Endometriosis - Malpractice Lawyers Injury Compensation ClaimsLEGAL HELPLINE: ☎ 855 804 7125
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Endometriosis - Medical Malpractice
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