Endometriosis Essay

The overgrown tissue of the endometrium persists with the usual endometrial changes that occur during the female reproductive cycles (Elnouri, 2016). The tissue thickens and bleeds during the normal monthly periods. The bleedings during the menstrual period, inflammatory responses that occur as a result, fibrosis and neovascularization are some of the consequences of the clinical manifestations of the disease. The overgrown tissue in the other parts lacks openings and commonly may lead to increased pain during periods often, adhesions of the overgrown tissue may result in the formation of endometriomas, irritation of surrounding tissues and formation of scar tissues. Endometrial tissue can also be in less common areas such as the lungs, the kidneys, stomach among others resulting in cyclic bleeding such as cyclic hemoptysis and catamenial seizures (Elnouri, 2016). Endometriosis is often underdiagnosed in some patients due to its asymptomatic nature in the early stages of development in women.

It also is one of the "invisible illnesses" and can have a psychological effect on women affected such as depression. Endometriosis is rated as among the topmost causes of infertility ranking as the third most common cause of infertility in women (30-50% of women with endometriosis will have infertility risks). Differential diagnosis Ovarian torsion- Ovarian torsion is a condition that results from the torsion of the ovarian pedicle or tissue which results in reduced venous return, edema, internal bleeding and often may lead to infarction due to the resulting ischemia. Ovarian torsion may mimic the common symptoms of endometriosis such as tenderness of the pelvic region, bleeding. Laparoscopy has a sensitivity of 97% in the diagnosis of endometriosis (Hirsch et al. The procedure involves a surgical intervention and visualization of the deposition of endometrial tissue outside the uterus.

The classic lesions in endometriosis are blue-black although findings may also indicate red, black or whitened areas. Observation of areas of adhesions and cysts in the surrounding tissues is also indicative of the condition. Endometriosis can be identified in the ovaries, broad ligament, uterosacral ligament, rectosigmoid colon and the bladder among others. There is a high level of evidence that proposes for a three-month use of a gonadotrophin-releasing hormone agonist or six months use of danazol in the management of endometriosis pain. Gonadotrophin-releasing hormones down-regulate the pituitary gland to induce an hypogonadotropic-hypogonadic state which leads to reduced pain for up to 6-12 months after medication. The use of the Gonadotrophin-releasing hormones has no effect on the improvement of the fertility with use, its use has been shown to improve pain in 85-100% of women.

Danazol acts through the inhibition of follicle stimulating hormone and luteinizing hormone at the midcycle hence limiting steroidogenesis. ACOG informs that surgical interventions in endometriosis only reduces the pain in endometriosis in the initial six months following the surgical interventions with recurrence occurring in a year’s time in most women (Armstrong, 2011). The patient should then be educated to understands the condition, its progress and the likely treatment regimens and care plan. Effective use of collaborative care within the inter-disciplinary teams is critical in ensuring that the patient care is comprehensive. Patient management to achieve optimal outcomes should include combination therapy which aims at reducing the size of the lesions and pain management of the condition. Depending on patient preference, and condition, the use of surgery and hormonal therapy as indicated by the NICE guidelines can be adopted in managing the condition to achieve prompt size reduction with pain management is done using the nonsteroidal analgesics.

Summary Endometriosis is a condition that may have debilitating effects on the patient reproductive health as well as their quality of life. The theories that relate the occurrence of endometriosis to phenomenon such as retrograde menstruation exist and have been considered credible, metaplasia of the coelomic cells resulting in endometrial tissue growth in the parts affected are some of the theories that have been established on to explain the genesis of endometriosis. Endometriosis can result in conditions and complications that may also contribute to reducing the quality of life for many. Infertility is one such consequence of endometriosis. Endometriosis-related infertility in patients can result into depressed state and difficulties adopting to the life with the disease. Patient education and counseling is hence a critical part of patient management to ensure that the patient receives patient education during care and management.

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