Alternative Medicine For Ovarian Cyst
Endometriosis (from endo, "inside", and metra, "womb") is a medical condition in women in which endometrial cells are deposited in areas outside the uterine cavity. The uterine cavity is lined by endometrial cells, which are under the influence of female hormones. Endometrial cells deposited in areas outside the uterus (endometriosis) continue to be influenced by these hormonal changes and respond similarly as do those cells found inside the uterus. Symptoms often exacerbate in time with the menstrual cycle.
Endometriosis is typically seen during the reproductive years; it has been estimated that it occurs in roughly 5% to 10% of women. Symptoms depend on the site of implantation. Its main but not universal symptom is pelvic pain in various manifestations. Endometriosis is a common finding in women with infertility.
Symptoms
Pelvic pain
A major symptom of endometriosis is severe recurring pelvic pain. The pain can be mild to severe cramping that occurs on both sides of the pelvis, radiating to the lower back and rectal area and even down the legs. The amount of pain a woman feels is not necessarily related to the extent or stage (1 through 4) of endometriosis. Some women will have little or no pain despite having extensive endometriosis affecting large areas or having endometriosis with scarring. On the other hand, women may have severe pain even though they have only a few small areas of endometriosis. Symptoms of endometriosic-related pain may include:
- dysmenorrhea – painful, sometimes disabling menstrual cramps; pain may get worse over time (progressive pain), also lower back pains linked to the pelvis
- chronic pelvic pain – typically accompanied by lower back pain or abdominal pain
- dyspareunia – painful sex
- dyschezia – painful bowel movements
- dysuria – urinary urgency, frequency, and sometimes painful voiding
- adenomyosis - painful and/or profuse menses
Infertility
Many women with infertility have endometriosis. As endometriosis can lead to anatomical distorsions and adhesions (the fibrous bands that form between tissues and organs following recovery from an injury), the causality may be easy to understand; however, the link between infertility and endometriosis remains enigmatic when the extent of endometriosis is limited. It has been suggested that endometriotic lesions release factors which are detrimental to gametes or embryos, or, alternatively, endometriosis may more likely develop in women who fail to conceive for other reasons and thus be a secondary phenomenon; for this reason it is preferable to speak of endometriosis-associated infertility in such cases.
Other
Other symptoms may be present, including:
- nausea, vomiting, fainting, dizzy spells, vertigo or diarrhea—particularly just prior to or during the period or after
- frequent or constant menses flow
- chronic fatigue
- heavy or long uncontrolable menstrual periods with small or large blood clots
- some women may also suffer mood swings
- extreme pain in legs and thighs
- Back pain
- extreme pain from frequent ovarian cysts
- Pain from adhesions which may bind an ovary to the side of the pelvic wall, or they may extend between the bladder and the bowel,uterus, etc
- extreme pain with or without the presence of menses
- mild to severe constipation
- frequent uti's (urinenary tract infections)
- urgent diarrhea
- difficulty carrying out normal day to day tasks
- incontinence
- anemia
In addition, women who are diagnosed with endometriosis may have gastrointestinal symptoms that mimic irritable bowel syndrome.
Patients who rupture an endometriotic cyst may present with an acute abdomen as a medical emergency.
Occasionally pain may also occur in other regions. Cysts can occur in the bladder (although rare) and cause pain and even bleeding during urination. Endometriosis can invade the intestine and cause painful bowel movements or diarrhea.
In addition to pain during menstruation, the pain of Endometriosis can occur at other times of the month and doesn't have to be just on the date on menses. There can be pain with ovulation, pain associated with adhesions, pain caused by inflammation in the pelvic cavity, pain during bowel movements and urination, during general bodily movement i.e. exercise, pain from standing or walking, and the final insult, pain with intercourse. But the most desperate pain is usually with menstruation and many women dread having their periods. Also the pain can start a week before menses, during and even a week after menses, or it can be constant. There is no known cure for Endometriosis.
Epidemiology
Endometriosis can affect any woman, from premenarche to postmenopause, regardless of her race or ethnicity or whether or not she has had children. It is primarily a disease of the reproductive years. Estimates about its prevalence vary, but 5–10% is a reasonable number, more common in women with infertility (20–50%) and women with chronic pelvic pain (about 80%). As an estrogen-dependent process, it can persist beyond menopause and persists in up to 40% of patients following hysterectomy.
Endometriosis in postmenopausal women does occur and has been described as an aggressive form of this disease characterized by complete progesterone resistance and extraordinarily high levels of aromatase expression. In less common cases, girls may have endometriosis symptoms before they even reach menarche.
Co-morbidity
Endometriosis bears no relationship to endometrial cancer. Current research has demonstrated an association between endometriosis and certain types of cancers, notably ovarian cancer, non-Hodgkin's lymphoma and brain cancer. Endometriosis often also coexists with leiomyoma or adenomyosis, as well as autoimmune disorders. A 1988 survey conducted in the USA found significantly more Hypothyroidism, fibromyalgia, chronic fatigue syndrome, autoimmune diseases, allergies and asthma in women with endometriosis compared to the general population.
Pathology and locations
Active endometriosis produces inflammatory mediators that cause pain and inflammation, as well as scarring or fibrosis of surrounding tissue. Triggers of various kinds, including menses, toxins, and immune factors, may be necessary to start this process. Typical endometriotic lesions show histologic features similar to endometrium, namely stroma, endometrial epithelium, and glands that respond to hormonal stimuli. Older lesions may display no glands but hemosiderin deposits as residual. To the eye, lesions can appear dark blue or powder-burn black and vary in size; red, white, yellow, brown or non-pigmented. Some lesions within the pelvis walls may not be visible to the eye, as normal-appearing peritoneum of infertile women reveals endometriosis on biopsy in 6–13% of cases. Additionally other lesions may be present, notably endometriomas of the ovary, scar formation, and peritoneal defects or pockets. Endometrioma on the ovary of any significant size (Approx. 2 cm +) must be removed surgically because hormonal treatment alone will not remove the full endometrioma cyst, which can progress to acute pain from the rupturing of the cyst and internal bleeding. Endometrioma is sometimes misdiagnosed as ovarian cysts.
Early endometriosis typically occurs on the surfaces of organs in the pelvic and intra-abdominal areas. Health care providers may call areas of endometriosis by different names, such as implants, lesions, or nodules. Larger lesions may be seen within the ovaries as endometriomas or "chocolate cysts", "chocolate" because they contain a thick brownish fluid, mostly old blood. Endometriosis may trigger inflammatory responses leading to scar formation and adhesions.
Most endometriosis is found on these structures in the pelvic cavity where it can produce mild, moderate, and/or severe pain felt in the pelvis and/or lower back areas. The pain is often more severe before, during, and/or after the menstrual period:
- Ovaries (the most common site)
- Fallopian tubes
- The back of the uterus and the posterior cul-de-sac
- The front of the uterus and the anterior cul-de-sac
- Uterine ligaments such as the broad or round ligament of the uterus
- Pelvic and back wall
- Intestines, most commonly the rectosigmoid
- Urinary bladder and ureters
Bowel endometriosis affects approximately 10% of women with endometriosis, and can cause severe pain with bowel movements.
Endometriosis may spread to the cervix and vagina or to sites of a surgical abdominal incision.
Less commonly lesions can be found on the diaphragm. Diaphragmatic endometriosis is rare, most always on the right hemidiaphragm, and may inflict cyclic pain of the right shoulder just before and during menses. Rarely, endometriosis can be extraperitoneal and is found in the lungs and CNS.
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