Endometriosis
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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]
- It is not yet clear exactly what factors, if any, increase the risk of endometriosis.[7]
- Several other 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]
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Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
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Causes[edit | edit source]
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Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
Endometriosis is a non-curable disease.[2] The goals of treatment focus on decreasing pain and incresing fertility. Likewise, 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:
- Medications to control pain - (refer to medication section)
- Horomone Therapy - (refer to medication section)
- Surgical management - less common approach due to unchanged etiology and rapid implant regrowth.[2]
- Non-traditional management - (refer to alternate/holistic management)
Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports[edit | edit source]
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Resources
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Endometriosis. MayoClinic.com. Sept. 11, 2008. Available at: http://www.mayoclinic.com/health/endometriosis/DS00289. Accessed : February 17, 2010.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 Goodman C., Fuller K. Pathology: Implications for the Physical Therapist. St. Louis, Missouri: Saunders Elsevier; 2009.
- ↑ 3.0 3.1 Endometriosis. MedlinePlus Medical Encyclopedia. January 2010. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000915.htm. Accessed: February 17, 2010.
- ↑ 4.0 4.1 Edwards, M. Understanding Endometriosis. Practice Nurse. December 2009; 38, 10: Proquest Nursing and Allied Health Source. pgs 22-25. Accessed: February 17, 2010.
- ↑ Ozakan S., Arici A. Advances in Treatment Options of Endometriosis. Gynecologic and Obstetric Investigation. October 2008; 67: 81-91. Accessed: February 18, 2010.
- ↑ Goodman C., Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis, Missouri: Saunder Elsevier; 2007.
- ↑ 7.0 7.1 Cite error: Invalid
<ref>tag; no text was provided for refs nameddifferential diagnosis - ↑ Troyer MR. Differntial diagnosis of endometriosis in a yound adult woman with nonspecific low back pain. Physical Therapy. 2007;87:801-810.
