The disease affects about 10% of women, and begins once puberty and menstruations begin and ends at menopause onset; centering on reproduction and menstruation (Alini, Ashrafi, Arabipoor, Shahrokh-Thraninejad, Sadatmahalleh, & Akhond, 2018, Palla, 2017). Many features are diagnostic of the illness, including symptoms, treatment, and a variety of types. Diagnostics have come a long way when it comes to endometriosis, though many more developments still need to be made. In the beginning, women would seek professional help because they were having issues with child conception. The women were around their 40’s, so doctor’s decided to use a procedure known as a laparotomy.
This procedure was only conducted as a last resort considering the abdominal cavity was to be cut open so the doctor could observe firsthand what was going on inside their patient. As a result, younger females were not diagnosed with endometriosis because doctors were not willing to conduct a laparotomy on women that could still theoretically give birth (Wood, Guidone, &Hummelshoj, 2016). A few years later laparoscopy was created, which is less invasive than laparotomy. This new development, now the more preferred treatment, caused laparotomies to be the method only used when the disorder is bad enough that no other treatments are an option (Wood, 2011). When conducting a laparoscopy, a long narrow camera is inserted into the abdomen through a small incision near the navel.
This allows for any lesions to be seen due to the cameras ability to magnify tissues; specifically endometrial lesions. Endometriosis may now be detected in younger women since it will not compromise any chances of becoming pregnant, if able. Laparoscopy is now mandatory for diagnostic criteria, and generally a biopsy is performed in order to determine if the cell is cancerous or if in fact endometriosis can be diagnosed (Wood et al., 2016). If the discovered endometriosis is not serious, then the laparoscopy being performed for diagnostic purposes will be paired with operative laparoscopy; a surgical procedure to remove the lesions. The pairing of the two will allow for diagnosis and treatment to be conducted at the same time. An exception to this is if endometriosis is found around the bowl; time for surgery preparations will have to be made. When it comes to less severe cases, gynecologists are able to treat the disorder, and only a limited amount are able to treat severe cases. If diagnosed with severe endometriosis, most cases will be referred to a surgeon to remove lesions (Wood, 2011).
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Several symptoms are characteristic of endometriosis. No matter what the symptom may be, they must be present for six months before any diagnosis may be considered (Alini et al, 2017). The most well-known symptom is painful cramps during menstruation due the lesions and their potential ability to form nerves and bleed just as when endothelial tissues do when menstruating; causing inflammation among surrounding areas and irritating the lesions themselves (Stratton & Berkley, 2011). Another symptom that is known to this disorder is pain during intercourse (Alini et al, 2018). Pain may occur because, depending where lesions are in the body, they may become irritated and cause pain. Alternatively, infertility could be an additional symptom experienced. This could be a result of how an oocyte of a healthy woman is different than that of an oocyte of a woman with endometriosis. The diminished oocyte may have less mitochondria and a corrupted spindle for example (Sanchez, Vanni, Bartiromo, Papaleo, Zilberb, Candiani,… & Vigano, 2017).
This idea is eluding to the idea that the corrupted oocytes may be the reason that pregnancy may not be achievable. Or it may explain why miscarriages occur, the cell is not developed the way it should be therefore the pregnancy will not be able to be carried out. Infertility may occur yet another way, two proteins within the body work together to prevent pregnancy from occurring. IFN-¡ controls stopping sperm from moving easily, and TNF-a is involved in follicular rupture – marking the beginning of ovulation. These proteins are designed to act together so ovulation may begin and sperm contain the ability to slow down for implantation, allowing for fertilization to occur. Increased levels of these proteins will create a toxic environment, therefore if a pregnancy were to happen to result, it would not survive due to an unsuitable environment. Both of these proteins acting together would also decrease the sperms ability to move towards the desired egg, which would also prevent implantation.
Both proteins are found in abundance in a women with endometriosis compared to a healthy female (Vassiliadis, Relakis, Papageorgiou, & Athanassakis, 2005). Treatment for endometriosis is controversial, and not widely understood based on the fact that causation has yet to be discovered. Two routes are generally taken when treating endometriosis; surgery or hormones. There are some that claim medication is preferred to be the first route a patient should take, potentially because the patient will feel better and it is noninvasive (Sheaves, 2013). Hormones, like birth control, simply suppress the symptoms; they will not cure the disorder. If the patient is suffering of cramps to the point they are unable to stand up straight during menstruation, hormones are known to suppress that characteristic, and allow that patient to function normally. In reality, the patient will still have endometriosis, but will no long have that symptom present due to its suppression.
The only sure way to be rid of the disorder is removal through surgery (Wood et at., 2016). Laparoscopic procedures may be performed, as discussed previously, but the lesions or cysts may be removed two different ways. First, removal may be achieved through excision; the most effective method. Excision requires the lesion to be cut from the body with extreme care so a pathologist may examine to determine if the tissue may be cancerous. The next method is coagulation, which removes lesions by burning them off. An issue with this method is that the lesions could grow back or healthy tissue could be destroyed in the process (Wood, 2011). Another reason excision is better is that it seems by conducting coagulation the patient may have a harder time in determining if those tissues are cancerous; which would be problematic if they were to grow back. Diagnosis of endometriosis has been proven difficult for many different reasons. First, there are no simple tests designed solely for endometriosis (Palla, Karaolanis, Katafigiotis, & Anastasiou, 2017).
Where the flu has a physical test and a broken bone can be seen on x-ray, endometriosis does not have a simple noninvasive test. The only true way to tell if endometriosis is present is through use of laparoscopy, though other modalities are quickly becoming more known for their diagnostic purposes. Computed Tomography (CT) is not the preferred modality for diagnosing because of the expense and low results. Magnetic resonance imaging (MRI) is useful for the pelvis, abdomen, uterus, all endometria areas, and can aid in determining whether surgery is a suitable option. MRI is one of the best options to choose due to its high detectability, but also has a downfall due to not determining endometriosis of the ureters specifically (Palla, 2017). Findings show that up to half the nephrons of the kidney could potentially be lost in those with endometriosis of the ureters. A useful diagnostic test that may be performed is a renal isotope scan, and it is a nuclear medicine scan that allows the radiologist to check the reliability of the kidneys. For this process to work, a radioactive tracer is attached to a molecule that moves it through the ureters to the kidney; gamma rays are then emitted and the resulting images are then recorded (Paknikar, 2016).
Ureteral endometriosis is generally only found when a woman is infertile and is seeking laparoscopic treatment as a result (Palla, 2017). Another idea that has been proposed is that the body mass index (BMI) may play a role in endometriosis. The key idea behind this is that low BMI and high BMI are known to have abnormal menstrual cycles, therefore body habitus is very important. Those of a higher BMI are known to have a decreased fertility rate, and those within the lower BMI ranger tend to miss their menstrual cycles altogether. Since BMI is so vital in this, consideration of the true body make up must be taken; that is the muscle to fat ratio. This is achieved through use of x-ray, specifically the dual-energy x-ray absorptiometry (DXA). DXA is used to narrow down the causation of endometriosis because differentiation of tissue and fat can be determined and identification of any similarities among cases may be noted (Backonja, Hediger, Chen, Lauver, Sun, Peterson, & Louis, 2017). Endometriosis has been linked to ovarian cancer. Not all forms of endometriosis, whether it be of infertility issues or simply mild to moderate stages, are of the same malignancy when it comes to potential linkage (Hidemann, Hartwell, Heidemann, & Jochumsen, 2014).
Because of the increased link, that is why routine biopsies are performed of the lesions removed during any and all procedures. For endometriosis to form, many mutations within the body are necessary to form. Within these mutations, a potential result, besides endometriosis, is cancer; specifically ovarian cancer (Dawson, Fernandez, Anglesio, Yong, & Carey, 2018). Endometriosis is a complex disorder that is underdiagnosed and misunderstood. More research will need to be conducted to further the understanding as to why this disorder occurs, and that will contribute to putting an end to endometriosis. Symptoms are crucial in the diagnosis of endometriosis, and the understanding the symptoms are real is the main component. Many treatments have come into play over the last few years, especially the less invasive radiologic modalities; and more will be discovered with conducted research.
