A Better Understanding of Endometriosis

What Is Endometriosis?

Endometriosis is a medical problem which affects the endometrium or the tissue that lines the womb or the uterus. It is a condition wherein the endometrial tissue is found outside the uterus, often anywhere in the pelvic area, the lower abdomen or in other areas of the body. Initially it may become undiagnosed until symptoms become bothersome and are not eased by simple treatments.

The symptoms typically develop between 25 to 40 years old though some cases can start early during the teenage years. Endometriosis may run in families. Thus women who have relatives who have endometriosis are at high risk for acquiring this condition. Endometriosis may also occur during the reproductive years because the lesion needs estrogen to proliferate. The exact cause of this disorder is unknown however it is thought that some endometrial cells from the womb or the uterus can get outside the uterus and spread into the pelvic area by spilling backwards along the Fallopian tubes during menstruation. These endometrial cells may then travel to the ovary, bladder, bowel, or Fallopian tube. These cells proliferate in the presence of estrogen; they then break down as during menstruation every month. However, these cells are trapped in the pelvic area and they cannot escape; thus they form patches of tissue called endometriosis. These patches or endometrial tissue are sticky and may stick in organs to form adhesions. Large patches of endometriosis may from cysts which may bleed every month during menstruation. These cysts are often called chocolate cysts because they are filled with dark blood.

Endometriosis can bring about symptoms such as painful menstrual periods, painful sex, pain in the lower abdomen and pelvic area, other menstrual symptoms such as bleeding in between periods and difficulty becoming pregnant (reduced fertility). Uncommon symptoms include pain on passing feces, pain in the lower tummy (abdomen) when you pass urine, and, very rarely, blood in the urine or faeces. The diagnosis of endometriosis is usually done using laparoscopy. This is a small operation that involves making a small cut, under anaesthetic, in the tummy (abdominal) wall below the tummy button (umbilicus). A thin telescope-like instrument (a laparoscope) is pushed through the skin to look inside. Patches of endometriosis can be seen by the doctor.

Endometriosis needs to be treated as soon as possible. If left untreated, it can worsen and can cause complications such as blockage or obstruction of organs such as the bowels or the ureters. Treament may be given to alleviate symptoms such as pain and heavy periods, and to improve fertility if this is affected. In mild cases and if pregnancy is not desired, treatment may be withheld by the physician. One in three patients with endometriosis may be able to clear up endometriosis and its symptoms without treatment.

A Better Understanding of Endometriosis

A recent study which made use of a mouse model of endometriosis has been developed that produces endometriosis lesions similar to those found in humans. This study is published in the The American Journal of Pathology and describes endometriosis as an estrogen-dependent inflammatory disorder. Researchers from the University of Edinburgh were able to find out that macrophages present in shed endometrium contribute to the development of the lesions.

In this study, transplantation of menstrual endometrial tissue was done on genetically identical mice. In brief, a donor mouse is induced to undergo menstruation using estrogen and progesterone. The tissue that is shed from the uterus is removed and implanted into a recipient mouse, allowed to grow, and then removed and analyzed. The results showed that lesions recovered from a variety of sites in the peritoneum of the mice shared histologic similarities with human lesions, including the presence of hemosiderin, cytokeratin-positive epithelial cells, vimentin-positive stromal cells, and a well-developed vasculature. All these are findings associated with endometriosis.

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