By Dr. Mapet Gudiel, Ob Gynecologist at Klinika Maharlika in Abu Dhabi
Endometriosis is a condition wherein endometrial tissues which are normally found in the endometrium, the inner lining of the uterus, are found outside the endometrium. It could be adenomyosis, there is thickening of a myometrial surface due to invasion of the endometrial tissues into the myometrium, or endometrial cyst or commonly known as “chocolate cyst”, the enlargement of the ovary due to accumulation of blood coming from ectopic endometrial tissues.
Endometriosis has its characteristic triad of symptoms, meaning if a patient has these 3 symptoms, the number one gynecologic problem that comes to mind is endometriosis.
To date, there’s no known particular cause for Endometriosis, However, most studies point to the estrogen hormone as the culprit. Gynecologists usually use the “menstrual reflux theory” to explain the pathogenesis of endometriosis.
Menstruation is defined as the shedding/sloughing off of the endometrial lining. A woman’s estrogen hormone is responsible for stimulating the endometrium to thicken. So if there is hormonal imbalance wherein the estrogen is more predominant than the progesterone, the endometrial lining becomes thicker and thus menstruation is heavier.
Normally, during menstruation, all menstrual blood is expelled through the vagina. But for some women predisposed to endometriosis, there are menstrual blood that will reflux and thus leading to invasion of the endometrial tissues to the myometrium, to the fallopian tubes, ovaries, and for some, to the intestines.
Now, when these endometrial tissues are implanted on these areas, each time a patient experiences menstruation, these endometrial tissues will bleed – thus giving rise to more health complications such as adenomyosis, endometrial cysts, and so forth.
There are several risk factors predisposing to endometriosis.
The diagnosis of endometriosis is usually made when you already have the clinical suspicion based on the characteristic triad of symptions: dysmenorrhea, dyspareunia and infertility, and you can confirm your diagnosis with a pelvic ultrasound preferably with a transvaginal scan.
In the Philippines, a transvaginal scan especially if done by an OB-GYN sonologist is enough. Here in the UAE, MRI facilities are available.
In some cases, when laparoscopy is done for other purposes, endometriosis can be an incidental finding.
If you suspect that you are suffering from endometriosis, you should see to consult with an OB-GYN specialist since this disease is a progressive one – meaning if you are left untreated, it could become worse because as long as you are menstruating, there is menstrual reflux which could lead to more chances for ectopic endometrial tissue implantation. This could ruin your chances of having children.
Likewise, the management of endometriosis is either medical or surgical depending on the severity of the case – so if it is still not that severe, it could be managed medically and you can still lead a normal life because suffering from pain or dysmenorrhea is not an experience to be suffered from by any woman. I used to have a patient who had a severe form of dysmenorrhea that even if she was given Nubain IV, the patient remained in pain.
You can contact Klinika Maharlika Abu Dhabi branch at 02 631 0209 and our clinic is located in Al Saif Tower, 3rd floor, Electra Street (back of Al Raha Hospital) in Abu Dhabi.