Pathogenesis and Pathophysiology of Endometriosis, Research Paper Example

Topic Overview

Endometriosis is a complex condition that impacts the lives of many women in the form of irregular menstrual cycles, pain, and reduced fertility, all of which impact up to ten percent of women in their reproductive years (Guidice, 2010). Furthermore, between 50 and 60 percent of women who experience pelvic pain have endometriosis, as well as 50 percent of all women with infertility issues, and the disease is evident across all racial and ethnic groups (Guidice, 2010). The most common symptoms are pelvic pain of a chronic variety and missed or nonexistent periods; therefore, these factors contribute to an increased number of doctor visits for this group of patients (Guidice, 2010). There are a number of key risk factors associated with endometriosis, including menstrual blockages, exposure to estrogen and other chemicals, the consumption of red meats, and patients may be at risk of autoimmune disease and various cancers (Guidice, 2010). For many women, endometriosis causes disability and may contribute to reduced wellbeing; therefore, proper diagnosis and treatment is required in order to ensure that the disease is properly addressed and treated in a timely manner (Guidice, 2010).

Anatomy and Physiology

Typically, endometriosis is identified through the existence of lesions, fibroids and scarring that are located on the ovaries and other reproductive organs (Guidice, 2010). Therefore, many patients require MRI or ultrasound imaging in order to make a definitive diagnosis (Guidice, 2010). Patients are diagnosed in accordance with the severity of the condition in a range of I-IV, from least to most severe (Guidice, 2010). As a result, patients must be properly diagnosed so that treatment is in accordance with the level of severity and damage related to the condition that may also impact the menstrual cycle and fertility over the long term (Guidice, 2010). Endometriosis is inflammatory in nature and a number of pathophysiological concepts have been suggested to identify its cause, including the following: 1) coelomic metaplasia, by which tissue is transformed into ectopic tissue of the endometrium; 2) Bone marrow stem and progenitor cells transform into endometriotic tissue; 3) benign metastasis, whereby endometriotic lesions form in other areas; and 4) retrograde menstruation, whereby endometrium is released during menstruation (Burney et.al, 2012). However, regardless of the theory proposed, a dependence on estrogen, a genetic predisposition for the condition, inflammation, and a resistance to progesterone are likely contributing factors to the condition and its influence on patients (Burney et.al, 2012). One perspective to consider is that endometrial cells are able to survive in the form of ectopic implantation, in addition to overcoming an immune response (Burney et.al, 2012). For women with endometriosis, there is a significant amount of inflammation that may contribute to pelvic pain that is observed through nerve fibers in the implants observed in the endometriotic state (Burney et.al, 2012). Furthermore, lesions that are observed through laparoscopy may increase in scope or remain intact, depending on other factors that influence the inflammatory response (Burney et.al, 2012). Therefore, the pathophysiology of the condition is highly complex and requires much consideration and focus in order to determine the root cause of the condition and its stage for the patient in question (Burney et.al, 2012). This step requires a thorough examination and any testing that is required to make a definitive diagnosis so that any possible treatments may begin in a timely manner.

Diagnostic Procedures

Due to the chronic nature of endometriosis, a definitive diagnosis must be determined in order to begin treatment in an effective manner. Therefore, it is important for the physician to be proactive in utilizing the appropriate diagnostic procedures in order to ensure that the desired outcomes are achieved. One of the most common diagnostic approaches is laparoscopy, which identifies the disease and determines its level of severity through a scoring system, including mild, moderate, and severe levels (Meuleman et.al, 2013). The laparoscopy procedure is the most viable option because the pelvic organs are the primary location of the disease and may be evaluated accordingly with this procedure (Meuleman et.al, 2013). For most patients, imaging methods are not a viable alternative because of the limited resolution that is required to properly identify lesions (Meuleman et.al, 2013). However, ultrasound may be an effective method of determining the extent of any endometriotic cysts that are located in the region (Meuleman et.al, 2013). In the event that deep infiltrative endometriosis is evident, it is important to identify any possible issues related to the bladder, urethra, and bowel through transvaginal or transrectal ultrasound (Meuleman et.al, 2013). Nonetheless, the appropriate testing method depends on the patient’s presentation and the type of symptoms that are evident that are contributing to the severity of the condition (Meuleman et.al, 2013).

Treatment Modalities

For patients with endometriosis, it is important to identify the extent of the disease in order to determine which treatment methods might be feasible at the time of diagnosis. Most importantly, patients should be able to gain some relief from the symptoms that they are experiencing as a result of the condition, including pelvic pain and infertility in many cases (Meuleman et.al, 2013). Patients who experience severe or intense pain on a continuous basis are likely to require pain-related measures in order to improve quality of life and to address the condition in a timely manner (Meuleman et.al, 2013). It is important for physicians to examine endometriosis as a chronic condition that requires ongoing attention and focus in order to establish an effective understanding of the disease, its symptoms, and how to alleviate said symptoms to improve quality of life (Meuleman et.al, 2013).

Pain-related treatments often include analgesics, combined oral contraceptives, progestins, and nutritional guidance on a regular basis, with anti-inflammatory NSAIDS in some cases (Meuleman et.al, 2013). For many patients, the ability to suppress the functionality of the ovaries is instrumental in alleviating pain through the use of combined oral contraceptives or the intrauterine device (Meuleman et.al, 2013). Patients may also be prescribed GnRH agonists to alleviate pain, but bone density must be considered with this method, along with other options that may contribute to possible side effects (Meuleman et.al, 2013). As a result, patients require ongoing evaluation and support so that their symptoms are addressed in a timely manner, while also considering any complications that may arise as a result of medications (Meuleman et.al, 2013).

In some cases, patients may require surgery when pelvic dysfunction impairs normal activities and if surgery may be able to correct this condition (Meuleman et.al, 2013). Therefore, patients who require surgery should be protected from excessive complications and other risk factors that impact their ability to recover and to achieve greater quality of life (Meuleman et.al, 2013). Ovarian cystectomy is a common approach in order to alleviate the development of new cysts, and in more severe cases that impact urinary and/or bowel function, other surgical procedures should be considered (Meuleman et.al, 2013). It is likely that many of these treatment approaches will be covered by insurance due to the debilitating and chronic nature of the disease and its impact on quality of life for many patients. It is important to evaluate each case individually and to determine how to best approach the disease in order to accomplish the desired treatment objectives.

Education

For patients with endometriosis, it is necessary for women who experience pelvic complications to understand the risk of the disease and how it may impact their quality of life and level of fertility. As a result, educational programs for patients who are diagnosed with the disease must be considered, particularly when they face infertility and other complications. Many questions have been raised regarding the ability to conceive naturally if surgical options have taken place; therefore, the severity of the condition must be closely evaluated in order to determine this potential (de Ziegler et.al, 2010). Educating patients regarding the nature of the disease and their options is critical in order to determine the most effective and least invasive course of action that should be taken. In addition, it is important for patients to understand the possible risks of infertility associated with endometriosis and if there are any possible alternatives to reduce this risk and to preserve fertility. Patients should also be prescribed medications in a conservative manner that also alleviate pelvic pain to improve quality of life. These factors must be considered in the development of an educational strategy that is designed to support patient needs in a focused and attentive manner that will also preserve patient health and wellbeing. Educating patients is essential to understanding the nature of the disease and how it impacts their lives on a continuous basis.

Cultural/Underserved/Disadvantaged Implications

For patients from disadvantaged or underserved populations, endometriosis may be very difficult to treat and to diagnose, particularly if patients do not have health insurance or do not visit a physician to obtain a proper examination and diagnosis. Therefore, it is important to address the needs of these populations and to consider any underlying factors that may serve as barriers to diagnosis and treatment for patients. It is believed that patients who suffer from endometriosis who may be from disadvantaged populations face additional risks that must be addressed by the healthcare team as best as possible, and this is accomplished by informing women regarding the nature of the disease, its primary symptoms, and how it impacts the reproductive system in different ways, including an increased risk of infertility. Patients must be provided with an accurate and definitive diagnosis and gain access to the proper treatments in order to improve their quality of life. This is an ongoing process that requires further investigation and evaluation in order to accomplish the desired objectives for patients from disadvantaged population groups.

Evaluation of Disease/Topic

For patients where endometriosis is suspected, it is essential to obtain the appropriate referrals that are required in order to be seen by a specialist and to determine a diagnosis. This process is essential for patients because it enables them to obtain adequate medical care and subsequent treatment for the condition. Furthermore, it is necessary to provide patients with the appropriate follow up instructions so that they are able to be evaluated in the future to determine the progression of the disease and if any changes are required to the current treatment plan. This process will enable them to obtain adequate access to the required experts so that they are able to achieve the desired outcomes in an effective manner. First and foremost, proper identification of the disease is required in order to ensure that treatment is effective and outcomes are optimal. Patients must be provided with an environment in which they are able to ask questions regarding the disease and where information is provided regarding any risks to fertility and other factors that may impact health. Physicians and nurses must be able to provide patients with information that will support and aim to preserve their overall reproductive health and wellbeing for the foreseeable future.

References

Burney, R. O., & Giudice, L. C. (2012). Pathogenesis and pathophysiology of endometriosis. Fertility and sterility, 98(3), 511-519.

de Ziegler, D., Borghese, B., & Chapron, C. (2010). Endometriosis and infertility: pathophysiology and management. The Lancet, 376(9742), 730-738.

Giudice, L. C. (2010). Endometriosis. New England Journal of Medicine, 362(25), 2389-2398.

Meuleman, C., Tomassetti, C., Gaspar Da Vitoria Magro, M., Van Cleynenbreugel, B., D’Hoore, A., & D’Hooghe, T. (2013). Laparoscopic treatment of endometriosis. Minerva ginecologica, 65(2), 125-142.