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Women’s health: more about endometriosis WOMEN’S HEALTH: MORE ABOUT ENDOMETRIOSIS
What happens in endometriosis
Once the fragments of endometrium have implanted they begin to respond to the fluctuating levels of the menstrual cycle hormones in the same way as the endometrium lining the uterus. Thus, the implants thicken and swell with blood and then break down and bleed each month. This blood then cannot escape from the body so it bleeds directly onto the surface of the surrounding organs, causing irritation which leads to inflammation, scarring and, sometimes, the development of adhesions.
As the disease progresses the implants gradually enlarge in size and may form small cysts.
As a cyst enlarges, the pressure within the cyst may cause it to rupture during menstruation, spilling the contents onto the adjacent tissues. This may in turn lead to the development of new implants.
What does endometriosis look like
Classical implants
Until recently, endometrial implants were thought to be fairly uniform in appearance. However, in the last few years there has been a growing appreciation that they have a range of characteristic appearances.
It is now understood that what were traditionally recognized as being classical implants are, in fact, probably only one end of the spectrum of appearances and that they are probably only typical of older implants.
Classical implants usually appear as tiny dots, or clusters of dots, on the surface of the organ or ligament on which they have implanted. They are usually only pinhead in size but they may be up to a centimeter or more in diameter. They range in colour from brown to black depending on how much old blood they contain. When magnified they may look like clusters of black grapes.
Atypical implants
The newly recognized implants are often called atypical implants but they are probably younger implants which, as yet, have very little old blood deposited in them.
Atypical implants are usually very small and are sometimes difficult to see. They may occur alone or in clusters and may be clear, white, yellow, orange or red in colour.
Microscopic endometriosis
In the early stages of endometriosis the implants may be too small to be seen without the use of a microscope. This type of endometriosis is often referred to as microscopic endometriosis.
Endometriomas
Endometrial cysts on the ovary are also known as endometriomas. They are usually less than two or three centimeters in diameter but occasionally may be 10 or more centimeters in diameter. They may be embedded in the ovary itself or they may lie on its surface. They are sometimes referred to as 'chocolate cysts' because they contain old dark blood which often has the appearance and consistency of melted chocolate.
Adhesions
Adhesions are bands of tissue which bind or matt together organs of the pelvic cavity and they may be formed as a result of endometriosis. They may have the appearance of sticky toffee which has been stretched from one organ to another.
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