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The Problems with Delayed Conception...

Dr. Kusum Yadav

Endometriosis is the presence of functioning endometrium in sites other than the uterine mucosa. In this condition fragments of the endometrium (lining of the uterus) grow outside the uterus. It is more common in women with delayed conception.

Delay in first conception in married women, that is much advocated and practiced today has its own advantages but we cannot deny the fact that it has many harmful effects too. This delay in first conception and adoption of a small family has led to an increased incidence of many gynaecological diseases. One of such diseases is endometriosis. It is the presence of functioning endometrium in sites other than the uterine mucosa.

In this condition fragments of the endometrium (lining of the uterus) grow outside the uterus. They are called endometrial deposits or implants and may occur on the ovaries (the most common place), fallopian tubes, in the muscle or on the outer covering of the uterus and on the lining of the pelvic cavity, occasionally they are found on the outside of the bowel.

The abnormal deposits of endometrium undergo hormone influenced cyclic changes, dying and bleeding at the end of each cycle. However the menstrual fluid cannot drain away and thus irritates other organs and tissues that it touches, causing inflammation of their surface and the formation of fibrous tissue that sticks them together. With time the adhesions contract, distorting the shape and function of the affected parts.

The surface of some endometrial deposits may become covered by a capsule of fibrous tissue. Fluid and blood then accumulate inside the capsule to form cysts, which become slightly bigger with each menstrual cycle. These are known as chocolate cysts as some of the fluid in the cysts is absorbed and the blood darkens, leaving the thick viscous fluid like melted chocolate.

Endometriosis affects women who are menstruating regularly and is less among women who start child bearing early and have had many pregnancies or have long spells without periods. Endometriosis is not cancerous or life threatening but it can cause many problems. The cause of endometriosis is still unclear.

About 25 percent of patients with endometriosis have no symptoms and are discovered accidentally. Symptoms are not related with the extent of lesion and are mostly related to the site of lesion. Women between the ages of 35-40 are mostly affected and the patients are mostly women who have not had children. Infertility, voluntary postponement of first conception until at a late age are often related. There is often a family history of endometriosis.

Dysmenorrhoea or period pain: This is the most common symptom. The pain starts a few days prior to menstruation and may be mild, moderate or severe. It gets worsened during menstruation and takes time, even after cessation of period to get relief of pain. It may be described as nagging or sharp, constant, throbbing, deep or boring. It may be in the centre or on either side of the lower abdomen and may spread to the genitals, groins, inner thighs, lower back, rectum and buttocks.

Abnormal menstruation: Menstrual period may be heavy, prolonged with clotting and spotting before periods. Periods may be irregular with occasional bleeding between periods. Many women with endometriosis ovulate irregularly or not at all.

Infertility: about 40-60% women with endometriosis will have problems getting pregnant but eventually at least half of them conceive. It may result from a failure to ovulate, adhesions that block the release of the ovum or its passage along the fallopian tube, hormonal imbalances and painful s*x.

Dyspareunia or painful s*x: Dyspareunia may be due to stretching of the structures of the pouch of Douglas. It is felt as increasing pain during s*x**l arousal, sharp jabbing pain during inter****se and deep aching afterwards.

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