Dr.K.

Shiva Kumar,
M.D(Hom)

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 Endometriosis is the growth of cells similar to
those that form the inside of the uterus
(endometrial cells) but in a location outside of
the uterus.

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 Endometrial cells are the same cells that are
shed each month during menstruation.
 The cells of endometriosis attach themselves
to tissue outside the uterus and are called
endometriosis implants.
 These implants are most commonly found on
the ovaries, the Fallopian tubes, outer
surfaces of the uterus or intestines, and on
the surface lining of the pelvic cavity.

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 They can also be found in the vagina, cervix,
and bladder, although less commonly than
other locations in the pelvis.
 Rarely, endometriosis implants can occur
outside the pelvis, on the liver, in old surgery
scars, and even in or around the lung or
brain.

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 Endometriosis affects women in their
reproductive years.
 The exact prevalence of endometriosis is not
known, since many women may have the
condition and have no symptoms.
 It is one of the leading causes of pelvic pain and
reasons for laparoscopic surgery and
hysterectomy.
 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.

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 Endometriosis is rare in postmenopausal
women.
 Endometriosis is more commonly found in
white women as compared with African
American and Asian women.
 Studies further suggest that endometriosis is
most common in taller, thin women with a
low body mass index (BMI).
 Delaying pregnancy until an older age is also
believed to increase the risk of developing
endometriosis.

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 The cause of endometriosis is unknown.
 One theory is that the endometrial tissue is
deposited in unusual locations by the backing
up of menstrual flow into the Fallopian tubes
and the pelvic and abdominal cavity during
menstruation (termed retrograde
menstruation).

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 The cause of retrograde menstruation is not
clearly understood. But retrograde
menstruation cannot be the sole cause of
endometriosis. Many women have retrograde
menstruation in varying degrees, yet not all
of them develop endometriosis.
 Another possibility is that areas lining the
pelvic organs possess primitive cells that are
able to grow into other forms of tissue, such
as endometrial cells. (This process is termed
coelomic metaplasia.)

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 It is also likely that direct transfer of
endometrial tissues during surgery may be
responsible for the endometriosis implants
sometimes seen in surgical scars (for
example, episiotomy or Cesarean section
scars).
 Transfer of endometrial cells via the
bloodstream or lymphatic system is the most
likely explanation for the rare cases of
endometriosis that develop in the brain and
other organs distant from the pelvis.

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 Finally, some studies have shown alternations
in the immune response in women with
endometriosis, which may affect the body's
natural ability to recognize and destroy any
misdirected growth of endometrial tissue.

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 Most women who have endometriosis, in fact,
do not have symptoms.
 Of those who do experience symptoms, the
common symptoms are pain (usually pelvic)
and infertility.
 Pelvic pain usually occurs during or just
before menstruation and lessens after
menstruation.
 Some women experience pain or cramping
with intercourse, bowel movements and/or
urination.

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 Even pelvic examination by a doctor can be
painful.
 The pain intensity can change from month to
month, and vary greatly among women.
 Some women experience progressive
worsening of symptoms, while others can
have resolution of pain without treatment.

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 Pelvic pain in women with endometriosis
depends partly on where the implants of
endometriosis are located.
 Deeper implants and implants in areas with many
pain-sensing nerves may be more likely to
produce pain.
 The implants may also produce substances that
circulate in the bloodstream and cause pain.
 Lastly, pain can result when endometriosis
implants form scars.
 There is no relationship between severity of pain
and how widespread the endometriosis is (the
"stage" of endometriosis).

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 Endometriosis can be one of the reasons for
infertility in otherwise healthy couples.
 When laparoscopic examinations are
performed for infertility evaluations,
endometrial implants can be found in some
of these patients, many of whom may not
have painful symptoms of endometriosis.
 The reasons for a decrease in fertility are not
completely understood, but might be due to
both anatomic and hormonal factors.

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 Lower abdominal pain,
 Diarrhoea and/or constipation,
 Low back pain,
 Irregular or heavy menstrual bleeding, or
 Blood in the urine.
 Rare symptoms of endometriosis include chest
pain or coughing blood due to endometriosis in
the lungs and headache and/or seizures due to
endometriosis in the brain.

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 Women with endometriosis have a mildly
increased risk for development of certain
types of cancer of the ovary, known as
epithelial ovarian cancer (EOC).
 This risk seems to be highest in women with
endometriosis and primary infertility (those
who have never borne a child), but the use of
oral contraceptive pills (OCPs), which are
sometimes used in the treatment of
endometriosis, appears to significantly
reduce this risk.

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 The reasons for the association between
endometriosis and ovarian epithelial cancer
are not clearly understood.
 One theory is that the endometriosis implants
themselves undergo transformation to
cancer.
 Another possibility is that the presence of
endometriosis may be related to other
genetic or environmental factors that also
increase a women's risk of developing ovarian
cancer.
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 Endometriosis can be suspected based on
symptoms of pelvic pain and findings during
physical examinations.
 Occasionally, during a rectovaginal exam (one
finger in the vagina and one finger in the
rectum), the doctor can feel nodules
(endometrial implants) behind the uterus and
along the ligaments that attach to the pelvic
wall.
 At other times, no nodules are felt, but the
examination itself causes unusual pain or
discomfort.

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 Unfortunately, neither the symptoms nor the
physical examinations can be relied upon to
conclusively establish the diagnosis of
endometriosis.
 Imaging studies, such as ultrasound, can be
helpful in ruling out other pelvic diseases and
may suggest the presence of endometriosis
in the vaginal and bladder areas, but still
cannot definitively diagnose endometriosis.

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 For an accurate diagnosis, a direct visual
inspection inside of the pelvis and abdomen,
as well as tissue biopsy of the implants are
necessary.

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 As a result, the only accurate way of
diagnosing endometriosis is at the time of
surgery, either by opening the belly with
large-incision laparotomy or small-incision
laparoscopy.
 Laparoscopy is the most common surgical
procedure for the diagnosis of endometriosis.

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 Endometriosis can be treated with
medications and/or surgery. The goals of
endometriosis treatment may include pain
relief and/or enhancement of fertility.
 Nonsteroidal anti-inflammatory drugs or
NSAIDs , GnRH analogs, oral contraceptive
pills ( oestrogen and progesterone in
combination ) are used in the treatment of
endometriosis.

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 Synthesis
 FEMALE GENITALIA/SEX - ENDOMETRIOSIS
 apis lach. malatox. med. nux-v. puls. pyrog.
sec. sep. thuj. Xan.(Xanthoxylum fraxinosis)

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 Murphy ;
 Female - ENDOMETRIOSIS, acute
 Acon. ant-i. Apis arn. Ars. Bell. Bry. canth.
cham. chin. Cimic. con. Gels. hep. hyos. Iod.
kali-c. kali-i. lach. lil-t. med. Mel-c-s. Merc-
c. nux-v. op. ph-ac. plat. Puls. rhus-t. Sabin.
Sec. Sep. Sil. stram. sulph. ter. til. verat-v.

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 Female - ENDOMETRIOSIS, acute - chronic
 alet. aloe Ars. Aur-m. Aur-m-n. bell. borx.
Calc. Carb-ac. caul. chinin-ar. Cimic. Con.
graph. Helon. Hydr. hydrc. inul. Iod. Kali-act.
kali-c. kali-s. kreos. lac-c. Lach. lyc. Mag-m.
med. Mel-c-s. Merc. nat-m. nit-ac. Nux-v.
Ph-ac. phos. plb. Puls. rhus-t. Sabin. Sec.
Sep. sil. stram. Sulph.

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 Complete repertory ;
 FEMALE - ENDOMETRIOSIS
 aphis apis calc-f. coloc. flav. foll. lach. mag-
p. nep. nux-v. puls. rauw. sep. stann. thyr.

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