It is a common disorder of women in the reproductive age. Every menstrual cycle, if ovulation takes place and the egg isn't fertilized, the lining of the uterus sheds through the vagina. This is a menstrual period, after the period endometrial will be thicker to prepare for the eggs of the next cycle. Although the exact cause of endometriosis is not certain, retrograde menstruation is the most likely explanation for endometriosis. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle. But the endometriosis is based on the estrogen hormone that is produced by the ovary, so the disease usually declines to disappear after menopause.

The displaced endometrial cells can attach to other organs, such as the ovary, fallopian tubes, intestine, urinary bladder, peritoneum, liver, diaphragm, extra peritoneum organ such as the lung, a cesarean incision, or the navel. The endometriosis can grow and continue to thicken and bleed over the course of each menstrual cycle, and causes the body to produce adhesion cover around the ovaries and can cause ovarian cysts, called “Chocolate cysts.”

Symptoms of endometriosis

The symptoms depend on the sticking site of endometriosis, including abdominal pain during the menstrual period, becoming more painful until painkillers are needed, cause school or work absence, or experiencing a  combination of conditions, such as back pain to the waist, coccyx, or legs, abdominal distention and swelling, diarrhea, more pain when defecating during the period, frequent urination, pain in lower abdomen during sexual intercourse, infertility after being married for several years and still can’t achieve pregnancy. The endometriosis can be diagnosed with medical history, a physical examination, and a pelvic examination to see any polyp in the posterior area of the uterus. In cases of virgin women, a manual tactile examination in the anus will be considered. If the results of all examinations are normal, the patients will be examined again during the menstruation period, because during this period the polyp would be enlarged, and more easily being examined by a finger. Another procedure which will be provided is Transvaginal ultrasound to check for chocolate cysts or any other abnormalities of the uterus, the ovaries, or the fallopian tubes. The endometriosis also affects infertility in the future, since to the fallopian tubes can be tied and constricted with the adhesion.

Treatment for endometriosis

Laparoscopic surgery will be considered first to see the site of the endometriosis and degree of adhesion, which can be classified into 4 levels, with level 4 being the most severe. During the laparoscopic procedure, the doctor can perform a dissection and ablation of the adhesion or polyp that are attached to several parts, such as intestine or urinary bladder. After surgery, the doctor will consider giving medication to the patient in order to atrophy the polyp.

The disease is a progressive disease. The doctor may consider treatment with hormonal contraceptives that can minimize pain and reduce the size of the polyp, but can’t get rid of the adhesion.

In the case of infertility, laparoscopic surgery should be considered to diagnose and treat the disease, and evaluate the degree of the disease, what organ is rounded with the adhesion, whether fallopian tubes are constricted or not, perform a hysterosalpingogram to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes, surgery, dissection, ablation of fibrosis that is attached any organs, and plan for achievement of pregnancy.

In case of normal results of the physical examination, the pelvic examination, and the ultrasound, the further test is laparoscopic to check for pelvic adhesion or endometriosis. The doctor can perform laparoscopic surgery at the same time. The doctors have to find the underlying causes of excessive pain of some people that make them suffer for a long time, and some misunderstand that this is a mental problem.

Many young women who are not married or have never had sex before are usually be scared to meet the obstetrician for a pelvic examination until the lesions becomes more serious, experience the chronic pain during menstrual period, so some have to be considered for a hysterectomy or ovariectomy, and are not able to have a baby, etc. At Nonthavej hospital we provide high technology techniques for the Gynecological examination, and you don’t need to be scared anymore.

The endometriosis can recur after surgery, medicational and hormonal treatments, especially for patients with chronic endometriosis. Therefore, the patients should be monitored periodically. And the disease will be completely recovered when the patients turns menopause (golden age), because there is no more ovarian hormone (estrogen), and this also affect any polyps to become atrophied.