Female reproductive issues: endometriosis, fibroids
Endometriosis is the condition where non-cancerous pieces of endometrial tissue (the layer of tissue that lines the uterus) are found in other parts of the body where they should not be appearing. Endometriosis is estimated to affect 10 to 15% of menstruating woman in the age range of 25 to 45 years old. The actual occurrence may be higher because this problem may be misdiagnosed. The risk factors include family history, having structural abnormality of the uterus, having the first baby after 30 years old or never having a baby. Asians are more prone to having endometriosis than Caucasians.
The causes of endometriosis are unclear although here are some possibilities:
a) Pieces of the uterus lining that shed off during the menstruation process did not flow out through the vagina. Instead, they flowed backwards towards the Fallopian tube and ovaries, and then subsequently some flowed into the abdominal cavity.
b) The cells of the uterus wall lining is not shed off properly but transported through blood or lymphatic network to other locations.
The endometrial cells would go to other locations, normally in the ovaries or ligament supporting the uterus, and increase in size. In some cases, the misdistributed endometrial cells are found at small and large intestines, bladder, urinary tracts and vagina, and very occasionally at some distant organs. These misdistributed cells respond to the hormones estrogen and progesterone, and may bleed when the person menstruate. The symptoms are severe pain and bleeding from the corresponding locations, most often as abdominal cramp and heavy menstruation flow. Occasionally, bleeding from the digestive tract or urinary tract can result, depending on where the misdistributed cells reside. Scar tissues that form subsequently may affect the working of the organs.
Fibroids are a commonly seen growth in the reproductive system. Fibroids are non-cancerous tumours composed of muscle and fibrous tissue. It affects around 20% of women under the 50 years old.
Although the actual reasons are not certain, high estrogen (female hormone) levels seem to stimulate fibroid growth. Fibroids can appear microscopic and slowly increase in size. The growth locations are mainly at the uterus wall, either on the surface or underneath. When fibroids are found during checkup, there are usually several of them, as they are seldom found in isolation.
Symptoms largely depend on the size and location of the fibroids. Fibroids that grow on the wall of the uterus usually cause pain, pressure and possibly heaviness in the pelvic area during menstrual periods. When the fibroids become large, depending on the location, they may press on the bladder or intestine. This may lead to frequent urge for urination, lower abdominal discomfort or constipation. Fibroids which grow under the lining of the uterus may cause bleeding. The symptoms are heavy menstrual flow that lasts longer than usual,accompanied by pain.
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