Endometriosis: Causes, Symptoms, Diagnosis and Treatment

welcome to Washington Hospital today dedicated to informing residents about healthcare topics and issues through programs featuring community forums and free health and wellness classes our goal is to empower community members with the information needed to make informed health decisions Washington Hospital has been providing health care to the residents of the Washington Township healthcare district for the past 60 years [Music] you today's presenter is dr. gel Riza Mansouri dr. Minh Suri is a board-certified obgyn she is also a member of the Washington Township Medical Foundation so our topic today is endometriosis its causes the symptoms and how to diagnose it as well as the treatments again so just to kind of go over what we're going to talk about endometriosis is sort of a very personal topic for many women especially generally and generationally some women especially the older ones that may have it are kind of very reluctant to discuss it with their physician so this is just one way to kind of get us to open more about open up more about it and learn more about this condition so the goals of our talk today are to define what endometriosis is kind of discuss some theories of how or what causes endometriosis what are the signs and symptoms of endometriosis what are the techniques we used to diagnose it and how do we treat it so hopefully we'll will cover all of that in a timely manner so what is Ana Mitri OSIS before we can really talk about enemy tree OSIS we have to talk about something most women normally have which is endometrial tissue inside our uterus lining the cavity of the uterus is tissue called an endometrium this is what normally thickens up during your menstrual cycle to prepare for pregnancy it does this in response to at your own body's estrogen production if a woman does not get pregnant she then bleeds this lining out in the form of a period so endometriosis is basically a matter of location it's endometrial tissue which we normally have in the endometrial cavity but it's in neutral tissue that's outside of the uterine cavity this endometrial tissue can implant on other areas of the pelvis and it becomes inflamed it can bleed it can activate pain receptors in response to our own estrogen production it's hard to really know the prevalence of endometriosis but in women who have like pelvic pain it's it can be as high as 30 to 40 percent the reason why it's a little hard to determine an exact number for the prevalence of endometriosis in our female population is because some women may have endometriosis but they may not have any symptoms and so they'll never necessarily go to their physician for evaluation or be diagnosed with it so when the endometrial tissue implants the common areas for where it can show up in the pelvis or in the body are usually closer to where the uterus is so closer to the uterus so these areas from most common talese are the ovaries naturally the ovaries are right next to those fallopian tubes or the openings of the fallopian tubes the anterior and posterior called the sack of the pelvis these are the pockets or of spaces in front of the uterus and behind the uterus they can also show up on the uterus sacral ligaments these are ligaments sort of near the cervix and and in the back of the uterus that helped us support our uterus of course they can show up on the surface or the outside of the uterus as well as the fallopian tubes now endometriosis is not just specific to our pelvic structures are representing material implants can also develop or show up on our other parts of our abdominal cavity such as on our sigmoid colon or intestines on our appendix they can show up sometimes even on more distant areas like our anterior abdominal wall we often may see this in women that have had surgeries for example a cesarean section and so an immaterial tissue can implant into the scar of that surgery and develop into an abdominal mass and endometriosis can occur even further away than the abdominal cavity it can appear even in the lungs or the brain but these two examples are very rare on the photo there is just sort of a stylized drawing of the female pelvis the really pink structure is the uterus behind it as the colon in front of it is the bladder and this just showing you the red dots are just showing you the multiple areas were in meiosis can develop so what causes endometriosis there are several theories that are out there the first theory is one of what we call retrograde menstruation so this is a process where instead of the period blood or the endometrial tissue that's been shed leaving the body through the cervix in the vagina it goes backwards where it flows through the fallopian tubes and out of the openings of the fallopian tubes into the pelvic cavity one of the findings that kind of supports this theory is that young women who have a congenital anomaly of the uterus where their uterine cavity is closed off and there's no way for the endometrial tissue to be shed and leave through the cervix they have a higher rate of endometriosis because they they there's nowhere else for that blood to go but potentially backwards through the fallopian tubes into the pelvic cavity but one of the other things that I've read through my research is that about 90% of women actually do have some amount of retrograde menstrual flow but not all of them are you know develop endometriosis another possible source is from stem cells so we do have cells in our body pockets of cells that may be remnants of multipotent cells that we develop in the embryonic stage when we're still developing in our mother's womb so these cells have the potential to become other tissues and so there are certain types of cells that we have that are again remnants of what we may have developed or had when we were growing in our mother's room and these particular cells are called mullerian cells bone marrow cells or even embryonic pockets of again cells that we had when we were developing in the womb these cells may already exist outside of the uterus and can develop into enemy tree OSIS and then there also is the theory of a new material cell spreading from the uterus through the bloodstream and the lymphatic system the third theory would kind of explain why some patients very rarely but why some patients can get endometriosis in their brains or their lungs again those two those two examples are very rare so what are the signs and symptoms of endometriosis so the endometriosis is interesting in that the severity of the actual disease how many implants we have where they are don't really coincide with their symptoms we'll have patients who have very severe symptoms and not have very much endometriosis disease in their pelvis and vice versa but typically when we do see our patients in the clinic these are the types of symptoms that the patients will complain about that may have it so dysmenorrhea we all know this as women it's the pain we get with our periods the dull crappy pelvic pain usually it begins several days before the period lasts through the period and for several days after which is pretty frustrating because that basically takes up two weeks of your menstrual cycle of your month then there's dyspareunia this is pain that occurs with vaginal intercourse for women who have pain all the time we then characterize them as having chronic pelvic pain and it's been described with anywhere from words such as dull throbbing sharp or burning another manifestation of endometriosis are abnormal periods especially periods that are heavier than usual in flow because our pelvic structures are very low we can in our pelvis in our abdomen endometriosis especially if it's occurring towards the back of our body or near our rectum can manifest as lower back pain and understandably many diseases that cause chronic pain can cause that particular patient to have chronic fatigue pain pain is very tiresome so that's also a common symptom also endometriosis has different symptoms based on where they implant so if the endometriosis implants are on the bowel it can cause diarrhea constipation let install it can cause pain with defecation if the endometriosis is on the bladder it can actually mimic a urinary tract infection you can have symptoms such as increased urinary frequency and pain with urination and that's why just as an aside for patients who are having symptoms that they think might be a urinary tract infection we do recommend that you be seen in clinic because it may not be a urinary tract infection it might be something else and we'd hate to just give you antibiotics if not warranted so now to get back to the talk so animate Rios's can also appear on the ureters the ureters are these tubes that bring urine from the kidneys down to the bladder and if it shows up on your your udders and you know they become inflamed they can cause a colicky upper back or side pain and also it can cause you to have blood in your urine so definitely for anybody who ever has blood in their ear and that is not normal you want to be seen by your physician okay endometriosis again that appears on the anterior abdominal wall as we had mentioned earlier can't present as a painful mass and sometimes it can bleed and the bleeding oftentimes tends to coincide with the menstrual cycles or the period endometriosis that shows up in the lungs or the chest cavity can present as chest pain lung collapse or what we call near mo thorax and also patients can have coughing up of blood another way that endometriosis presents if not with pain is with infertility or reduced fertility endometriosis is you know when the implant on the pelvic structures oftentimes with repeated inflam and scarring will cause the pelvic Anatomy the uterus the fallopian tubes the ovaries to potentially scar together and also to scar to surrounding tissues like the lining of her abdominal cavity as well as our bowel when this happens when our anatomy is distorted it does make it more difficult to get pregnant another thing that happens is when every time the implants become inflamed they trigger the immune system they bleed this whole inflammatory process makes it very difficult for the ovaries to function so it makes it difficult for ovulation fertilization and even implantation of an embryo to occur in one particular study of a thousand women who were confirmed to have endometriosis 25% of them actually presented to their physician with infertility as opposed to pain through my readings and just based on my stock knowledge you know of having had patients with this condition if you were to look at a population of women undergoing treatment with the for infertility with Reproductive Endocrinology and infertility specialty clinics up to 40% of them will have endometriosis so it really does impact a woman's reproductive function another sign of endometriosis is something a little bit more obvious is an endometrium ah this is more commonly known as a chocolate cyst so this occurs when a neutral tissue implants within the ovary and then of course with in response to estrogen it undergoes inflammation it bleeds it releases inflammatory enzymes and all of these substances stay within the ovary it has it can't leave it's stuck inside the ovary and so it just keeps collecting and assist and so it basically forms like a little water balloon but instead of containing water it contains old blood and inflammatory material and the contents actually looks like Hershey's chocolate syrup and that's why it's it's more common or layman's name is a chocolate and about thirty to forty percent of women with endometriosis are going to have an endometrial m'a an endometrial may is a benign cyst so if you look at the picture over there the pink structure is the uterus and the structure to the left of that is the endometrium ah and in this particular case that endometrium is larger than the top of that uterus fibroids are a different structure so fibroids are a monoclonal tumor of the smooth muscle of the uterus so they usually develop from the uterine muscle so more from the pink structure it doesn't necessarily accumulate with with blood but it is muscle tissue and it feels more like a rubber ball or even a boiled egg you can't it can I'm having multiple you fibroids as well as if the fibroids are within the uterine cavity that can cause heavy bleeding and painful bleeding yeah so how do we diagnose endometriosis so when we have a patient who comes in with a constellation of symptoms or signs that we just discussed one of the first things we have to do of course is a thorough review of their medical and surgical history as well as do a basic physical exam it's important to do the medical history because we want to sort of get details about the individuals pain how long they've had it the severity where they're feeling the pain what types of diagnostic procedures were already done and what types of treatments they've already had and is very important to get a good or very clear surgical history from the patient because one of the treatments of endometriosis is actually surgery so when we're evaluating patients the three most common symptoms patients will report the trifecta of symptoms would be abdominal pelvic pain dysmenorrhea or painful periods as well as heavy menstrual bleeding so heavier flow of the periods some of the common findings are on exam our tenderness on the vaginal exam so for the women they know this exam for the men they may not know so part of a pelvic exam is what we call a bimanual exam and this is when we put two fingers on the vagina to put pressure on the cervix and we push down on the uterus as well as the surrounding an axle and that the EDD miksa are the areas to the sides of the uterus where the ovaries and fallopian tubes would be so with pressing on those areas oftentimes women with endometriosis will have tenderness over the uterus or sides of the uterus where the ovaries are one of the other findings that sometimes will actually feel nodules through the vaginal mucosa if there are any endometriosis lesions that have made it as far down as the vagina of course and that naxal cyst or a variance cyst would be a clue telling us that a patient might have an endometrium are a chocolate cyst another thing that can happen sometimes a set of the uterus being sort of up and down is the uterus can kind of be tilted more to one side or the other it's kind of rare but every now and then if a patient has an endometrial implant that has actually shown up on the surface of the cervix or the surface of the vagina then that would be an indication also banana meat Rios's now in terms of laboratory tests and I'm talking about blood tests that we could do there really aren't any good markers there are some markers that are being studied and are experimental but aren't really available for use by physicians or by the the medical community a half ca-125 there so ca-125 is cancer antigen 125 you may have heard of it because it is one of the markers we look at when we're trying to evaluate a woman who might have ovarian cancer it's also a marker used to monitor women who have ovarian cancer and are being treated with chemotherapy or radiation to see if they're getting better from the ovarian cancer ca-125 though it's not a very specific marker it actually increases in inflammatory conditions so sometimes in women that have enemy tree OSIS their ca-125 can be very elevated other things that can elevate say 125 is for example pelvic inflammatory disease or a pelvic infection so not very specific it's not necessarily something we'd get automatically when we're evaluating a patient for possible endometriosis so we know that the endometriosis implants they they will act similarly to our own endometrial tissue inside our uterine cavity so one of the things that we can get as women is uterine cancer or endometrial cancer where there's over thickening of that lining and then cancer can develop so the implants have that potential and has sometimes have shown changes that mimic that process within the endometrium but we it's really something we should we need to study more well the average time actually for diagnosis from the onset of symptoms to diagnosis of endometriosis is about seven years so that's a good point because the women many women live with the symptoms and and don't realize that this is a possible diagnosis for them so what about imaging studies and when wherever we're evaluating a patient a female patient for any kind of reproductive possible reproductive problem our first go to imaging studies a pelvic ultrasound and typically this is done transnationally because we're getting closer to the organs you need to look at you do an abdominal II through the abdomen you need to go through skin fat fashiona muscle just a little harder to see things so this is particularly specifically a pelvic ultrasound Trant done through the vagina this type the this is the one of the more helpful imaging studies for endometriosis if an endometrium off for example is seen that is diagnostic for endometriosis sometimes you'll actually be able to see nodules so if the endometrial implants are large enough and they're collecting enough that blood and inflammatory material you might even be able to see nodules on an ultrasound so this is the image to the left is actually a picture about what an endometrial may looks like the image to the right shows endometrial my implants look like there are a couple of dark areas to the right of the endometrium that are actually implants now unfortunately the most definitive diagnosis or the most definitive way to confirm the diagnosis of endometriosis is through surgery so basically a surgery where we can see the implants biopsy the implants and then send it to pathology for histologic diagnosis surgery that we do is typically done through what we call laparoscopy so this is a type of surgery where we make very small incisions in the abdomen and pelvis and we use long pencil-thin instruments which includes a camera to examine the pelvic cavity so if you look at the picture on top that's sort of a stylized picture of a person undergoing laparoscopy and you can see small incisions and those long instruments going into the pelvis the picture on the bottom actually shows what endometriosis implants look like when we are doing this type of surgery now not every patient may want to undergo surgery there are definitely risks to surgery such as infection bleeding injury and sometimes it may not be safe for a patient to undergo surgery they may have other illnesses diseases that make it a little bit more risky to do a procedure so there are non-surgical ways to definitively diagnose endometriosis one of the ones I said earlier is basically the presence of an endometrial month there's an endometrium ah you have endometriosis sometimes if a patient has a lesion again that has shown up on the the mucosal side of the vagina at the side we can see when we're doing a pelvic exam then we can biopsy that and send it to pathology there is also procedure called cystoscopy which is basically using a camera to look inside the bladder and if endometriosis implants are found inside the bladder it can also be biopsied and sent to pathology for confirmation that it's endometriosis if on pelvic exam a rectal vaginal exam is done I know this sounds gruesome but it's a it's an exam where we're feeling that it's at the bottom or the posterior wall of the vagina as well as through the rectum if we feel modules there and you also see nodules on an ultrasound that was done concomitantly the mat also tells you yes that is endometriosis but you don't always need to do surgery or have histological diagnosis or a biopsy to confirm before you start treatment if a if a patient has the science the symptoms and there are ultra sound findings I'll tell you this is endometriosis you can make a presumptive non-surgical diagnosis and initiate treatment so doing surgery is not necessary to initiate treatment we have a saying in medicine when I was going to medical school about making a diagnosis on an illness so II used to say if somebody looks like at many sounds like Aunt Minnie and smells like aunt Minnie with aunt Minnie so how do we treat enemy trio sis now this is a difficult one as our guest has explained the treatment is still still very difficult so the America Society of reproductive medicine put out a statement that they'd like us to use that endometriosis is their chronic disease that requires a lifelong treatment plan and the plan depends on the individual and what their goals are in life as well as how they're presenting and what their symptoms are so we we would tailor the treatments based on how bad their symptoms are if they have pain or not because because like I said a good percentage of women that may not be there presenting symptom in infertility so some women have the goal of wanting to conceive and so certain treatments are not really appropriate for them it also depends on the disease extent and location so enemy tree OSIS actually has a grading system in terms of the amount location and amount of scarring that the implants have caused and they go from grades one through grades four so this type the the grading of the disease would also guide the kind of treatment that needs to be done the patient age the patient is at the end of their reproductive life and have no desire for children that would also guide what kind of certain what kind of treatment could be done the medications that we do offer have side effects so it depends also on how well patients can tolerate side effects or whether they have any or not and some treatments are not available to certain populations and so that can also limit the the treatments that we do are determined the treatments that we do so let's get started on the treatment for patients that have mild to moderate pain this is sort of defined loosely as patients where are women who don't have any absences or regular absences for school foe with from school or work from the pain the first line of treatment believe it or not as NSAIDs so ibuprofen motrin advil naproxen celebrex there's not really a really strict randomized control trial that tells us this works but it has a low side of it profile there's low risk of use compared to other medications we have it's cheap it's affordable and we do know that it is effective in treating painful periods so dysmenorrhea painful periods with or without endometriosis we do know is successfully treated with motrin or ibuprofen and the other benefit of ibuprofen is it can be used even if you're trying to get pregnant the only exception though is celebrex which to be honest with you we don't use that often an ob/gyn anyway but it the reason why is because it can delay ovulation for women who are trying to conceive now the next sort of bastion of treatment that we do use very commonly are combined oral contraceptives these have been found in studies to be effective in treating endometriosis being and there are some studies although this is sort of on the fence cuz not all studies show this but there are some studies that show that combined oral contraceptive or birth control pill can [ __ ] the progression or slow the progression of endometriosis we also the other benefit is if a patient is not wanting to get pregnant it also provides their birth control now whenever we're talking about the combined oral contraceptives these are the birth control pills that contain both an estrogen and progesterone some birth control pills don't have any progesterone so this contains an estrogen and progestin it comes in multiple patches so it can tailor to a patient's needs or desires in terms of how they use a medication it comes in the pill form of course which we're all very familiar with it comes in a weekly patch form as well as a vaginal ring that could be used kept in place for 21 days or three weeks birth control we know and we've seen this in our population we've been able to use it safely for the long term in it one of the things also that a combined estrogen progesterone birth control pill does it it actually decreases our risk for ovarian cancer and endometrial cancer so I'm sort of an added side benefit to ways to use it which I think I was started doing it when I was a resident is the birth control pills comes in a 28-day pack the last seven days are sugar pills they don't have any hormones in them and that's allow a woman to or to have a withdrawal bleed and you can actually refrain from taking the withdrawal week and just keep taking pills that have the the drug in them so you through throw away that pack after 21 days and start a new pack this is what we call a continuous regimen in this matter then you don't have that decrease in hormones that brings about that period or that withdrawal bleed and it can also be used typically it doesn't have to be the the continuous regimen but we do know that the continuous regimen does potentially treat the endometriosis a little bit better now as I mentioned earlier birth control pills hormonal contraception also comes in a progestin-only contraceptive so progestin is the synthetic form of progesterone our pregnancy hormone the hormone we make when we're pregnant and it can be used in place of an oral contraceptive especially if a patient is not a good candidate for estrogen because estrogen is not a hundred percent safe and the estrogen we take whether in birth control or for hormone replacement therapy does increase your chance for clot formation so forming a deep vein thrombosis or even a pulmonary embolism so the common forms of it kind of scientific terms are north and your own acetate that's otherwise known as a Cheston there's also a Madrasi progesterone acetate which comes in the pill as well as a shot and many of you may have heard this it's called depo-provera it's a an injection of hormone that you can get every three months so it's nice and that you don't take a pill everyday the other benefit of progestins because we didn't really talk about this the NSAIDs help treat the pain but they don't reverse the process but the progestin can inhibit the enemy triada growths the endometriosis implants from to getting worse it can also potentially cause the endometrial implants to atrophy that's just a scientific term for it gets smaller thinner yeah shrinks them down exactly it also inhibits our pituitary stimulation or our own production of our ovarian estrogen for debt and progesterone so one of the themes that you'll notice is that these are the first this is the second and third medication we're talking about our medications that will reduce our own body's production of estrogen because the endometriosis implants are very estrogen dependent and again because it doesn't have the estrogen it's a little bit safe it has all safer profile in terms of forming clots in your veins but like everything else we have in medicine everything has side effects so one of the side effects of progestin-only birth control pill is it can cause irregular bleeding or unscheduled bleeding it can cause you to not have a period at all sometimes while you're on the medication in cause wait it is associated especially more so the shot than the other forms of progesterone more specifically for the depo-provera it can cause weight gain or mood changes so progestin-only contraceptives also come into two other long-acting forms which are actually very popular forms of birth control in our in our ladies who are within their reproductive years one is called Nexplanon which is basically a four centimeter long plastic rod that contains the medication in it it goes right underneath the skin and something we can place in clinic and it slowly releases a and hormone over three years and then there's the progestin releasing intrauterine device or IUD this is the benefit of this is the amount of estrogen you get in your herb progesterone sorry you get in your bloodstream it's a little bit lower the majority that hormone stays within the vicinity of your uterus and public structures the common brand names we have available are Mirena kaileena and Scylla now for moderate to severe pain these are for those unfortunate ladies that do miss work that are impacted the function of their daily functioning or is impacted by their their pain one is called gonadotropin-releasing hormone we can just call it gnrh agonist so this is a chemical that likes to attach to G and RH receptors it blocks the those receptors so that our own GnRH cannot reach those receptors basically the short would be the punchline to this medication is that it also decreases our own body's production of estrogen the common brand names that we have in the United States are Lupron which is I think the more oral form of it and depo Lupron which is also an injection that could be given monthly as well as every three months so depo Lupron has been shown to be more effective than other treatments it down again down regulates for production of an estrogen it can also cause the endometriosis implants to shrink but basically what it's doing is it's putting us into chemical menopause so for the ladies that are you know expected to have their usual or tit with are within the age of having normal estrogen product production it can cause symptoms of menopause such as hot flashes vaginal dryness decreased libido mood swings headaches even more serious decreasing their bone density if you use it for a long period so you take a 30 year-old woman who has severe endometriosis it put them on depo loop on it's like they're they're getting a sneak what its gonna be like when they hit 50 51 which is the average age of menopause so sometimes we mitigate these side effects by giving back a little bit of hormone so typically it's either giving back or giving a woman a little bit of a progestin-only birth control or a combined oral contraceptive now this one's a little bit more confusing so the first one was GnRH agonist it likes to goes on to the receptors and it acts kind of like GnRH but not in the same way but this one actually just prevents it completely antagonizes the ability of Gian arch to go on to the receptor so again punch line it decreases our body's production of estrogen it does work immediately and the benefit of this particular medication is it comes in both an oral and an injectable forms some patients don't like needles I don't blame them I don't like them either so this is one that comes in an oral form and the dose can be adjusted to minimize symptoms and optimize symptom relief but just like with the depo lupron this one can also cause those symptoms of menopause as well as decreased bone density the brand name that we have or actually it's another brand name this is actually the the name of the drug is called alag Alixe the brand name is or elisa so you might see that in the medical or magazines that you might see the advertisements for it now there's another class of medications called aromatase inhibitors so be honest with you I don't really use this too often for endometriosis I use it for other things in the ob/gyn field we use it as adjunctive treatment for example for women who have breast cancer because again it down regulates our production of estrogen what it does is it turns off this enzyme called aromatase we have this enzyme is mostly sitting sort of in the fat fatty tissue of our abdomen and aromatized converts male hormone women make a little bit of meal and it converts that hormone into estrogen so basically it gets rid of that source of estrogen that way our body makes in terms of endometriosis it is considered an off-label use so typically again we usually use this as an adjunctive treatment for breast cancer and it actually naturally is used also for the treatment of infertility for women who are not ovulating this is the main side effect of this as with the alag Alixe and the depo lupron our bone loss and the typical ones that we do we would use our anastrozole and letrozole so now to get to the more definitive treatment so surgery unfortunately is where a lot of women in a going if the other treatments don't work so the through the surgery we can actually look at the implants if they're safe to remove we can resect them we can also oblate them which is to to kind of use an electro surgical unit to destroy the implants the other benefit of doing surgery is at the time of surgery you can get biopsy of these implants again to confirm the diagnosis and the invasiveness or the severity of surgery can also vary so from less invasive to more invasive less invasive a conservative way to search a surgically treated a patient is again to remove or oblate any implants the one thing I have to say though is the implants have to be where they're safe to ablate so if the implant is on bowel or on sensitive tissues let near blood vessels well certainly it's not a safe area to Reese necessarily resect or oblate those structures if there is an endometrial present then yes we would do it what's called Asustek t'me which is to peel back or open up that ovary to remove that cyst for women who may be done with childbearing or just want that ovary removed sometimes we just remove the ovary with a cyst in it with these surgeries like we mentioned earlier one of the things that happens with endometriosis is is scar formation diffuse scar formation so one of the things that we do do is we try to break up the scar unfortunately though surgery is a double-edged sword whenever you do surgery it does cause scar formation so we wouldn't do it just to lice adhesions but if we happen to be there for any other reason then we will do so now the most definitive therapy is actually a hysterectomy so basically to remove the uterus and possibly to remove the ovaries as well so that's why the age of a woman is important if they're towards the end of their reproductive years and they have no longer have any desire to have children or they're close to menopause then hysterectomy with removal of the ovaries would be an ideal treatment of note a reason I have an asterisk next to endometrium ah is one of the things that we found is if we try to resect and then don't we ever remove it you can actually destroy some of the follicles now as women we are our ovaries contain all of the follicles or eggs we're ever going to have we don't make new ones when we're born we have about half a million and then we lose a handful every month once your menstrual cycle starts so that's why that's why we end up with menopause we run out of eggs so for especially for patients that want to still conceive or being treated for fertility you want to protect those eggs so unless inanimate Roma is causing severe symptoms or they're very large for example greater than 5 centimeters there's potentially a benefit to just leaving it alone so the endometriosis implants are basically endometrial tissue that are just outside of the uterine cavity and as we know endometrial tissue inside cavity can turn into cancer it can turn into or can develop endometrial cancer and it's actually a cancer that is fed by or develops from estrogen our own estrogen production so excessive estrogen production without that concomitant progesterone production can cause the our endometrium are natural or normal and image from in the cavity to become what we call hyperplastic the cells can become a typical and that's what develops into cancer so some studies have shown that the implants can also undergo the same process but we're not a hundred percent sure about the the significance of this so I do believe it's something that we need to do larger studies on but I'm going to say that they probably have the same potential to do so I think one of the things that limits it though is the endometriosis implants differ slightly from our own endometrial tissue in that they become more fibrotic and fill more with sort of inflammatory immune materials so for example they have a lot of macrophages these implants do the macrophages our immune system sort of garbage-truck cells they eat up other cells that are abnormal so so the composition of these implants do change and sometimes instead of becoming a remaining as active tissue they can be mostly scar and blood yeah after your surgery after your last ovary was removed your physician said that implants can still can still remain yeah so that's a good point the majority of cases of endometriosis we know occur in women who are who are in their reproductive years so from you know men Archaea when your periods start to menopause and often times the symptoms do improve or even resolved when menopause occurs but a small percentage of patients with endometriosis are pre-pubertal so young girls who haven't even started menstruating it and also women who are postmenopausal my my thinking bee even though the ovaries are gone we could still be producing estrogen through the aromatize enzyme in our adipose tissue so that fun video tissue we have in the front there always working on trying to lose both men and women that has that enzyme it can actually convert male hormone as testosterone even though we don't make very much into estrogen and potentially then that estrogen can can cause implants to remain that's one theory behind it so one of the things I came across my readings is especially with the multipotent cells theory and the retrograde Administration theory is that there might be other factors genetic factors not specifically a mutation on a single gene that we can identify but multiple genetic factors that might predispose us to developing an Demetrios as' so dysmenorrhea is just a general term we have for painful periods so you can have dysmenorrhea even if you don't have endometriosis or in the process of shedding our endometrial lining our uterus will naturally crab will release inflammatory markers will make a chemical called prostaglandin which causes the cramping and also activates pain receptors so so the endometriosis that's not inside your uterus can cause the same the same pain so absolutely they are connected absolutely if you do have a younger person the younger woman in your family that's having issues with their periods or missing school if your program is not working well absolutely bring them to bring them to a gynecologist I agree [Music]

Channel: InHealth: A Washington Hospital Channel

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Keywords: Endometriosis causes symptoms diagnosis treatment, hormones, ovaries, washington, hospital, healthcare, medical, total, surgery, procedure, inhealth, fremont, california, Tissue, Uterus, endometrium, fallopian, tubes, pelvis, pelvic, pain, ultrasound, mri

Id: 5m0Ht9TmVtU

Length: 45min 22sec (2722 seconds)

Published: Thu May 30 2019