Wednesday, 19 September 2012

Back to basics: what are the complications of endometriosis?


Pain
Long term (chronic) pelvic pain is the most common complaint for women with endometriosis, and it can significantly impair the quality of life, including work and social activities.

Women commonly describe active endometriosis pain as burning, dull, heavy and miserable.

Infertility
The main complication of endometriosis is difficulty in getting pregnant (sub-fertility) or not being able to get pregnant at all (infertility).

Endometriosis does not equal infertility! Little research has been carried out when it comes to endometriosis and fertility, but, it is important to remember that having endometriosis does not automatically mean that you will never have children. Rather, it means that you may have more problems in getting pregnant.

Studies indicate that women with minimal-mild endometriosis take longer to conceive (become pregnant) and are less likely to conceive than women in general. It also appears that the more severe the woman's endometriosis, the more likely it is that she will have difficulty becoming pregnant. Thus, women with moderate-severe endometriosis tend to have more difficulty conceiving than women with minimal-mild endometriosis.

Many women with endometriosis have children without difficulty, and many others become pregnant eventually - though it may take time. Surgery can improve fertility by removing endometriosis tissue, but there is no guarantee that this will allow you to get pregnant. You may also require the help of assisted reproductive technologies.

The longer someone has endometriosis, the greater the chance that their fertility will be affected. However, it is estimated that up to 70% of women with mild-moderate endometriosis will still be able to get pregnant without treatment. Pregnancy is also known to reduce the symptoms of endometriosis, although the symptoms often return once the menstrual cycle returns to normal.

Infertility can be related to scar formation and anatomical distortions due to the endometriosis; however, endometriosis may also interfere in more subtle ways: cytokines and other chemical agents may be released that interfere with reproduction.

Effects on other parts of the pelvic region
Ovarian cysts (fluid-filled cysts in the ovaries) can form when the endometriosis tissue is in or near the ovaries. In some cases, ovarian cysts (endometriomas) can become very large and painful. They can bleed or rupture, causing severe pain.

Adhesion's are bands of fibrous scar tissue, which forms inside the body. They can be found anywhere in the body between almost all organs and tissue. For women with endometriosis, they can bind an ovary to the side of the pelvic wall, or they may extend between the bladder and the uterus etc.

Whilst adhesion's are more often than not spoken of as a post-operative complication, this does not necessarily hold entirely true for women with endometriosis, even though they, of course, are a group of people who often have had numerous surgeries and thereby, by that factor alone, increase their risk of developing further adhesion's.

Endometriosis, however, can cause local inflammation, which is a key factor in adhesion formation. Adhesion's may therefore form as a result of endometrial implants bleeding on to the area around them, causing inflammation, which again leads to the formation of scar tissue as part of the healing process.

Adhesion's vary in appearances from thin and transparent to thick, dense and opaque. In some cases, adhesion's have been found to such an extent throughout the pelvis to create what is known as a 'frozen' or 'fixed' pelvis.

Just like endometriosis itself, adhesion's can cause pain and subsequently affect a woman's quality of life to the extent that her day-to-day activities are impaired. Women with endometriosis describe the pain associated with adhesion's as stabbing, sharp, pulling, intense and nauseating.

Yet, whilst the problem of adhesion's in endometriosis is widely recognised, there is at the moment no way of preventing them, when caused by the disease alone, nor a fool proof prophylactic which can be applied during surgery, though many companies are at present working on finding a product which prevents adhesion's.

Other complications can include
  • bowel obstruction: implants can sometimes form in the intestine and cause painful bowel movements, constipation or diarrhoea
  • ureteral obstruction: implants can occur in the bladder (although less commonly) and cause pain and even bleeding during urination
  • peritonitis from bowel perforation can occur
  • an increased risk of certain types of cancer, particularly ovarian cancer
  • an increased risk of miscarriage or giving birth prematurely: there is no evidence that endometriosis causes women to have repeated miscarriages, also, there is no evidence that treating endometriosis results in women having fewer miscarriages.

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