Endometriosis (“endo”) is the proliferation of uterine endometrial tissue outside of the uterus, typically in the pelvic area. It can be a painful and debilitating condition and is a leading cause of infertility in women. Endometriosis is more common between the ages of 25-45, affecting about 10% of women.
The endometrial tissue is most often found in the ovaries, fallopian tubes, ligaments that hold the uterus in place, and on the outer surface of the uterus.
Clinical Features:
Most commonly there is pelvic pain, especially during menstrual periods, which varies from mild to severe.
Also: painful menstruation (dysmenorrhea), painful intercourse (dyspareunia), heavy menstrual bleeding, infertility, nausea, fatigue.
There may also be gastrointestinal or urinary symptoms (eg pain during urination) during menstrual periods.
This can lead to depression and anxiety sometimes.
Aetiology:
Not fully understood.
Several theories:
- retrograde menstruation (menstrual blood flows backward into the pelvis)
- cellular metaplasia where cells change from one form to another
- genetic factors
- hormonal imbalances
- immune system dysfunction
Diagnosis:
Diagnosis is generally based on the medical history, physical examination, and imaging tests like ultrasound.
Definitive diagnosis is often made through laparoscopy to directly visualize the endometrial tissue.
Treatment:
There is no cure for endometriosis; treatment is usually aimed at controlling symptoms.
Pain management with NSAIDs and analgesics (eg ibuprofen, naproxen)
Hormonal therapies (eg oral contraceptives) to suppress the growth of endometrial tissue
Surgery to remove endometrial tissue. In severe cases, there may be a hysterectomy
Fertility treatments may also be used if want to become pregnant.
Some women do experience a resolution or reduction in the painful symptoms of endometriosis after menopause.
Living with endometriosis can be challenging. Symptom management includes the medical treatments, lifestyle changes, and emotional support with the use of support groups and counseling.
Impact on Fertility:
Endometrial tissue outside the uterus can lead to the formation of adhesions or scar tissue, blocking or damaging the fallopian tubes, impairing the release of eggs.
Fertility treatments, such as IVF, may be necessary for women who are trying to conceive.
Relevance to Podiatry:
Empathy and understanding.
Leg pain can be a reasonably common symptom; due to a sciatic endometriosis; pain can radiate to the foot.
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