Endometriosis: Examination of Uterus Key To Treatment ― Obafunwa

 THE AWARENESS THAT ALL menstrual cramps are not necessarily normal occurrence in women is increasingly gaining ground by the day especially among young women.

This is because, the age of menarche, according to reproductive health specialists, Obstetricians and Gynaecologists, “have dropped from about twelve to fifteen years it used to be many years back, to about ten years and in some cases we now have young girls of nine years old having their first menstrual experience”, says Dr Adewole Elugbadebo of Adeyinka Medical Centre, Iseri, Lagos.

Similarly, since Fertility Experts like Dr Abayomi Ajayi, Medical Director, Nordica Fertility Centre, Lagos and Asaba have taken interest in sensitizing and educating Secondary School Children (where most adolescents are found), on medical conditions such as Endometriosis and Fertility, the knowledge level has tremendously shot up.

There is no doubt also that more medical practitioners have taken interest to learn more on the diagnosis and treatment of the condition using Laparoscopy unlike previously when diagnosis was merely by clinical examination.

Knowledge on Endometriosis is equally increasing among the populace as more women are being seen at fertility clinics presenting with severe endometriosis as underlining cause of infertility. (a 2010-2016 ten year Survey among 61 women at Nordica Fertility Centre, Lagos)

Endometriosis is known to describe a condition where pieces of womb lining tissue called endometrium, are deposited elsewhere outside the womb, in the pelvis or abdomen, for example; and the adhesions or internal scar tissue the condition causes, tend to bind organs together, such as the ovaries and fallopian tubes thereby causing severe pain.

The endometrium on the other hand according to the WebMD, and the cervix are interconnected. The cervix is the lower part of the uterus that opens into the vagina. It is also called the neck of the uterus. The endometrium is the mucous membrane that lines the inside of the uterus (womb).

The endometrium changes throughout the menstrual cycle. It becomes thick and rich with blood vessels to prepare for pregnancy. If the woman does not get pregnant, part of the endometrium is shed, causing menstrual bleeding.

Speaking with Healthstyplus online, Former Vice Chancellor Lagos State University (LASU) and renowned Anatomic and Forensic Pathologist, Professor John Oladapo Obafunwa noted that beyond the usual reproductive organs where endometriosis has been commonly identified, “Endometriosis can involve the skin around abdominal scars, in rare cases post Caesarean sections”.

Obafunwa added that on close observation too, endometriosis can also be seen in the umbilical region with the woman classically presenting with monthly pains and bleeding from the navel ie. belly button.

This was first described in the medical literature by Dr. Villar in 1886 in the article titled “Tumeurs de L’ombilic”

According to the Anatomic and Forensic Pathologist, “This history is so classical that the diagnosis should not be missed.

“A biopsy sample sent to an Anatomic Pathologist will at microscopy reveal endometrial glands with accompanying stroma embedded in the skin tissue”, Obafunwa pointed out.

He disclosed also, “Endometriosis can many times be asymptomatic and it is only revealed when the Anatomical Pathologist is microscopically reviewing organs removed at surgery for other reasons.

“It is therefore not uncommon to find it incidentally in a uterus that was removed in the course of treating fibroids or other causes of heavy menstrual bleeding”, said Obafunwa.

The Consultant Pathologist is thus of the opinion that for an effective diagnosis and treatment options for a woman with suspected Endometriosis, it is necessary to carry out tissue sampling of the affected area for histopathology purposes.

“Actually”, said Obafunwa, “All tissues removed from the human body should be sent to the Anatomical Pathologist for histopathological diagnosis.

“Unfortunately this is not done by Clinicians for various indefensible reasons. Histopathological assessment by the pathologist will achieve a number of things:

  • Confirm or perhaps disprove a clinical diagnosis. Should the latter happen, it will offer the patient another alternative treatment protocol and even protect the clinician.
  • Reveal an additional diagnosis or an incidental finding which might or might not attract additional treatment.
  • Provide relevant disease epidemiological data of public health significance.
  • Confirmation of a negative clinical observation can save the surgeon (or other clinician) a lot of legal headaches.

Why do endometrial sampling?

According to a publication on this in Health & Medicine- ‘Endometrium In Pathology’, There are four main indications for endometrial sampling: Determination of the cause of abnormal uterine bleeding; Evaluation of the status of the endometrium in infertile patients, including histological dating; Evacuation of products of conception, either spontaneous abortions or termination of pregnancy and Assessment of the response of the endometrium to hormonal therapy, especially estrogen replacement in perimenopausal and postmenopausal women and Tamoxifen therapy for breast cancer.

Endometrial Biopsy:

An endometrial biopsy is an investigative procedure where a doctor takes a small sample of the lining of the uterus (endometrium) and sends it to the Anatomical Pathologist who will process and look at it under a microscope for abnormal cells or a variety of other changes.

An endometrial biopsy helps in finding out what problems are located in the endometrium. It also helps to know if the body’s hormone levels that affect the endometrium are in balance.

An endometrial biopsy may also be done to find the cause of abnormal uterine bleeding and to check for overgrowth of the lining (endometrial hyperplasia), or to check for cancer.

Also, when a woman is unable to fall pregnant, an endometrial biopsy may also be done to see whether the lining of her uterus can support a pregnancy.

An endometrial biopsy could be done at the same time with hysteroscopy, which allows the doctor to look through a small lighted tube at the lining of the uterus.

Why Do Endometrial Biopsy?

An endometrial biopsy is done to: •Check for cancer of the uterus; •Find the cause of heavy, prolonged, or irregular uterine bleeding; It is often done to find the cause of uterine bleeding in women who have gone through menopause and •See whether the lining of the uterus (endometrium) is going through the normal menstrual cycle changes.

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