ENDOMETRIOSIS

Introduction:

The socio–economic changes in human life and the altered reproductory practices like delayed first conception, limited number of pregnancies, cause various adverse changes in women’s health. Endometriosis is one such disease which will affect the reproductive capacity of the female and disable them with its symtomatology.?

DEFINITION:

Endometriosis is defined as the presence of functioning endometrial tissue, including glands and stroma, outside the uterus. It is called endometriosis interna or Adenomyosis when it is found in the myometrium.

Endometriosis is a painful reproductive and immunological disease affecting millions of women worldwide. Till recent years this disease has not received much attention though the number of patients are increasing and leading to rise in the incidence of hysterectomy. It is more prevalent than breast cancer, yet continues to be treated as an insignificant. Even in this age of medical advances endometriosis remains a conundrum to patients and practitioners alike. woman ranging from adolescence to post-menopause.? The disease can be so painful as to render a woman or teen unable to care for her self or her family or attend work, school or social functions studies have even shown an elevated risk of certain cancers in woman with Endometriosis. Medical and surgical treatments having so many disadvantages can give partial relief to the patient and there is no absolute cure.

The most frequent sites of implantation are the pelvic viscera and the peritoneum. Endometriosis varies in appearance from a few minimal lesions on otherwise intact pelvic organs to massive ovarian endometriotic cysts that distort tubo-ovarian anatomy and extensive adhesions often involving bowel, bladder and ureter. Considerable progress has been made in understanding the pathogenesis, spontaneous evolution, diagnosis and treatment of endometriosis.

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There is a need to bring the Ayurvedic treatment into lime-light for endometriosis, because the modern line of treatment has got some disadvantages like prolonged administration of hormones which has got lot of disadvantages. If the conservative treatment fails surgery is the only alternative Ayurveda can give a better solution for endometriosis through a varied range of treatments which does not pose any hazards to the patient.

Enodmetroma is an area of endometriosis usually in the ovary that has enlarged sufficiently to be called a tumor. An endometrioma filled with old blood resembling tarry or chocolate coloured fluid is called a Chocolate cyst.

Incidence and prevalence:

During the last couple of decades the incidence of endometriosis has been increasing due to the post-ponement of first conception and adoption of small family norm. Even increasing awareness among the gynecologists and development of advanced diagnostic techniques is one factor for more identity of the cases (women of proven fertility) the prevalence of endometriosis ranges from 3% to 43%.:.

Age:
Even though it is common in between the ages of 15 – 45 years, it is one of the reproductive age group disorders. It is a chronic disease, which gains its existence gradually.

Aetiology:
The exact etiology is not known. But so many theories are put forwarded.

The important theories are as follows:

1.?????? Sampson’s theory of retrograde menstruation: This theory states that retrograde flow of menstrual debris through the tubes at the time of menstruation causes viable endometrial cells to reach the peritoneal cavity and implant there. Experimental creation of retrograde menstruation is resulted in wide spread endometriosis in animals.

2.?????? Familial tendency – genetical.

3.?????? Narrow cervix favouring ante grade menstruation.

4.?????? Immunological factors: Deficient cellular immunity with impaired clearance of regurgitated endometrial cells due to deficient function of natural killer cells or macrophages.

5.?????? Local factors: cell adhesion molecules such as integrins or cadherins may be involved in the implantation of endometrial fragments

6.?????? Role of oestrogen: Endometriosis is an oestrogen dependent condition.

Pathogenesis:

Retrograde menstruation: The endometrial fragments get implanted in the peritoneal surface of the pelvic organs. Subsequently cyclic growth and shedding of the endometrium at the ectopic sites occur under the influence of the endogenous ovarian hormones.

Coelomic metaplasia: According to Meyer and Ivanoff chronic irritation of the peritoneum by the menstrual blood may cause coelomic metaplasia which results in endometriosis. The mullerian tissue remnants may be tapped within the peritoneum which undergoes metaplasia and be transformed into endometrium.

Direct implantation: The endometrial or decidual tissues start to grow in susceptible individual when implanted in the new sites.

Lymphatic theory: The normal endometrium may metastise the peri-lymyph nodes through the draining lymphatic channels of the uterus.

Vascular theory: It is through the direct spread from blood vessels.