Endometriosis is a condition in which tissue resembling the mucous membrane of the uterus (the endometrium) grows outside the uterine cavity.
Dr. David Soriano – a leading specialist in the treatment of endometriosis. Head of the Endometriosis Unit, Chaim Sheba Medical Center
The most common areas for the growth of tissue outside of the uterus in the pelvic organs are the ligaments that hold the uterus, pelvic peritoneal membrane and reproductive organs (ovaries and fallopian tubes), as well as the area around the uterus.
Endometrial tissue injury often leads to an increase of anatomically similar to the reproductive organs – bladder and colon. In rare cases, the tissue is detected in muscle tissue of the uterus, and even in distant organs such as the diaphragm, lungs, or brain.
Endometrial tissue reacts to hormonal changes that occur during the menstrual cycle. Also endometrial tissue that are outside of the uterus responds to these hormonal changes. It causes local inflammation, immune activation and inflammation hypersecretion materials that cause pain. It also forms scar tissue or adhesions around the endometriosis and adjacent organs, and the development of ovarian cysts (vesicles filled with liquid brown).
Endometriosis can sometimes cause severe pain during menstruation, nausea and fatigue in young girls, and they need painkillers. Pain and feeling on the verge of losing consciousness require diagnosis. Especially in families where the mother or sister suffered severe dysmenorrhea (pain during menstruation).
The combination of chronic pelvic pain during menstruation and ovulation with particular concern requires careful study. In this case, most likely, this is due to endometriosis, and early diagnosis can significantly help.
Endometriosis can cause a wide variety of symptoms. Its characteristic symptoms: severe back pain before and during menstruation, increased bleeding during menstruation, severe pain in the pelvis or lower abdomen for a few months, severe stomach cramps during menstruation, nausea, vomiting and feeling on the verge of loss of consciousness during menstruation, pain during sex, gastrointestinal disorders such as constipation, painful exit, diarrhea, especially during menstruation, bleeding from the rectum (during menstruation), pain or urgency (especially during menstruation) infertility.
Diagnosis of endometriosis
Suspicion that the woman may suffer from endometriosis usually based on one or more of the features described above. Women with a family history of endometriosis in need of early diagnosis and monitoring.
Doctor examines and performs ultrasound. Upon detection of typical endometriosis doctor takes a sample of tissue for the laboratory examination.
The only way to take a sample of this method of direct internal inspection of laparoscopy (introduction of an optical instrument through a small incision in the navel, through which specialist can examine the abdomen and pelvic organs). Laparoscopy is an invasive surgical procedure that is performed under general anesthesia.
Sometimes the diagnosis of endometriosis is set randomly during laparoscopy performed for another purpose, such as resection of ovarian cysts or check the status of women tubal infertility or severe pain ovaries with suspected ovarian torsion. The advantage of laparoscopy in the opportunity to take a tissue sample (biopsy) for accurate diagnosis of endometriosis, assess the severity of the disease, identify the location, size and number of lesions in the pelvis. The skilled artisan will find the lesion and can assign an effective treatment.
Treatment of Endometriosis
Currently there is no way a complete cure of the disease, but our skilled professionals due to years of experience may recommend medications or surgical techniques that help to significantly alleviate the symptoms and increase a woman’s chances of pregnancy. Effective and proper treatment depends on the type and severity of symptoms, age of the woman and her readiness for operation.
When the main symptom is pain before and during menstruation, primary care, which is needed by a woman, it should be pain relief. The next step could be a long and continuous treatment contraceptive drugs. Tablets inhibit endometriosis, hormone stimulation and tissue structures is reduced uterine bleeding during the menstrual cycle. This treatment, like other hormonal therapies, allows to inhibit ovulation cycles are aimed at reducing the size of the lesions and a decrease in inflammation around them.
In more severe symptoms, absence of response to treatment, infertility, doctor may recommend laparoscopic surgery to remove endometriosis. Especially in cases of women who want to become pregnant, surgical treatment shows better results than drug therapy.
Laparoscopic surgery in the treatment of endometriosis
Laparoscopy is the tool of choice accurate diagnosis of endometriosis, its location and severity, as well as it allows to perform a surgery without opening the abdominal cavity. The doctor performs only a puncture in the navel.
In the study the abdomen and pelvis expert can assess the condition of the ovaries and fallopian tubes, uterus, check the integrity of the genital organs, find endometriosis, adhesions, cysts, endometrial determine the extent of involvement of the pelvic organs.
Endometriosis is manifested in different ways, with morphology typical for a wide range of glucose lactate introduced for determining the size of endometrial lesions from 1 mm to 10 cm. Since lesions appear in different forms depending on the period of development, there is a chance during surgery miss endometriosis. Therefore, it is important to carry out the operation with the aim of a diagnostic laparoscopy pathological tissue sampling with a view to identifying it.
Purpose of the operation in each case individually. This can be a diagnosis, a division of adhesions and removal of ovarian cysts, research into the causes of infertility and infertility treatment because of endometriosis.
The most common reasons for performing laparoscopic surgery in women with endometriosis are the presence of a large ovarian cyst, intense pelvic pain that does not respond to treatment, or repeated unsuccessful attempts to become pregnant.
The advantages of laparoscopy
The main advantages of laparoscopy include:
– Diagnosis and treatment without opening the abdominal cavity
– Smaller damages than after open surgery
– Less chance of infection during surgery
– Quick recovery
In the course of the treatment of women with endometriosis and infertility takes into account such factors as the age of the woman, the duration of infertility, pregnancy last, the presence of ovarian cysts and the degree of endometriosis.
The overall pregnancy rate after laparoscopic procedures in Israel – about 50%.
Benign tumors of the uterus (fibroid)
Amenorrhea (absence of menstruation)
Dysmenorrhea (painful menstruation)
Menorrhagia (heavy menstrual periods)
Vaginal infections (vaginitis), including fungal, bacterial, protozoal and viruses
Cancer and precancerous genital conditions including ovaries, fallopian tubes, uterus,cervix, vulva