Pathophysiology and Epidemiology
Endometriosis is a key cause of infertility in the world. It is a condition that manifests itself through chronic pain and bareness. Pathophysiology heightens one's understanding of the physiological processes associated with a certain medical condition. The peritoneal macrophages, as well as ectopic endometrial cells, yield TNF and interleukin-1β which are excellent examples of cytokines which trigger nuclear factor kappaB (NFκB) and activator protein 1 (AP1), also known as transcriptional factors ( Parasar, Ozcan, & Terry, 2017) . The main impact of active transcriptional factors is that they attach themselves to the DNA of the endometriosis and ectopic cells, initiating genes which encrypt several proteins such as granulocyte, macrophage colony stimulating factor(GM-CSF), and cytokines like IL6 and IL8, among others. Aside from this, other immunological aspects play a pivotal role in the pathogenesis of this disease ( Parasar, Ozcan, & Terry, 2017). Notably, endometriosis is comparable to autoimmune ailments, whereby the action of autoantibodies against antigens in the endometrial cells leads to the development of granulocyte, macrophage colony stimulating factor(GM-CSF). The physiological activities often lead to sterility in endometriosis patients.
Additionally, the existence of inconsistent levels of cytotoxic and active T lymphocytes in the peripheral blood during menstruation also leads to endometriosis. Vicissitudes in regulatory T cells are often due to modifications in the immune response. One of the main characteristics of the condition under scrutiny is a chronic inflammatory reaction, as well as the extreme levels of inflammatory cytokines especially in the serum and the peritoneal fluid. Macrophages, dendritic cells, and (NK) cells found in the peritoneum, even in their preeminent numbers are unable to detect and destroy endometrium tissues scattered in the abdominal activity. Concurrently, reactive O2 species are produced at extreme levels. The high regeneration activity that occurs in the endometrium tissue is attributed to the presence of progenitor and endometrial stem cells in the basal section of the endometriosis. Notably, endometriosis lesions are formed due to the presence of additional uterine stem cells, as well as progenitor cells produced by the bone marrow. If the stem cells penetrate the abdominal cavity supports the supposition that some of the glandular cells in this disease’s associated lesions are of monoclonal origin.
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Several factors increase the risk of endometriosis. Hormonal variation increases an individual’s risk of contracting the disease. The risk is also greater in women who experience short-length menstrual cycles and early age menarche, while the threat is relatively lower in ladies who use oral contraceptives. Recent studies have also discovered a link between a woman’s Body Mass Index and endometriosis. The hormonal differences between skinny and overweight women are used to support this hypothesis ( Parasar, Ozcan, & Terry, 2017) . Additionally, common habits such as alcoholism, caffeine intake, and taller heights also said to heighten the risks for endometriosis while regular and intensive physical activity, the consumption of fish and omega three fatty acids, and smoking, are associated with decreased risk. The relationship between endometriosis and smoking has not yet been determined. Interestingly, while smoking heightens the risk of contracting a myriad of diseases, it actually, decreases the risk of endometriosis. Nonetheless, few studies have scrutinized this issue, which calls for further investigations into the matter.
Differential Diagnoses for Endometriosis
Three differential diagnostic procedures are used for endometriosis. Pelvic Inflammatory Disease is the first diagnostic criterion that is used to determine whether a patient is suffering from endometriosis. PID is characterized by symptoms such as dysuria and dyspareunia during menstruation. It is primarily caused by bacteria found in the vagina, cervix, fallopian tubes, and ovaries. The bacteria mostly come from STI’s such as chlamydia and gonorrhea. PID is ruled out by a laparoscopy, vaginal swab, as well as a transvaginal ultrasound.
Ovarian cysts are the second differential diagnoses. The condition is usually associated with intense pain, dysuria, dyspareunia, and dyschezia, during menstruation. Sacs filled with fluid, which are located in the ovaries, are referred to as cysts. Most of these swellings disappear without any medical intervention ( Juhasz-Böss et al., 2014 ). Nonetheless, the enlargement or multiplication of these lumps can cause unbearable pain and other adverse reproductive issues. The condition is ruled out through a pelvic exam aimed at palpating the inflamed masses in the ovaries. Similarly, patients are also examined using ultrasound for the purpose of visually verification and nullification.
Endometriosis is the final differential diagnosis. Patients who report painful cramping, dyschezia, dysuria, dyspareunia, and sterility for a period of more than six months are tested for endometriosis, soon after the two previously discussed conditions are ruled out. The main reason for this is because patients with PID and Ovarian cysts have symptoms that are similar to those of endometriosis ( Juhasz-Böss et al., 2014 ). Thereafter, physicians visualize endometrial growth outside the womb using a transvaginal ultrasound. Nonetheless, laparoscopy is the most effective way to diagnose the condition. LSC reveals whether the pelvis is normal or if there are any abnormalities in the endometrium.
Applicable Diagnostic Studies
Evidence-based practice has become one of the topmost priorities of every medical institution. Extensive analysis of the available research on the different diagnostic procedures for endometriosis is required to determine the ones that provide the most accurate results. The study by Hirsch et al. (2018) is one of the most applicable diagnostic studies. The article conducts a systematic review of previous and recent literature on the topic. Hence, the researcher can make comparisons of the research findings of each of the sources analyzed by Hirsch et al. (2018). The process is critical for determining the approach that is not only accurate but convenient regarding costs and time. The research examines one hundred and fifty-two diagnostic articles, which comprises ten that have the same findings. Undeniably, the authors provide reasonable and evidence-based arguments, which can be analyzed further, making it highly relevant to this research.
Similarly, Becker, Gattrell, Gude, and Singh (2017) also conduct a systematic review of endometriosis diagnoses. The article is not only relevant but applicable to this research since it scrutinizes the evidence of fifty-eight scholarly and peer-reviewed sources on the topic. Notably, these sources are retrieved from scholarly medical websites such as Medline and Embase. Additionally, all types of studies ranging from descriptive, observational, and randomized control trials are examined by the authors. Hence, the article enables the researcher to make significant comparisons between the findings of each of the sources used, which is an effective step for the acquisition of quality evidence. It further examines the flaws evident in each of the diagnostic criteria used in the selected articles. The study by Becker, Gattrell, Gude, and Singh (2017) can, therefore, be used in this research.
Prevention
Recent studies confirm that there are some measures that women can take to decrease their chances of contracting endometriosis. Wu, Yang, Tobe, and Wang (2018) argue that the disease cannot be prevented. Even so, there are steps that people could take to suppress their chances of endometriosis. The authors recommend practices that decrease the levels of estrogen in the female body. Extreme levels of this hormone thicken the uterus lining during the menstrual cycle, which is risky. Hence, women should seek hormonal birth control procedures that have lower estrogen levels. Secondly, they should also embrace regular physical activity to maintain a healthy weight since BMI is greatly associated with an increased risk for this ailment. It is also crucial for women to avoid the consumption of large amounts of alcohol since it intensifies the levels of estrogen in the body. Wu, Yang, Tobe, and Wang (2018) also urge women to avoid caffeinated products since they also augment estrogen levels in the body. Concurrently, women would be able to lead healthy lives.
Commonly Prescribed Drugs
Patients have several treatment alternatives for endometriosis. Women who suffer from intense pain due to cramping are recommended various symptom-relieving medications such as painkillers, hormones, and surgery. Non-steroidal anti-inflammatory treatments such as Ibuprofen, diclofenac, and acetylsalicylic acid are usually prescribed for endometriosis. Patients who report cases of excruciating pain are treated with opioids. The medications have some side effects which range from nausea, headaches, and stomach-related problems.
Hormone-based medications are also used to treat this condition. Notably, these remedies impede the production of hormones in the ovaries, which stops ovulation. Hormonal drugs are therefore not recommended for patients planning to get pregnant. Four primary types of hormonal medications, namely: the contraceptive patch, progestin’s, GnRH analogues, and androgenic substances are used as a treatment option. The treatments impede the accumulation of mucous membranes in the endometrial implants, an effective pain relieving strategy. In severe cases of endometriosis, the womb and the ovaries are removed through surgery, a process known as a hysterectomy. The treatment options are provided by medical practitioners based on the severity of pain.
Conversely, other non-pharmacological approaches have proven effective for pain reduction in endometriosis patients. Chronic pain is one of the symptoms of this disease. Studies show that acupuncture is effective for alleviating this pain (Marqui, 2014). Over the years, acupuncture has been employed to treat bareness, pelvic pain, and other symptoms of endometriosis. It is, therefore, a productive complementary therapy that should accompany pharmacological treatment. Nonetheless, more research on the effectiveness of this treatment is required to ascertain its role in the management of endometriosis.
Best Practices for Optimal Outcome
Programs intended at enlightening the society on the risk factors, symptoms, and treatment of endometriosis should be established for the best health outcomes of women in different communities. The promotion of health literacy is critical since it makes women cautious of their lifestyles. For instance, most of them are bound to stop over consuming alcohol when they are aware of the impacts that the substance has on their bodies. Concurrently, the quality of female life would increase.
Additionally, programs aimed at promoting cultural competency among medical staffs should also be employed. The main reason behind this claim is because culture is one of the factors that hinder effective treatment. Medical professionals gain knowledge on how to approach people from different cultures when they are enlightened on different cultural beliefs and customs. For instance, most professionals find it impossible to convince endometriosis patients of Hmong origin to undergo surgery to remove their ovaries mostly due to the approaches they use. Notably, direct eye contact is regarded disrespectful among the Hmong’s, and physicians should avoid this cue at all costs. Furthermore, the Hmong’s believe that surgery enables the spirit to escape from the body and they condemn this practice. Culture-based programs would enable medical staffs to determine ways of addressing and handling such issues when they arise. The programs should, therefore, be the priority of each medical organization.
Endometriosis affects a great number of women worldwide. It is one of the principal causes of infertility globally. Medical organizations, in liaison with state governments, should organize and facilitate educational programs to inform societies about the risk factors, symptoms, and treatments of endometriosis. Additionally, medical staffs should also be culturally trained so that they can attain the skills needed to handle patients from different ethnic backgrounds. As a result, the cases of endometriosis would decrease.
References
Becker, C. M., Gattrell, W. T., Gude, K., & Singh, S. S. (2017). Reevaluating response and failure of medical treatment of endometriosis: a systematic review. Fertility and Sterility , 108 (1), 125-136.
Hirsch, M., Begum, M. R., Paniz, É., Barker, C., Davis, C. J., & Duffy, J. M. (2018). Diagnosis and management of endometriosis: a systematic review of international and national guidelines. BJOG: An International Journal of Obstetrics & Gynaecology , 125 (5), 556- 564.
Juhasz-Böss, I., Laschke, M. W., Müller, F., Rosenbaum, P., Baum, S., Solomayer, E. F., & Ulrich, U. (2014). Endometriosis: a survey of current diagnostic and therapeutic options and latest research work. Geburtshilfe und Frauenheilkunde , 74 (08), 733-742.
Marqui, A. B. T. D. (2014). Non-pharmacological approach to pain in endometriosis. Revista Dor , 15 (4), 300-303.
Parasar, P., Ozcan, P., & Terry, K. L. (2017). Endometriosis: Epidemiology, diagnosis and clinical management. Current obstetrics and gynecology reports , 6 (1), 34-41.
Wu, B., Yang, Z., Tobe, R. G., & Wang, Y. (2018). Medical therapy for preventing recurrent endometriosis after conservative surgery: a cost‐effectiveness analysis. BJOG: An International Journal of Obstetrics & Gynaecology , 125 (4), 469-477.
