To understand endometriosis let us quickly and briefly revise our knowledge about the anatomy of uterus. Uterus consists of three layers – the outermost peritoneal covering or perimetrium, the middle muscle layer or myometrium, the innermost mucus membrane or endometrium.
So what is endometriosis:
It is a disease in which endometrium spreads outside its normal location.
Endometriosis is a benign condition but has the power of invading healthy adjacent structures.
It is believed that endometriosis is in genes.
Researchers have reported that those women who have a family history of the disease are five times more likely to develop endometriosis. It is an oestrogen dependent disease. Often symptoms decrease during pregnancy, and usually disappear after menopause.
What are the sites of endometriosis:
1 When the endometrium invades the underlying myometrium it is called Adenomyosis interna.
2 The endometrial cells can attach to the ovaries, fallopian tubes, outer surface of the uterus, bladder, umbilicus, appendix, sigmoid colon.
Endometrial tissues outside the uterus respond to the sexual hormones in the same way the tissues inside the uterus respond – it swells and thickens, then sheds to mark the beginning of the next cycle. The blood that is shed from the endometrial tissue in abdominal cavity has no place to go, resulting in pools of blood causing an inflammation that forms scar tissue. The scar tissue can block the fallopian tubes or interfere with ovulation.
Another affect is formation of ovarian cyst which may again interfere with ovulation.
What are the causes of Endometriosis:
There are a few theories suggesting the probable causes of endometriosis.
One such theory is that some of the menstrual tissue backs up through the fallopian tubes into the abdomen where it implants and grows. Another theory indicates that it is a genetic birth abnormality in which endometrial cells develop outside the uterus during fetal development.
What are the symptoms of endometriosis:
1. Pain – Deep dull pain in the mid pelvis, radiating to sacrum, lumbar region, rectum and lower abdomen. In case of rupture of the cyst , severe pain occurs.
2. Dysmenorrhoea – before during or after menses.
3. Menorrhagia with shortened cycle.
6. Bowel symptoms – Severe constipation or discomfort during defecation. Attacks of diarrhoea and tenesmus may occur.
7. Bladder symptoms – Unexplained attacks of periodic urinary infection with cyclical haematuria.
Physical examination reveals fixed tender enlarged retroverted uterus , fixity of large cystic swellings.
What are the complications of Endometriosis:
1. Ovarian cyst – It is the most common complication of endometriosis. It may also be called chocolate cyst because of the dark reddish brown blood inside it. The size of the cyst may vary from 1mm to 10cm.
2. Scar tissue may cause kidney impairment by blocking urine flow through the ureters.
3. Scar tissue may block the bowels.
4. Scar tissue may twist an ovary.
5. An ovarian cyst may rupture.
6. Decay of endometriosis cells may damage normal tissue.
7. Pneumothorax may occur if an endometrial implant is located in the lung.
8. Nervous system problems, such as seizures or paralysis, may occur if an endometrial implant is located in the brain or spinal cord.
Exams and tests:
A history of symptoms and menstrual periods.
A routine pelvic examination may reveal an abnormal mass.
Laproscopy is needed to confirm the diagnosis of endometriosis.
Ultrasound CT scan MRI In case of infertility, tests to find out the causes.
Home treatment may ease the pain and discomfort and supplements the medical treatment.
Applying heat such as heating pad or hot water bottle to the lower abdomen or a warm bath may relieve the pain by improving the blood flow.
Elevating the legs by placing a pillow under the knees when lying straight and placing knees up to the chest when lying on side will relieve back pressure.
Regular exercise improves the blood flow, increases secretion of certain pain relieving substances as endorphins naturally produced by the body.
Although there are no specifics, but certain drugs have special affinity for female genitals. Therefore according to the totality of the symptoms, we can s_elect the indicated remedy. I have found following drugs useful covering the symptom picture of Endometriosis.
It is the drug often used in Gynae cases. Just imagine a tall lady of narrow pelvis, devoid of intellectual lines, of irritable temperament, who desires to be left alone and lie down quietly, no disturbance from children, even caressing from husband is irritating, has developed an aversion to sex, suffers from constipation, a sensation of ball in the anus not better by stool, frequent urination with heaviness of bladder, feels bearing down or dragging in the lower abdomen, she feels sudden hot flashes and sweat of the whole body. She has brown patches on cheeks and forehead. She feels better by short sleep and eating.
This drug is for timid, weeping, mild, gentle, yielding lady who is easily moved from laughter to tears, seeks consolation, is inclined to be fleshy.
She complains of severe premenstrual colic, her urine dribbles while coughing , laughing or sneezing, sitting or walking. Her wandering pains are better walking in open air. She feels chilly even in a warm room. In the morning, on waking, she feels excitement of genitals and desire for coition.
NUX VOMICA –
The N.V. woman is lean, dyspeptic, bent forward, withered, of premature age who is angered easily, tears the things and scolds others. . She has pain in the uterine region, radiating to anus with frequent ineffectual desire for stool. During menses she has nausea in the morning with chilliness and attacks of fainting. She has painful frequent desire to urinate without passing a single drop. She craves bitter things, tonics.
A nervous, hysterical, awkwardly silly female, who drops the things while handling due to incoordination of muscles. The drug has affinity for right side -right ovarian cyst with stinging pains, complaints with violence and rapidity. Hyper aesthesia when occupied and not thinking of her problems.
Pain in uterine region from side to side, more the flow more the pain in hysterical and rheumatic constitutions. Many pains in different parts of the body are reflex symptoms from uterus and ovarian diseases. Left inframammary pains, cramping in muscles and joints. Restless and unhappy state of mind with heat on the top of the head.
AURUM MUR NATRONATUM –
Uterus is enlarged and fills the whole abdomen. The uterus is ossified and ovaries indurated.
AURUM MET –
Sterility with enlarged and hard uterus and ovaries She is depressed
because of her sterility. Her menses are frequent, profuse and excoriating.
She is melancholic, longs for death has suicidal thoughts. Constipation is during menses.
Left ovary swollen, painful, ovarian cyst. Pains shifting from left to right side or upwards to chest. Scanty painful discharge of black blood, headache during menses, relief of the symptoms by blood flow.
CALC. CARB –
Too early, profuse and long lasting menses, menses return from mental emotions or overexertion. Sterility. Dysmenorrhoea, sweating of head and cold damp feet in blond flabby female.
The list of the remedies may be quite exhaustive .The formation of cyst in the ovary suggests the sycotic and spread to the inner lining of the uterus and to the other organs, the syphilitic nature of the disease. Therefore antimiasmatic drugs would also help.
Proper follow-up of the case and the assessment of the relief of the symptoms is what is expected in otherwise incurable disease called endometriosis.