- What Is Endometriosis?
Abnormal growths of tissue that resemble the endometrium histologically, but present in locations other then the uterine lining are observed in the disease endometriosis. It occurs commonly in women who are at their reproductive ages (American Medical Network, 2011).
- Causes for Endometriosis
Retrograde menstruation has been attributed to be the leading cause for endometrioses. Proposed in 1920, it postulates that during menstruation, there are viable endometrial portions shed. These fragments pass through the uterine tubes and develop into endometrial lesions once deposited on the peritoneal surfaces in the pelvic cavity.
Another theory postulates that tissues of the endometrium could be passed along the hematogenous or lymphatic route. Sometimes, the peritoneum, due to irritation, may undergo metaplasia to turn into endometrial tissue.
There are genetic links to the development of endometriosis too. About 7-9% patients with endometriosis have first-degree female relatives also diagnosed with the disease.
- Endometriosis Pathologic Physiology
Pain occurs premenstrually in patients with endometriosis. Pain is due to inflammation and pressure in the lesions and also due to the proximity of the implants to the nerves. Degrees of pain in endometriosis are related to the depth of invasion.
The association of endometriosis with infertility has long-been studied. This may occur due to the destruction of tubal and ovarian tissues although the uterine tube occlusions are not that frequent.
Alterations in the volume of peritoneal fluid may also be a cause for the infertility. Peritoneal fluid prostaglandins, F2 and E2, increases cause infertility due to altered ovulation and tubal motility.
- Signs and Symptoms of Endometriosis
Pain in the pelvis, infertility, and alteration in menses are common signs. Midline pelvic pain before and after menses and dyspareunia may develop. When there are implants in the large intestine, pain during defecation, abdominal bloating, and menstrual rectal bleeding are some symptoms present. Hematuria, dysuria and suprapubic pain are possible with balder implants.
Renal function is impaired when there are implants in the bowel or the ureters. A number of symptoms occur when there is erosion of lesions in the advanced stages of the disease, which can be termed as the aggressive stages of endometriosis. Endometriomas can cause torsion in the ovaries. Sometimes, their contents that are irritating may spill into the cavity of the peritoneum and this may lead to chemical peritonitis.
Counseling, in the appropriate manner, is necessary for the patients with endometriosis. The disease needs to be staged on which basis future interventions can be planned. The symptom the patient is experiencing and the desire to bear a child all determine the future course of the appropriate therapy. Relief from pelvic pain and pregnancy may be achieved in patients treated rightly.
Current therapies for endometriosis do not offer complete cure, but just relief. Sometimes, there is recurrence of endometriosis even after definitive surgery (about 3%). After conservative surgery, the recurrence does not exceed 10% in three years.
The future treatment options may be refined ones to the treatment options existing now. Normally, hysterectomy is not needed for the majority of cases that can be treated with conservative surgery alone.
- Nursing Interventions and Patient Teaching in Endometriosis
- The patient must be asked to verbalize their feelings experienced due to the illness.
- The patient must be helped to develop strategies that assist in coping with the disease condition.
- Upon very high bleeding during menses, the patient needs to be assessed for anemia.
- The patient’s response to the therapeutic interventions needs to be monitored (NursingFile, 2008).
- Clarify to the patient misconceptions on disease complications and fertility problems.
- Counsel the patient for earlier options of childbearing as fertility is an issue with endometriosis.
- Recommend to the patient to undergo as Papanicolaou test and a pelvic examination every year.
- The side effects relating to pharmacological interventions need to be taught to the patient.
- Treatment with Oral contraceptive pills
A pill a day for 6-12 months is the required dose of the monophonic products used. Oral contraceptives use results in merely suppressing the disease and not in curing it completely.
- Various Methods of Contraception
Contraceptive methods are five in number. Factors such as age, history of illness, number of sexual partners, frequency of sexual activity, and desire to bear babies in the future should be considered for considering a particular type of contraceptive method for a woman. Health care professionals must be sought to decide on the appropriate birth control method.
The different methods of contraception include:
- Barrier methods
- Hormonal methods
- Emergency contraception
- Intrauterine methods
- Questions: Answer if True or False
- There is accompanying alteration of menses in endometriosis..T/F
- Genetic influences do not play a role in the development of the diseaseT/F
- Chemical peritonitis is an accompanying complication in endometriosis.T/F
American Medical Network (2011), Endometriosis, Retrieved from http://www.health.am/gyneco/more/endometriosis-prognosis/.
NursingFile (2008), Nursing Interventions for Endometriosis, Retrieved from http://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-endometriosis.html