ENDOMETRIOSIS

 

ENDOMETRIOSIS -Subha . R

Endometrium tissue goes outside the uterine lining and starts growing there

Causes

·       Retrograde menstruation -menstrual blood shed out flow back through the fallopian tube and into the pelvic cavity

·       Endometrial cell transport – tissue transported through blood

·       Direct transplantation -it is after surgery

·       Transformation peritoneal cells

·       Embryonic cell transformation – oestrogen may transfer embryonic cell – cell in the earliest stage of development

Spread—pt with 20 yrs nose bleed during every menstrual cycle took the tissue bleed ..

endometrial tissues their in nose,Around on the pelvic organ,Ft, Ligament , Lining of the pelvic , Bladder ,Cervix, intestine , Rectum , Stomach , Vagina

Ovarian endometrioma ( chocolate cyst ).Ovary start to proliferate .It builds up over there and form as cyst .It is very large cyst

Sign

·       Dysmenorrhea – pelvic pain before and extend several days into a menstrual period

·       Dyspareunia – pain during or after sex

·       Pain with bowel movement or urination – during menstrual period

·       Menorrhagia -occasional heavy menstrual period or inter menstrual bleeding ..increase amount of bleeding

·       Infertility -

·       Other signs and symptoms – fatigue, diarrhoea , constipation , bloating or nausea especially during menstrual period

 Risk factor

Family history

Early menstruation ( 11 yrs)

Shorter menstrual days

Heavy menstrual period lasting more than seven days

Never giving birth

Going through menopause

Low body mass index

 

 

Pathology

In endometriosis

Under the influence of hormones endometrial tissue that is located outside the uterus thickens breaks down and bleeds each month. This blood cannot exit the body the blood becomes trapped form cysts scar tissue and adhesions infertility

Common area

1.       Ft

2.       Bladder

3.       Ovary – endometrioma

4.       Utero sacral ligament

5.       Intestine

6.       Cervix

Diagnostic method

n  surgical visual inspection

n  serum cancer antigen 125 greaterr than 35

n  cytokine int -6

n  serum cancer antiger 19-9

n  transvaginal usg – retroperitoneal and uterosacral ligament

n  ct

n  mri

n  laproscopy

Bimanual examination:-

n  signs may be absent or may include tender nodules in the posterior vaginal fornix

n  uterine motion tenderness is positive

n  a fixed and retroverted uterus will be felt

n  teender adenexal masses resulting from endometriomas

n  utero sacral pain

n  prognosis

n  laproscopic adhesive lysis

Treatment

n  medroxyprogesterone

n  danazol

n  presacral neurectomy

n  salpingo oophorectomy

 

n  diagnostic laproscopy—place of endometriosis , rupture the endometriosis

 

n  chances of fertility is there or it also reduced

n  by doing ablation there is reduction stored ovum

n  analgesic

n  oral contraceptives

n  androgenic agent

n  progestogens – medroxyprogesterone – if menstruation doesn’t happen endometrium doesn’t grow ..line of treatment for 6 months is stopping of menstruation – the tissue will automatically shed

Ayurvedic treatment

n  don’t have any medicine to stop

n  pitta samana

n  shobha hara

n  more bleeding- vata pitta

n  more adhesions – vata kapha

n  lekhana property medicine

n  vata shmana

n  krimi chikitsa also done

 

don’t go for all this treatment ..see the condition ,,,what is the concern

 

internal medicine

1.       sukumara  ks

2.       phala sarpi, sukumara ghritam- don’t use

3.       bowel and urinary -gandharvahstathi

4.       mahathikthakam- adhesion removed

5.       guguulu panchapola choorna

6.       rejotone – menorrhagia is reduced

7.       kurunjikuzhambu -lekhana

8.       vaishwarna guduchiyathi

9.       trayandhi ks- granthi

10.   kumari asava –  uterine booster

11.   dhanwantaraaristam – pain

Sodhana

snehapana

n  dadimadi

n  kalyanaka

n  tikthaka

n  Ashoka

n  Chiruvilvadi

n  Tila taila

Virechnaa

n  Eranda taila

n  Hingutriguna tailam

Lekhana vasti

Makshikam-125ml

Lavana -15g

Sneham-80ml Kalkam

 Vaitarana vasti

Sahacharadhii tilataila

Milk-avara

Uttaravasthi— in endometriosis Uttara vasthi contraindicated , in some case tissue loadged in ft or ovary ,, it is prescribed in ovulatory period

Kshara tailam

Dhanwantaram 101

Ksheerabala 101

Anuvasana vasti

Shaacharadhi tailam

Prevention

n  Pregnancy and breast feeding

n  Eating fruits – citus fruits

n  Not to use sanitary pad for more than 6 hrs

n  Menstrual cup also cause for endometriosis

n  Intake of spicy and salty is avoided

n  Proper exercise is advised

n  Unnecessary surgery is avoided 

 

 

·       Immune system disorder

·       Genetics – genetic changes