Summary of Endometriosis
What is endometriosis?
Endometriosis is an inflammatory disease of the endometrium of the uterus where endometrial glands are abnormally placed which can cause fibrosis (Hickey 2014). Endometriosis affects women of reproductive age. The exact number of women who are affected by endometriosis is unknown because some women can be asymptomatic for years but it is estimated to affect over 5 million women in the United States between the ages of 15 and 44 (NIH 2017). The direct cause of endometriosis is unknown. Some theories about the cause of endometriosis include weak immunity, an abnormal change in epithelial tissue, and retrograde menstruation, (when blood carrying endometrial cells moves back into the fallopian tubes), endometrial cells being transported to other parts of the body, and surgical scarring from a C-section or hysterectomy (Mayo Clinic 2016). Symptoms of endometriosis include chronic pelvic pain (the most common symptom) pain during sexual intercourse, pain during waste excretion, bleeding heavily during menstruation, and infertility (Mayo Clinic 2016). Endometriosis has been shown to double the risk of an ovarian cancer diagnosis (Hickey 2014). Endometriosis can be hard to diagnose through clinical examination but pain during a vaginal examination can be an indicator (Hickey 2014). Transvaginal ultrasonography seems to be the best diagnostic test, receiving a high percentage in sensitivity, specificity, and accuracy (Hickey 2014). Laparoscopy is surgery that allows doctors to look at organs in the abdomen and is recommended in the cases of women suffering from infertility (Hickey 2014).
Etiology of Endometriosis
Due to the fact that the exact cause of endometriosis is unknown, many factors can be related to the emergence of the condition. Two major factors that affect one’s vulnerability to endometriosis are sex and age because endometriosis affects women of child-bearing age. Risk of endometriosis increases with age until women start to go through menopause (Vigano 2004). Race/ethnicity does not seem to be a factor in the development of endometriosis. It has been reported that endometriosis is greatest among women with higher levels of income (Vigano 2004). This finding could relate to the idea that people of lower socioeconomic status have less access to medical care and may account for the undiagnosed population. Use of oral contraception has been shown to suppress the manifestation of endometriosis by regulating the menstrual cycle and promoting lighter periods (Vigano 2004). An environmental factor that may be a cause of endometriosis is exposure to dioxins (Vigano 2004), which are byproducts of industrial work and have been linked to a number of conditions, such as cancer and development issues in children (EPA 2017). The genetic factors of endometriosis are thought to be “inherited in a polygenic/multifactorial mode”, which means the presence of the condition is determined by 2 or more genes and the effects of the environment (Hansen & Eyster 2010). According to the National Institute of Health, having a close relative that has been diagnosed with endometriosis, starting the menstrual cycle at age 11 or earlier, having monthly cycles that are 26 days or less, and/or having menstrual periods that last for 8 or more days may increase one’s risk of endometriosis (NIH 2017). Some factors that could potentially lower one’s risk of endometriosis are pregnancy, starting the menstrual cycle between ages 18 and 20, getting 4 or more hours of exercise per week, and having little body fat (NIH 2017).
Description of Patient
The patient is a 25-year-old woman. The patient started her menstrual cycle at age 12. At age 22 she noticed that the length of her period increased from 7 to 8 days and started to be more painful. At age 24 she started to experience pelvic pain during and around the time of her menstrual period, which increased in severity over time. The patient has an aunt that was recently diagnosed with endometriosis. Her aunt also suffered from chronic pelvic pain and this alerted her to get checked out. During the patient’s clinical exam, the physician thought she could be suffering from pelvic inflammatory disease but notice that pelvic pain was the only symptom that fit with that theory and suggested a laparoscopy. This procedure revealed small masses of tissue were found outside of the patient’s endometrium and the physician diagnosed her with Endometriosis. The physician prescribed the patient an oral contraceptive as a form of hormone therapy to regulate her menstrual periods and prescribed NSAIDs to manage the pain.
The course of the symptoms of endometriosis is difficult to determine because most women report experiencing pain during their menstrual cycle and endometriosis is hard to diagnose without invasive procedures (Hickey 2014). Conditions that have a comorbid relationship with endometriosis include pelvic inflammatory disease, infertility, cardiovascular diseases, and diabetes (Teng 2016). The symptoms of endometriosis affects women physically and psychologically thus having a negative effect on quality of life (Ferreira 2016). This negative effect on quality of life could be due to the severity of pelvic pain, lack of sexual intercourse to avoid a painful experience, and loss of the hope of bearing a child, in the case of infertile individuals. Endometriosis is not curable but it is treatable. Treatment for endometriosis includes pain medications, use of contraceptives, gonadotropin-releasing hormone (Gn-RH) agonists and antagonists (drugs that inhibit the production of hormones that stimulate the ovaries, and in severe cases, removal of endometrial masses (laparoscopy) or hysterectomy (Mayo Clinic 2016). A retrospective study found that over 40% of infertile women were able to conceive a child without any medical assistance after receiving laparoscopic surgery (Lee 2013).