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In the contemporary world, endometriosis constitutes a somewhat significant burden; on the overall quality of life of not only adolescent but also reproductive-aged women. Generally, endometriosis is termed as an enigmatic disorder highly characterized by abnormal growth of endometrial cells/tissue including endometria glands as well as stroma, in extra-uterine locations; thus outside the uterus (Parasar, Ozcan, & Terry, 2017). Endometriosis is to a great extent confined to either the serosal or the peritoneal surfaces/ sites found in the pelvic organs among them the ovaries, uterosacacral ligaments, broad ligaments, Douglass pouch, fallopian tubes, and the pelvic peritoneum (Karaman et al., 2012). However, it also less frequently affects other areas such as the vagina, gastrointestinal tract, inguinal hernia sac, as well as the round ligaments and more rarely affects organs and tissues such as the urinary system, lungs, and the pleura (Karaman et al., 2012).
In accordance to published prevalence estimates, endometriosis affects approximately 10-15% of all women on a global scale predominantly those during the reproductive/premenopausal period of life. Moreover, it affects about 25% of infertile women and about 70% of women suffering from chronic pelvic pain (Parasar, Ozcan, & Terry, 2017). In the US endometriosis affects about 11% of women between the ages of 15 and 44 years.
While the actual cause of the endometriosis disorder remains unknown, there has been several proposed theories to explain the causes which account for the disparate observations; with regard to its pathogenesis. As a result, a unifying theory with regard to the cause of endometriosis remains mystifyingly elusive. Some of the major theories on the causes of endometriosis among women include,
This theory is considered as the oldest principle that provides an explanation of the etiology of endometriosis. The theory of retrograde menstruation asserts that this condition is primarily caused by the retrograde flow/deposition of either sloughed endometrial debris/tissue or cells; thus through the fallopian and ultimately unto the pelvic cavity which occurs during the menstruation period (Agarwal, & Subramanian, 2010). After the back flow, the tissue or cells then implant themselves on a specific or various organs present in the pelvis where it then grows.
According to the theory, endometriosis is caused by extra-uterine cells which abnormally transform or rather trans-differentiate into endometrial cells. Generally, the theory postulates that the disease originates from the metaplasia of specialized cells which are located in the mesothelial lining of not only the abdominal peritoneum but also the visceral (Karaman et al., 2012). Metaplasia theory further asserts that both immunological and hormonal factors are the responsible for stimulating the overall transformation of the normal peritoneal tissues or rather cells into endometrium-like tissues.
Over the years, numerous study have directly related genetic polymorphisms as a major factor that contributes significantly to the overall development of endometriosis. Concerning this, the genetic basis; thus for the development of endometriosis is evidenced by many reports of familial aggregation, whereby, women with an affected first-degree relative are at a higher risk of developing the disease (Karaman et al., 2012).
Immune System Disorder
According to research, autoimmune diseases are extremely common in women that suffer from endometriosis, hence, the immune dysfunction theory asserts that the pathogenesis of endometriosis to a great extent involves a defective immune response in endometriosis patients. Concerning this, the theory argues that regurgitation of the endometrial tissues and cells causes a somewhat inflammatory response consequently causing a defective “immune surveillance” which, in, turn prevents the elimination of menstrual debris and on the other hand promotes the implantation as well as growth of these cells in ectopic sites (Karaman et al., 2012).
Symptoms and Complications
There are numerous symptoms associated with endometriosis which vary, concerning this, while some women tend to experience somewhat mild symptoms others experience moderate to extremely severe symptoms. Moreover, the symptoms generally vary primarily depending on the location of the implants. Despite this, some of the symptoms include pelvic pain which is in most instances associated with menstrual period, a condition termed as dysmenorrhea (Parasar, Ozcan, & Terry, 2017).
Generally, extreme or rather unbearable pelvic cramping and pain usually begins before and might extend for days after menstruation and is often accompanied. Another major symptom is dyspareunia which is refers to extreme pain during sexual intercourse, these two conditions tend to become progressive; hence, chronic and can last up to 6 months (Parasar, Ozcan, & Terry, 2017). Women with endometriosis also experience, heavy menstrual bleeding, periods that last longer than a week, nausea and vomiting, as well as fatigue.
Other symptoms of endometriosis vary in accordance to the location of the implants, for example in the gastrointestinal tract symptoms include rectal bleeding, diarrhea, and colonic obstruction, and in the urinary tract symptoms include ureteral obstruction, hematuria, urinary frequency, and suprapubic or in other instances pelvic pain (Shaw, 1992). Common complications of endometriosis are such as infertility, bladder and intestinal-related complications, inflammation, development of ovarian cysts, increased risk of ovarian cancer, inclusive of both adhesion and development of scar tissue.
Perhaps one of the most challenging aspects of endometriosis is diagnosing the problem since there exists no single test for evaluation. Some of the major strategies for diagnosing the disease is based in the symptoms of pelvic pain including findings from physical exams such as the rectro-vaginal and pelvic exams where the obstetrician-gynecologist physically assess whether there are endometrial implants in the uterus and pelvic walls. While physical examination cannot be entirely relied upon; other diagnosis tests include imaging exams such as through ultrasound, radiologic imaging, as well as through the use of the Magnetic resonance imaging (MRI) (Parasar, Ozcan, & Terry, 2017).
Generally, in diagnosing endometriosis the most common and definitive method is ultimately the surgical methods which requires laparoscopy or laparotomy (Parasar, Ozcan, & Terry, 2017). Surgical laparoscopy is termed as a minimally invasive procedure whereby, a somewhat thin, lighted tube that usually small or rather miniature camera mounted is inserted into the human body through an incision located in the pelvic area. During laparoscopy, biopsies are also commonly conducted in so as to obtain a tissue diagnosis.
Conclusively, several reproductive-related factors have over the years been consistently associated with greater risk for endometriosis. In relation to this, hormonal variation tends to have a somewhat significant impact on the overall risk of developing endometriosis. Concerning this, some of the major risk factors include, shorter lengths of the menstrual cycle, delayed childbearing or rather nulliparity, Alcohol consumption, müllerian duct defects, low body mass index, late menopause, familial history, as well as early age menarche all of which are associated with increased risk (Parasar, Ozcan, & Terry, 2017). On the other hand, application of oral contraceptives, multiple births, regular exercises, late menarche, and prolonged lactation are to a great extent associated with decreased risk of endometriosis.
Karaman, K. et al. (2012). Endometriosis of the Terminal Ileum: A Diagnostic Dilemma. Case Reports in Pathology. Retrieved from: http://dx.doi.org/10.1155/2012/742035
Agarwal, N., & Subramanian, A. (2010). Endometriosis – Morphology, Clinical Presentations and Molecular Pathology. Journal of Laboratory Physicians. The National Center for Biotechnology Information. Retrieved From: doi: 10.4103/0974-2727.66699
Parasar, P., Ozcan, P. & Terry, K. (2017). Endometriosis: Epidemiology, Diagnosis and Clinical Management. Retrieved From: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5737931/
Shaw, W. R. (1992). Atlas of Endometriosis. Illustrated. CRC Press.
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