Health Update

by Dr. Brix Pujalte

A QUICK check of “sheol” (read quotation) shows it is esoteric Hebrew for “grave” or “pit” or sometimes the Judaic example of Hell.

How appropriate then that endometriosis makes the uterus a kind of grave because it leaves some women who have it infertile. They also engage in painful sex so I guess that could be hell too.

Endometriosis. The endometrium is the inner lining of the uterus. If pregnancy does not occur (following the normal menstrual cycle) this layer is shed and hence the bleeding from the vagina. Abnormally, in endometriosis, tissue that belongs inside the uterus is found elsewhere: On the ovaries, on the bowels, bladder and so on. The terrible thing is that these tissues behave the same way as though they were home. So as hormones rise and fall, the extrauterine endometrium also thickens, sloughs off and bleeds.

Causes. There are several theories why endometriosis occurs. One relates to the backflow of menstrual blood that contains endometrial cells. The cells reach the fallopian tubes (connecting the ovaries and uterus), lodge there and eventually grow. Another proposes that endometrial cells are potentially already outside the uterus but are triggered to develop because of genetic or environmental influences. Still another theory links the female hormone estrogen. It has been shown to promote endometriosis making it a disease of the endocrine system.

Signs and Symptoms. It is possible to have endometriosis and not feel anything. Most of the time though, the following signs and symptoms are noted:

* painful menstruation (dysmenorrhea) with pelvic pain and abdominal cramping

* painful sex (dyspareunia) and sometimes painful bowel movements or urination

* occasional heavy periods (menorrhagia) or bleeding in between periods

* infertility (from up to 30-40 percent of patients).

Because of these presentations, endometriosis can be confused with irritable bowel syndrome or IBS, ovarian cysts, or pelvic inflammatory disease (PID).

Diagnosis. The doctor to see is the obstetrician-gynecologist. A pelvic exam may reveal scars or cysts in the reproductive organs. In a vaginal or abdominal ultrasound, sound waves help create images that are scrutinized for abnormalities. Your OB-GYNe might also request for magnetic resonance imaging (MRI). However, the standard for diagnostics is a tissue biopsy.

Treatment. The doctor’s approach to treating endometriosis depends on the severity of the signs and symptoms and in many cases, on the desire of the patient to one day bear children.

Pain can be managed with over the counter analgesics. Antiinflammatories include mefenamic acid, ibuprofen, piroxicam, nimesulide, and diclofenac. Supplemental hormones may be helpful for endometriosis pain. In fact, some doctors would question the diagnosis of endometriosis if hormones do not contribute to pain diminution. Oral contraceptives (containing estrogen and progestin) regulate the growth of endometrial tissue and can decrease the amount of menstrual flow. Danazol is a drug that blocks the production of ovarianstimulating hormones preventing menstruation. It may also suppress the growth of endometrial tissue. Similar actions can be seen with the use of gonadotropin-releasing hormone agonists and antagonists. Surgery is also a treatment option. In laparoscopy, small abdominal cuts allow the surgeon to identify and destroy abnormal endometrial tissues with videoassisted instruments. In laparotomy, a larger incision facilitates removal of the endometriosis. The uterus and both ovaries may also be taken out – as a last option for severe cases.

Unrecognized and untreated, endometriosis is a “sheol” for women.

Understand the signs and symptoms and investigate further. You may yet uncover endometriosis. Those severe menstrual cramps could mean something more sinister.

Source: Manila Bulletin