exist in combination with endometriosis.
- A large percentage of women experience co-morbidities such as[7][8]:
-fibromyalgia
-hypothyroidism
-chronic fatigue syndrome
-allergies
-asthma
-rheumatioid arthritis
-multiple sclerosis
-systemic lupus erythematosus
-auto-immune disorders
Medications[edit | edit source]
- Anti Inflammatories (NSAIDS) - Over the counter or prescribed NSAIDS work by decreasing the pain and amount of inflammation in the region of disease caused by displaced endometrial tissue or scaring. NSAIDS also decrease pain associated with menstrual bleeding by blocking the protein prostoglandin.[9]
Prescription NSAIDS[9]
Generic Name | Brand Name | ||||||||
celecoxib | Celebrex | ||||||||
ibuprofen | Motrin | ||||||||
ketoprofen | |||||||||
naproxen sodium | Anaprox | ||||||||
piroxicam | Feldene | ||||||||
sulindac | Clinoril
2. Birthcontrol Horomones- creates horomone levels in the body similar to those during pregnacy. This may slow or cesase the growth of endometrial implants, and stop the shedding and discharge of menstrual fluid which will lead to a decrease in pain.[9] This treatment may be used in the form of a pill, patch or ring and has been shown to have the least amount of side affects.[9]
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]The following are common tests used to identify physical clues leading to the diagnosis of endometriosis:
Causes[edit | edit source]The exact cause of endometriosis is unknown, yet several theories have been developed that explain the existance of displaced endometrial tissue.
(1) The most common theory suggests that mentrual blood containing endometrial cells flow into the pelvic cavity via the fallopian tubes through a process known as retrograde menstruation.[1] This form of endometrial migration has been shown to occur in 90% of women affected by endometriosis.[2]
(2) Another common theory strongly suggests that the presence of foreign endometrial tissue may be due to a faulty immune system.[1] Dysregulation or dysfunction of the immune system allows endometrial cells to spread, and thrive in areas they do not belong.[2]
Other theories include: (3) the spread of endometrial tissue via the lymphatics or vascular system. This form of etiology could account for the presence of endometrial tissue in the lungs.; (4) Meyer's theory suggests that endometrial cells transform from one type of cell to another through metaplasia which explains the presence of displaced tissue in the joints[2]; (5) Some believe in the existance of "pre" endometrial cells which were responsible for the formation of embryonic reproductive organs. Researchers theorize that genetic or environmental factors allow for the formation of foreign endometrial tissue later in life[1]; (6) Speculation of intraoperative implatation of endometrial tissue due to a hystorectomy or episiotomy has been noted.[2]
The following factors may place you at greater risk for developing endometriosis:
Systemic Involvement[edit | edit source]add text here Medical Management (current best evidence)[edit | edit source]Endometriosis is a non-curable disease.[2] The objectives of medical treatment focus on resoring normal pelvic anatomy, removal of endometriotic implants, and prevention of reoccurance to decrease pain and increase fertility.[10] In order to achieve these goals, the course of medical management depends heavily on the severity of symptoms, severity of disease, age and future child bearing plans.[3] Generally, conservative treatment is recommended to control symptoms prior to surgical management.[1]
Treatment options include:
The main aspect of medical management is aimed at reducing or blocking ovarian function due to the fact that endometriosis is related to horomone funtion.[4] Common medical treatments and their functions are listed in the medication section. In the instance that symptoms are severe and disabling, or conservative medical treatment fails, surgical proceedures can be useful in removing/destroying implants and decreasing or ceasing symptoms. It is important to note that implant regrowth may occur following removal and may only be a temoporary source of symptom relief.[4]
Surgical Management:
Physical Therapy Management (current best evidence)[edit | edit source]add text here Alternative/Holistic Management (current best evidence)[edit | edit source]add text here Differential Diagnosis[edit | edit source]add text here Case Reports[edit | edit source]Differential Diagnosis of Endometriosis in a Young Adult Woman with Nonspecific Low Back Pain. Mark R Troyer proquest.umi.com.libproxy.bellarmine.edu/pqdweb Resources[2]
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