Pain during periods is very common and is called as Dysmenorrhoea or simply as menstrual pain. Menstrual pain can be sharp, dull or shooting pain. They also cause nausea and if very severe, may force the patient to take leave from work. It may precede menstruation by several days or a few hours, or may accompany it. It usually subsides as the bleeding decreases. When the pain is related to an underlying disease or disorder, it is called as secondary dysmenorrhoea.
What are the causes of secondary dysmenorrhoea?
The common causes of secondary dysmenorrhoea are endometriosis, uterine fibroids and sexually transmitted diseases.
What is endometriosis?
Endometriosis is the growth of endometrial tissue cells that normally grow inside the uterus (womb), in a location outside of the uterus. Endometriosis is most commonly found on other organs of the pelvis like ovaries, fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. The exact cause of endometriosis has not been identified. Endometriosis is more common in women who are experiencing infertility than in fertile women, but the condition does not fully prevent conception.
Endometriosis is said to occur in families. What is the percentage?
Eight percent of daughters of affected mothers, 6 percent of siblings of affected sisters, 7 percent of cousins and first-degree relatives are said to be affected. 30 - 40 percent of patients with endometriosis are infertile.
Why does endometriosis occur?
There are many theories surrounding the origin of endometriosis. But the most common cause is the one associated with retrograde menstruation. In all women when menses occur, some amount of blood is seen regurgitating through the fallopian tubes back into the pelvic and abdominal cavity. Although many women have been demonstrated to have some amount of retrograde menstruation, only a few develop endometriosis. There is usually clearance of this blood by the immunological system. When there is an alteration of the immune system, the deposits of the blood linger on inside the pelvic cavity.
The most common site where it gets deposited are the ovaries (50%) and the ligaments in the pelvis and behind the uterus. The less common sites are the bladder, rectum fallopian tubes, etc.
What are the symptoms?
The symptoms of endometriosis may be highly variable from one patient to another. The magnitude of the symptoms may not correlate with the extent of the disease. The common symptoms are pelvic pain and infertility. Pelvic pain usually occurs during or just before menstruation and lessens after menstruation. Some women experience pain during sexual intercourse, bowel movements or urination. Patients can also have bleeding when they pass urine or stools. Endometriosis can be one of the reasons for infertility in otherwise healthy couples.
In which age group the endometriosis is common?
Endometriosis has been reported only in the reproductive ages, which means right after the start of the menstrual cycle until menopause or immediate post-menopausal years. While most cases of endometriosis are diagnosed in women aged around 25-35 years, endometriosis has been reported in girls as young as 11 years of age. Endometriosis is rare in postmenopausal women.
What are the treatments available for the same?
Endometriosis can be treated medically or surgically. Medical treatment includes pain relief medications or medications to interrupt the periods.
Surgical treatment involves laparoscopy which is a Key-hole surgery performed under general anaesthesia where a small telescope is inserted into the abdomen through a cut in the belly button to clear the endometriosis.
The goals of endometriosis treatment may include pain relief or enhancement of fertility. Common pain killers can be used to decrease pain. Since endometriosis occurs during the reproductive years, many of the available medical treatments for endometriosis rely on interruption of the normal cyclical hormone production by the ovaries. These medications include GnRH analogs, oral contraceptive pills, progestins and Danazol.
What is the association of endometriosis and infertility?
In vitro fertilization (IVF) procedures are effective in improving fertility for some women with endometriosis. IVF makes it possible to combine sperm and eggs in a laboratory and then place the resulting embryos into the woman’s uterus. IVF is one type of assisted reproductive technology that may be an option for women and families affected by infertility related to endometriosis.
In moderate to severe cases, scarring or adhesions in the pelvis may cause infertility. The fallopian tubes and ovaries may adhere to the lining of the pelvis or to each other, restricting their movement. The scarring and adhesions that takes place with Endometriosis may mean that the ovaries and fallopian tubes are not in the right position, so the transfer of the egg to the fallopian tubes cannot take place. Similarly, Endometriosis can cause damage or blockage to the inside of the fallopian tube, impeding the journey of the egg down the fallopian tube to the uterus.
Success rate
Many doctors feel that for a woman who has Endometriosis, the best chances of pregnancy occur during the six to nine months period following treatment with a laparoscopy procedure. Pregnancy rate with test tube baby procedure following a certain protocol of treatment can reach upto 40 - 50%.