Endometriosis, Essay Example

Case Scenario

A 19 year old female presented with a complaint of chronic pelvic pain. History revealed that the patient has been complaining of severe dysmenorrhea that started when she was 15 years old. She was treated with combined oral contraceptives for the dysmenorrhea. However, dysmenorrhea progressively worsened despite treatment with combined oral contraceptives. Pain is now constant and not just associated with her menstrual cycle although pain is worse during her menstrual cycle. The patient had started becoming sexually active over a year ago. She states that sexual intercourse had become painful over the last 4 months. Physical examination of the patient yielded normal results except for tenderness on the abdominal and uterine area. The patient has no history of sexually transmitted diseases and had no bowel and bladder irregularities.

Differential Diagnosis

1. Pelvic inflammatory disease
2. Urinary tract infection
3. Ovarian cysts
4. Pelvic adhesions

A complaint of chronic pelvic pain is usually caused by pelvic inflammatory disease. Ovarian cysts can also cause chronic pelvic pain and can be ruled out through physical examination or by conducting an ultrasound. Similarly, abdomino-pelvic pain can also be caused by disorders of the gastrointestinal tract and the urinary tract. Urinary tract infection can be ruled out by obtaining a urinalysis, urine culture and complete blood count.

Endometriosis

Endometriosis is a gynecological condition afflicting women. It is characterized by the proliferation of the endometirum at a site other than the uterine cavity, most commonly on the abdominal cavity. Endometral cells are often influenced by hormones, thus even cells that are similar to those found in the endometrium respond to hormonal changes. Endometriosis typically occurs among women during their reproductive years, affecting about 6-10% of women and associated with infertility (Bulletti et al. 441). Symptoms of endometriosis may vary and depends on the site where the disease is active. However, a universal symptom of endometriosis is pelvic pain. The pain can vary from mild to severe and it is typically localized on the pelvis, rectal area, lower back and sometimes, even on the legs. The severity of the pain is not associated, however, to the extent of endometriosis. Some women with extensive endometriosis can have no pain or very little pain associated with the disease while some women with a mild case of endometriosis can report extreme pain (Stratton & Berkley 327). Other symptoms associated with endometriosis include painful sexual intercourse, dysmenorrhea, difficulty urinating and generalized fatigue.

Laparoscopy is the main diagnostic tool to confirm the diagnosis of Endometriosis. It is a surgical procedure to view the abdominal cavity and although this is the gold standard in confirming a diagnosis of Endometriosis, most health insurance plans may not cover this as an initial test. Ultrasound and MRI are also popular diagnostic imaging tools. However, a normal ultrasound or MRI result does not totally eliminate the possibility of Endometriosis as the areas affected by Endometriosis may be too small to be picked up Ultrasound or MRI.

Patient education regarding endometriosis should ideally begin during the initial phase of adolescence as part of a strategy towards gaining comprehensive health information. At an early age, these women need to know which symptoms to look out for and the importance of seeking medical help. As Endometriosis is often a chronic disease, ongoing support, education and treatment is essential. Support and information should also be given to family members of women who have Endometriosis in order to address concerns and the impact of the disease. Furthermore, intensive counseling is required for women who want to become pregnant.

Works Cited

Bulletti, C. et al. Endometriosis and infertility. J. Assist. Reprod. Genet. 27 (8): 441–7. 2010.

Stratton, P. & Berkley, K.J Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications. Hum. Reprod. Update 17 (3): 327–46. 2011