Wednesday, October 29, 2008

Extragenital Endometriosis

Endometriosis is a pathological process, characterized by abnormal growth of cells that is similar to the cells lining in the uterus. There can be found elsewhere outside the uterus. As for the implant growing at different organs and system, they are termed extragenital Endometriosis.
The endometrial cells share the same properties with the original one inside the uterus, they shed and bleed in each menstrual cycle.
The implants can be in the urinary bladder, intestine, kidneys, lungs, esophagus, post operative scar, conjunctiva, brain.

causes: still unknown by the experts. They are suggesting the immune and the hormonal system play an important role.

Theory 1:
Back flow of the menstrual blood carrying endometrial cells into the target site, via bloodstream or lymphatic system, they reach to other organs and system. This could also happen during abdominal operation, c-section, uterine perforation, conservative myomectomy. This is the most likely explanation for the rare cases of endometriosis that develop in the brain and other organs distant from the pelvis, thus migration theory.

Theory 2: embronic genesis. There are areas lining the pelvic organs possess primitive cells that are able to grow into other forms of tissue, such as endometrial cells. (This process is termed coelomic metaplasia.)

Theory 3:
Dysfunction of the immune response system, which may affect the body's natural ability to recognize and destroy any misdirected growth of endometrial tissue.

Theory 4: Hormonal disorder. Steroidal and gonadotropic hormones disorder. Hyperestrogeny and increase FSH( follicle stimulating hormone) lead to rise of the activity of the implant endometrial cells.

Who is affected?
Women in their 25-35. Some reports show girls as young as 11 years of age.
More commonly found in white women as compared with African American and Asian women. Studies further suggest that endometriosis is most common in taller, thin women with a low body mass index (BMI). Delaying pregnancy until an older age is also believed to increase the risk of developing endometriosis.

clinical picture:
1. Intestinal endometriosis: abdominal pain coinside with menstruation. Sometimes intestinal obstruction.

2. Endometriosis of the urinary bladder: disordered micturation or even blood in urine, ( hematuria).

3. Endometriosis of the lung: coughing with blood ( hemoptysis) and chest pain during menstruation.

4. brain endometriosis: headache and seizures.

How is extragenital endometriosis diagnosed?

Other symptoms related to endometriosis include:pain during intercourse, lower abdominal pain, diarrhea and/or constipation, tenesmus( bowel evacuation) during menstruation, low back pain, irregular or heavy bleeding( menorrhagia), hematuria.

In rectovaginal exam (one finger in the vagina and one finger in the rectum), the doctor can feel nodules (endometrial implants) behind the uterus and along the ligaments that attach to the pelvic wall. At other times, no nodules are felt, but the examination itself causes unusual pain or discomfort.

Chest xray
Ultrasound: reveal nodules or endometriotic cysts
laparoscopy: corroborated with biopsy. therapeautic laparoscopy can also be done during this manipulation.

tumor marker test: Cancer antigen 125 (CA 125) in blood, but it's not as sensitive to mild or moderate disease. As with cancer, CA 125 doesn't perform well as a screening test for endometriosis because it's least sensitive when the disease is in its earliest stages.

depends on severity and the implants.
2 types: medication or surgery

For pain: NSAIDS (ibuprofen)
For the hormones:
1. Goserelin:Zoladex

2. Norcolut

3. Utrogestan

as for endometriosis the treatment as below:

Gonadotropin-releasing hormone analogs (GnRH analogs)

Gonadotropin-releasing hormone analogs (GnRH analogs) have been effectively used to relieve pain and reduce the size of endometriosis implants. It prevents menstruation and lowers estrogen levels, causing endometrial implants to shrink.

Oral contraceptive pills

Oral contraceptive pills (estrogen and progesterone in combination). The most common combination used is in the form of the oral contraceptive pill (OCP).


Progestins (Provera, Cycrin, Amen) are more potent than birth control pills and are recommended for women who do not obtain pain relief from or cannot take a birth control pills. But not recommended in women with plan pregnancy.

Danazol (Danocrine)

a synthetic drug that creates a high androgen (male type hormone) and low estrogen hormonal environment by interfering with ovulation and ovarian production of estrogen. Eighty percent of women who take this drug will have pain relief and shrinkage of endometriosis implants, but up to 75% of women develop side effects from the drug.

Aromatase inhibitors

they block the conversion of hormones such as androstenedione and testosterone into estrogen and by blocking the production of estrogen from endometrial implants themselves. This deprives endometriosis of the estrogen it needs to grow. Early studies suggest that aromatase inhibitors are at least as good as other hormonal approaches and may be better tolerated. Also used in treating breasts cancer.
  • Lupron depo shot is also a gonadotropin and is used to lower the hormone levels in the woman's body to prevent any growth of endometriosis. The lupron shot is given in 2 different doses a once a month for 3 month shot with the dosage of (11.25mg) or a once a month for 6 month shot with the dosage of (3.75mg). This puts the body into a "medicated menopause", resulting in side effects such as mild to severe hot flashes or a drop in bone density (which usually recovers after treatment). The therapy is less invasive than surgical approaches.
Laparoscopy. Endometrial implants may be excised or obliterated by laser. If the disease is extensive and anatomy is distorted, laparotomy (opening of the abdominal wall via a larger incision) may be required.
In severe cases of endometriosis, a total hysterectomy and the removal of both ovaries may be the best treatment.
Surgery is always combined with oral medication to suppress recurrent.

1 comment:

Gorgeous Ol' Eve Loves Vanilla. You? said...

My obst/gynae teacher told us that women should give birth constantly because back in those days, when women bred factories.. there were hardly endometriosis cases.

Because women never had time for menstruation, therefore to backflow of blood ;)

template by