The diagnosis and management of endometriosis

A

Abdominal hysterectomy A hysterectomy carried out through a cut in the abdominal wall. 

Add-back When taking certain hormones, Gonadotropin releasing hormone agonists (GnRH agonists), that put the body into an artificial menopause, the side effects can include menopausal symptoms such as hot flushes, loss of libido, vaginal dryness, headaches, loss of concentration or mood swings. A serious ‘hidden’ side effect can be loss of bone density – which can lead to osteoporosis. To try to counteract these side effects, small doses of oestrogen/progestogen in the form of HRT, Livial, or Norethisterone are given at the same time. They replace some of the hormones that are removed by the hormone treatments.

Adenomyosis A disease where endometrial tissue grows in the muscle layer of the wall of the womb, bleeding and causing pain. This is not the same as endometriosis. 

Aromatase inhibitors Medication that stops (inhibits) the enzyme aromatase from working. Aromatase changes androgens into oestrogen. These drugs are occasionally being used to treat women with endometriosis, if those women have not responded to other treatments. These drugs are used to treat some breast cancers. They are still in the experimental phase for the treatment of endometriosis.

B

Bilateral salpingo-oophorectomy Surgery to removal both ovaries and fallopian tubes.

Bowel resection Surgery to remove a part of the bowel. The procedure may remove the portion of the bowel where an obstruction is located. Complications of a bowel resection include fistula, the formation of adhesions, and the possibility of a colostomy.

C

Cauterisation The removal or destruction of tissue with a laser or an electrical current. This can help with heavy bleeding and removal of endometriosis deposits.

Cervix The 'neck' of the womb or the opening between the body of the womb (uterus) and the vagina. 

Chocolate cyst (endometrioma) A cyst in the ovary, filled with old blood, also known as an endometrioma. It occurs when there is bleeding into a cyst. They are called chocolate cysts because the blood is dark colored and looks like liquid chocolate.

Chronic: Persistent and lasting a long time.

D

Dysmenorrhea Painful periods.

Dyspareunia Painful sex.

E

Endometriosis is defined as a disease characterized by the presence of endometrium-like epithelium and/or stroma outside the endometrium and myometrium, usually with an associated inflammatory process

 

Endometrioma See chocolate cyst 

F

Fallopian tube A tube that lies between the ovary and the womb, and transports the eggs to the womb. A woman has two Fallopian tubes.

Follicles Areas in the ovary, filled with fluid, containing the eggs that are released during ovulation. 

G

Gonadotropins The hormones that control the function of your ovaries. They are called the Follicle Stimulating Hormone (FSH) and the Luteinizing Hormone (LH). 

GnRH agonists and GnRH antagonists are both used to regulate hormone levels, but they work in different ways.

GnRH Agonists:

GnRH (Gonadotropin-releasing hormone) agonists mimic the natural GnRH that the body produces. When the medication is administered, it initially causes a surge of LH (luteinizing hormone) and FSH (follicle-stimulating hormone), which stimulates the ovaries to produce estrogen. Overtime GnRH agonists cause a decrease in LH and FSH production. This suppresses the ovaries and lowers estrogen levels.

GnRH Antagonists:

GnRH (Gonadotropin-releasing hormone) antagonists work differently. Instead of stimulating the release of LH (luteinizing hormone) and FSH (follicle-stimulating hormone), they block the GnRH receptors causing an immediate suppression of LH and FSH, stopping the ovaries from producing estrogen.

H

Hormone Replacement Therapy – HRT Medication used to mimic the effects of estrogen. It is prescribed after a hysterectomy or during menopause (either natural or medical) to counteract the effects of the menopause. Those effects include hot flushes, night seat, loss of libido, mood swings, loss of bone density and vaginal dryness. HRT has its own risks and should be carefully considered before taking.

Hysterectomy The removal of the womb from the body during surgery. There are several different ways this is done, see below:

·     Total hysterectomy: The removal of the womb (uterus) and the cervix, under anaesthetic.

·     Sub-total hysterectomy: The removal of just the body of the womb (uterus).

·     Total hysterectomy with bilateral salpingo-oophorectomy: Removal of the womb (uterus), cervix, ovaries and fallopian tubes.

Hysteroscopy A procedure in which the doctor examines the inside of the womb (uterus) under anaesthetic, by inserting an instrument (hysteroscope) into the womb. Minor surgery, such as the removal of a polyp, can be done at the same time.

I

In Vitro Fertilization (IVF) Literally means "in glass." Fertilization takes place outside the body in a small glass dish. 

Infertility The inability to become pregnant; if a couple has a year of regular, unprotected sex and doesn’t become pregnant, then that is also classed as infertility.

IUCD (Intrauterine Device) A device placed into the womb to prevent pregnancy.

L

Laparoscope: An instrument, like a small telescope with a light on one end, used to look at the inside of the pelvis, during a laparoscopy. 

Luteal phase The part of the menstrual cycle between ovulation and menstruation.

Luteinising hormone (LH) One of the gonadotropins - the hormone that is responsible for releasing an egg.

Laparoscopy Usually done under general anaesthetic, a small telescope with a light on the end (the laparoscope) is inserted into the pelvis through the navel (belly button).

M

Menopause When a woman’s ovaries stop functioning and her periods stop. This can either be artificially induced through drugs or a hysterectomy, or happen naturally.
Menorrhagia Heavy periods. 

Menstruation The monthly cycle where the body prepares for pregnancy.

Miscarriage Spontaneous loss of a fetus from the womb.

N

Nausea Feeling sick or queasy and needing to vomit.

Neurectomy The removal of a nerve, can be done to help relieve pain. 

Neuropathic pain Pain caused by damage to the nervous system, which affects its ability to perceive pain. This pain is usually chronic and lasts longer than the time taken for damaged tissue to heal. It can be treated with pain modifiers such as anti-depressants or anti-convulsants.

NSAIDs such as Ibuprofen, Voltarol and Ponstan (mefanemic acid) block the production of prostaglandins in the body. Prostaglandins occur naturally, in response to injury or disease, and cause pain and inflammation. They have a number of functions including making the womb contract during a period (which helps with the shedding of the womb lining). These contractions can cause pain. It is thought that women with endometriosis may produce more prostaglandins than women without the condition.

O

Oligomenorrhea Infrequent periods

Ongoing pregnancy A viable intrauterine pregnancy of at least 12 weeks duration confirmed on an ultrasound scan.

Oophorectomy The removal of one or both of the ovaries.

Ovarian cyst A growth in or on the ovary, filled with fluid. Called an endometrioma, when caused by endometriosis and filled with dark, old blood.

Ovarian Hyperstimulation Syndrome A side effect of fertility treatments that stimulate the ovaries to produce follicles (eggs). It can be life threatening. It occurs when too many follicles (with eggs) are produced.

Ovarian failure When the ovary no longer responds to the hormone FSH and does not produce follicles (with eggs) – either because it is damaged or hasn’t formed properly or has no eggs left. This can be spotted by a blood test in which the FSH in the blood is raised. 
Ovulate/ovulation When the egg is ripe and is released from the ovary. The follicle surrounding it breaks open and it will travel into the fallopian tube, to wait for fertilization. If the egg then becomes fertilized it will travel into the womb and implant.

P

Peritoneum The thin tissue that covers the walls of the pelvis and abdomen on the inside, as well as the pelvic organs.

Pregnancy When a baby develops inside the womb, from being an embryo to developing into a fetus. Pregnancy lasts for nine months until the woman gives birth.

Premature menopause Menopause that occurs naturally before the age of 40. Also known as premature ovarian failure.

Premature ovarian failure A condition where the ovary runs out of eggs before the woman would normally go through a menopause.

Presacral neurectomy A procedure where the nerves behind the womb are cut – the aim for this to stop or reduce pain.

R

Retrograde menstruation When you have a period, some of the endometrium (womb lining) flows backwards, out through the fallopian tubes and into the abdomen. This tissue may then implant itself on organs in the pelvis and grows. It has been suggested that most women experience some form of retrograde menstruation, but their bodies are able to clear this tissue and it does not deposit on the organs. This theory does not explain why endometriosis has developed in some women after hysterectomy, or why, in rare cases, endometriosis has been discovered in some men, when they have been exposed to estrogen through drug treatments.

S

Salpingectomy The removal of the fallopian tube during surgery.

Side effects Problems that occur when medication or a treatment goes beyond the desired effect or problems that occur as well as the desired effect of the treatment/medications

T

Transvaginal scan an ultrasound performed through the vagina, using a special vaginal transducer. Transvaginal scans give better resolution of the ovaries and fallopian tubes. The procedure is usually painless, noninvasive, and safe.

Tumor A mass of cells growing inside the body. They can be benign or cancerous.

U

Ultrasound An investigative procedure where the inside of the body is looked at (visualised) using high-frequency sound waves.

Uterosacral ligaments: The supports that hold the womb in place inside the body. This is a common place to find endometriosis.