During the menstrual cycle of a woman , the uterine lining is shed by the body (endometrium), leading to menstrual blood flow or periods. But sometimes the shed endometrium flows backward through the fallopian tubes into the pelvis. This is known as retrograde menstruation, and it can lead to endometriosis.
Retrograde menstruation is a distinct possibility during periods in any woman with a normal open fallopian tube. However, around 20-25 percent of women have the genetic predisposition and changed immunological milieu, which allows this displaced endometrium to develop in ectopic places in the ovaries, in the form of cysts, in the back of the uterus, caesarean section scar, belly button, nose, or the lungs.
When a woman with endometriosis bleeds on the outside each month, she also has progressive bleeds on the inside. Most of the time, it is an incidental finding during a health check-up, a routine pelvic scan, or to discuss infertility.
Endometriosis can cause anatomical distortion in the pelvis and ovaries, and the formation of endometrial cysts in the ovaries can compress normal ovarian tissue, diminishing the number of egg generating follicles in 25-30 percent of infertile women. The immunological milieu becomes toxic for the egg when the anatomical structure is disrupted, reducing sperm motility in the female pelvis and the fertilization of the egg and sperm.
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According to the Endometriosis Society of India, endometriosis affects over 25 million females in India, with the majority not being diagnosed until their 30s or 40s.
The most prevalent symptom is dysmenorrhea or period pains, followed by chronic pelvic pain, painful intercourse, painful passing of stool during periods known as dyschezia, endometriosis in the bladder, and blood in the urine. Those who have endometriosis in the caesarean section scar, due to the tissue deposited there during childbirth, may have an inflammation each month.
Not just that, adenomyosis (endometriosis in the muscle of the womb) causes extremely painful periods, and some women are completely incapacitated during the first few days of menstruation, requiring complete bed rest, hot water bags, and other quality-of-life measures.
Menopause, symptomatically, improves the condition, as the lack of estrogen hormone, stops the tissue from proliferating. Menopause, however does cause symptoms such as mood swings, vaginal dryness, hot flushes, and night sweats in 2.2 percent of women. However, in 2% of women post-menopause, hormone replacement therapy and obesity may allow the endometriosis to proliferate.
Although the diagnostic accuracy is limited, clinical examination, including vaginal examination where appropriate, should be considered in individuals with suspected endometriosis to find deep nodules or endometriomas. Ultrasounds, MRIs, and laparoscopies are commonly used to diagnose endometriosis.
Depending on the aspirations of the patient and the severity of the situation:
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