Endometriosis

Clinical Manifestations of Endometriosis

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These tissue implants respond to the cyclic hormonal changes of the menstrual cycle and cause menstrual-like internal bleeding that leads to inflammation, scarring, and adhesions in the pelvic cavity.

The exact number of women that experience endometriosis is hard to define as some women have severe symptoms and others are asymptomatic. Women who undergo laparoscopy for pelvic pain have an incidence of 1% to 7% of endometriosis (Schenken, 2013). Endometriosis is responsible for approximately 25% of infertility issues (Hornstein & Gibbons, 2012).

Some women with advanced endometriosis are essentially asymptomatic and are unaware of the disease until the condition presents during abdominal or pelvic surgery. Other women may experience debilitating, almost continuous pelvic pain, with only minimal abnormal tissue growth. The woman typically experiences the most pronounced symptoms right before the onset of the menstrual period.

Cyclic pelvic pain that occurs in conjunction with menses is a classic symptoms of endometriosis. Menorrhagia, dysmenorrheal, and dyspareunia (painful intercourse) are other common symptoms.

Depending on where the endometrial implants are located, the pain and bleeding can involve the bladder, leading to hematuria, or it can affect the bowel, leading to blood in the stools and painful defecation. Although endometriosis appears to play a role in infertility for some women, others experience no apparent difficulty with conception.

Endometriosis is difficult to diagnose due to the varied symptoms. In addition, the practitioner can easily attribute the symptoms to other conditions.

Physical examination reveals pelvic tenderness, particularly during menses. Laparoscopy is the primary diagnostic tool for endometriosis because the surgeion can directly visualize the characteristic endometrial lesions and take biopsy samples. Disadvantages include that laparoscopy is an invasive surgical technique.

Treatment

Treatment for endometriosis depends on the severity of the woman’s symptoms, extent to the disease, desire for fertility, and the woman’s treatment goals. The woman with mild pain may respond well to NSAIDs and oral contraceptives.

Medication therapy for severe symptoms aims to suppress ovulation and induce an artificial menopause, which in turn results in suppression of abnormal tissue and relief of pain. Side effects include symptoms associated with menopause, such as labile emotions, hot flashes, and vaginal dryness. Bone density should be monitored in artificially induced menopausal patients.

Surgical intervention can be conservative, destroying the abnormal tissue while preserving reproductive ability. Surgical intervention can also be semiconservative, destroying reproductive function but maintaining ovarian function, or radical, involving removal of the uterus and ovaries.

Nursing Care

Chronic pain is a common nursing diagnosis for the woman with endometriosis. Evaluate the character and severity of pain. Assist the woman in finding ways to cope with and descrease pain. Nonpharmacologic measures used to relieve PMS discomfort can also be used for the woman experiencing pain from endometriosis. Encourage the use of analgesics, as ordered.

Provide emotional support. Frequently the woman has suffered years of pain before the practitioner makes a diagnosis. Allow the woman a chance to discuss her feelings. She may particularly have this need if the endometriosis is causing infertility problems. Encourage the woman to ask questions. Assist the woman and her family in making treatment decisions by providing information regarding the advantages, disadvantages, possible risks, and likely outcomes of each treatment option.