Endometriosis - Medical Malpractice LawyersLEGAL HELPLINE: ☎ 855 804 7125
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Endometriosis a gynecological problem where the normal endometrial lining of the uterus travels up the fallopian tube and ends up outside the uterus, where it implants and grows independently. It can grow on the uterine wall, the ovaries, the bowels and the tissue surrounding the pelvic structures. In rare cases, it can spread beyond the boundaries of the pelvis.
The endometriosis tissue acts just like regular endometrial tissue. It proliferates in the days before the menstrual cycle and it bleeds during the menstrual period. When it acts like endometrial tissue and bleeds, it causes a great deal of pain during the menstrual period. Cysts can form, which are called endometriomas, and the surrounding tissue can become very irritated.
The main symptom of endometriosis is pain in the pelvis, which is usually associated with the menstrual period. This is much greater pain than is associated with the regular menstrual period. It gets worse over time.
Other signs and symptoms of this disorder include the following:
- Pain with intercourse, that usually occur during or following sexual activity.
- Pain with urination or bowel movement, especially if the endometrial tissue lies on the bladder or bowel.
- Excessive bleeding, including bleeding between periods.
- Infertility. Many women with endometriosis seek help with an infertility specialist.
- Miscellaneous symptoms include diarrhea, bloating, nausea, fatigue, and constipation, especially during menstrual periods.
Endometriosis is sometimes misunderstood and is mistaken for other diseases, such as an ovarian cyst or pelvic inflammatory disease. It can even be mistaken for irritable bowel syndrome, which causes similar symptoms.
No one knows the real cause of endometriosis but there are several different theories on how it occurs:
- It can be due to retrograde menstruation. This is considered the most common reason behind getting endometriosis. The menstrual tissue passes up the fallopian tubes during menstruation and it settles within the pelvic cavity instead of outside the body where it belongs.
- The cells in the abdominal and pelvic cavities have embryonic cells that grow into endometrial cells.
- There can be implantation due to a C section or endometrial scar that contains endometrial tissue within the scar.
- Endometrial cells can transport themselves through the lymphatic system or through the blood vessel.
- The immune system can be disordered to the point that the body is unable to recognize the abnormal cells growing outside of their normal location.
There are several risk factors of endometriosis, which include the following:
- Never giving birth in the past
- Having a first or second degree relative that suffered from endometriosis
- Having a certain medical condition that prevents the passage of menstrual tissue outside of the body
- Having a history of a pelvic infection
- Having a history of a uterine abnormality
It often happens many years after the onset of menarche (the first period). If you get pregnant, the signs and symptoms go away temporarily. The signs and symptoms go away as soon as you reach menopause, unless you take an estrogen containing supplement.
The complications of endometriosis include infertility. About one third to one half of women with endometriosis has some form of infertility. There can be tube blockage with endometriosis tissue, preventing ovulation. Women with mild to moderate disease, still have a chance of conception and the ability to carry the pregnancy to term. These women are advised to have children as soon as possible before the endometriosis gets worse.
Another possible complication includes ovarian cancer, which occurs at a higher than normal rate in women who get endometriosis. The other type of cancer that can occur is endometriosis-associated adenocarcinoma, a rare type of cancer that happens in older women who have had endometriosis.
Diagnosis & Treatment
Endometriosis can be diagnosed via a pelvic examination and ultrasound of the pelvis, which can show blood, endometriomas and endometrial tissue. A laparoscopy shows a much better picture of what is going on in the pelvic area.
Treatment includes medication for pain and surgery to remove as much endometrial tissue as possible. Hormone therapy with birth control hormones or other combinations of hormones can reduce pain and bleeding in women who do not desire a pregnancy.
Medical Malpractice Lawyers
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Endometriosis involves the growth of endometrial (uterine lining) tissue outside of the uterus. The tissue tends to travel up the fallopian tubes and get out into the pelvic space. There it connects to normal tissue and begins to grow pseudo tumours that bleed during menses and cause pain due to pressure on nerves and other tissues and due to the bleeding during menses. The tumours of endometriosis are called endometriosis implants. They are most commonly found on the fallopian tubes, the ovaries, the outer surface of the uterus, the intestines or on the lining of the pelvic space. Other places endometrial implants can be found are the cervix and vagina externally or on the bladder, internally. Very rarely, the endometriosis implants can be bloodborne and can be found in old surgical scars or in the liver or brain.
Endometriosis affects only women in their reproductive years. It is believed to affect between 3 percent and 18 percent of women and involve more than a million women. It is one of the leading causes of pelvic pain in women and can affect girls as young as 11. The most common ages of diagnosis are between 25 and 35 years old. It can lead to infertility in women. Delaying pregnancy until the later years of life and being tall and thin seems to predispose a woman to getting endometriosis.
The exact cause of endometriosis is unknown. It is believed to be caused by a back up of menstrual blood and tissue through the Fallopian tubes. This is called retrograde menstruation. It is also possibly caused by primordial cells that turn into endometrial lining cells in the pelvic space. Direct transfer of endometrial cells to pelvic tissue during a caesarean section or other uterine surgery can also be part of the reason behind getting endometriosis. An altered immune system is seen in women with endometriosis so they may not be able to destroy the aberrant tissue. There seems to be mildly higher risk of cancer of the ovary in women who have endometriosis.
The diagnosis of endometriosis is based on having the symptoms of painful periods and pelvic pain. The doctor can to a rectovaginal examination, which can reveal a mass or just tenderness on examination. Sometimes several nodules can be felt on the back of the uterine wall. An ultrasound can be done to show evidence of endometrial implants. It can visualize the bladder, uterus, fallopian tubes and ovaries. If this is not helpful, a laparoscope is used to identify the implants using a camera inserted into the posterior vagina or into the abdomen. In a laparoscopy, the tissue seen can be biopsied for later evaluation in a laboratory. This can exclude the possibility of malignant tumours being present in the pelvis.
Endometriosis can be treated by means of surgery or medications. Sometimes both modalities are used. The goal of treatment is to preserve fertility by also treating the pain and other symptoms associated with endometriosis.
Medications used in endometriosis include the use of nonsteroidal anti-inflammatory medications such as naproxen and ibuprofen. They control both the pain and inflammation of the tissues seen in endometriosis. They block prostaglandin production, which blocks the pain. This medical use of NSAIDs are particularly used in those patients who have not been surgically treated and who have presumptive endometriosis on the basis of having pain during menstruation.
Another treatment includes gonadotropin-releasing hormone analogs. They relieve the pain and reduce the size of the endometrial implants by suppressing oestrogen and progesterone production in the body. In many ways, these medications mimic menopause. It is given by nasal spray and by injection. Side effects include hot flashes, irregular vaginal bleeding, vaginal dryness, fatigue, mood swings and loss of bony density. It is possible to add back small amounts of oestrogen and progestins in a pill form so that the side effects can be avoided.
Birth control pills can be used to treat endometriosis. The woman can take the pill continuously and not take the placebo pills found in the birth control package. This limits the lining of the uterus and diminishes the pain associated with bleeding episodes.
Depo-Provera or other forms of progesterone can limit the pain and growth of endometrial implants. The major side effects include bloating, weight gain, breast tenderness, depression and irregular uterine bleeding. This form of birth control is not recommended for those who are planning a pregnancy.
Danazol is recommended for severe endometriosis. It is a synthetic androgen that blocks the ovulation and ovarian production of oestrogen and progesterone. It gives pain relief in up to eighty percent of women. Side effects include weight gain, acne, oedema, reduction in breast size, oily skin and hirsuitism.
Aromatase inhibitors are a rather new approach to the management of endometriosis. These block local oestrogen formation within the endometrial implants themselves. They include Arimidex and Femara.
Surgical treatment of endometriosis includes laparoscopic or open surgery to remove and or burn off the implants. This is an effective treatment with few after effects.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here