VISION

To be the most effective and reputable endometriosis non-profit organisation in the Caribbean. MISSION To forge a permanent bond that spreads hope through information, support and empowerment to all those affected by endometriosis.

CONTACT
Trinidad & Tobago Endometriosis Association (TTEA) P.O. Box 131, Wrightson Road Port of Spain, Trinidad endoassoc.tt@gmail.com T: (868) 720-3560; (868) 333-3793 Trinidad and Tobago Endometriosis Association

Endometriosis
Endometriosis is a complex hormonal and immunological disease in which uterine tissue grows in other areas of the body apart from the uterus. Typically, uterine tissue is located in the uterus and it is shed and replenished each month which results in the menstrual cycle (period). Thus, endometriosis like the uterine tissue in the uterus responds to hormones and so builds up and breaks down each month. Since there is no outlet for the blood, this results in internal bleeding, formation of painful growths and adhesions, degeneration of the blood and tissue of the area as well as inflammation of the area. Endometriosis is commonly concentrated in the pelvic cavity that involves the ovaries, fallopian tubes, the ligament supporting the uterus, the areas between the vagina and the rectum, the outer surface of the uterus, and in the lining of the pelvic cavity. It is also found on the intestines, in the rectum, on the bladder, vagina, cervix, vulva (external genital) and in abdominal surgical scars. Though uncommon, endometriosis has been found in organs like the lungs, diaphragm, and in some cases, the brain.

Signs and Symptoms

The most common symptoms and signs of endometriosis are dysmenorrhea and chronic pelvic pain. Other common symptoms and signs include the following:
Dysmenorrhea painful, sometimes disabling cramps which may include the rectum and legs during menses; the pain may get progressively worse over time. Chronic/Intermittent Pelvic Pain mild to severe lower back and abdominal pain. Dyspareunia painful intercourse. Infertility common with the progression of the disease. Diarrhoea / Constipation frequent and sometimes painful bowel movements particularly with menses and alternate bowel movements. Dysuria urinary urgency and frequency; sometimes painful voiding. Nausea vomiting. Chronic Fatigue weakness; muscle pain; impaired memory and/or mental concentration; and insomnia. Complications internal scarring; adhesions; pelvic cyst & endometrioma (chocolate cyst); ruptured cyst; and bowel obstruction.

Stages of Endometriosis
Surgically, endometriosis is classified into four stages.
- endometriosis spots in the fallopian tubes and ovaries

This painful, disruptive and life-altering disease affects girls and women ranging from menstruation to menopause regardless of their race, class, ethnicity and socio-economic status. Girls and women are urged not to ignore the signs and symptoms.

Stage II - Minimal Stage The endometriosis deposits are few and isolated. Stage III - Moderate Stage The growths are profound and the scar tissue and adhesions are prominent.

Stage II - Mild Stage There are small superficial adhesions, scar tissue and growths. Stage IV- Severe Stage The deep growths are numerous and the adhesions are extensive.

Diagnosis
While there are many suspected cases of endometriosis, the disease is only confirmed by surgery. Basically, the two types of surgical procedures are: Laparoscopy This surgical procedure is done under anaesthesia. The abdomen of the patient is distended with carbon dioxide gas to make the organs visible, and a laparoscope (a tube with camera and light) is inserted in a tiny incision in the abdominal cavity. The surgeon examines the condition of the abdomen and if present, views the extent of the disease. Laparotomy This surgical procedure involves a large incision through the abdominal wall to access the abdominal cavity. The surgeon examines the condition of the cavity and the disease, if present.

Endometriosis Theories
The cause of endometriosis is still unknown but a number of theories have been postulated. Some of the more common theories follow: The Retrograde Menstruation Theory or Transtubal Migration Theory This theory posits that during menstruation there is a reflux of some of the blood through the fallopian tubes that is deposited and attached unto the surface and grows. Ceolomic Metaplasia Theory This theory hypothesizes the possibility of the peritoneal and endometrial cells later transform (metaplasia) from one cell to the other which is perhaps triggered by inflammation. Transplantation This theory suggests that endometriosis deposits in specific patients can be spread directly. Endometriosis can be transplanted by surgery to other areas, for example, to abdominal surgical scars. This can result in endometriosis growing into different tissue layers. Also, though uncommon, endometriosis can be transplanted by the blood (lymphatic system) into peripheral organs such as the brain and the lungs. Genetics Theory This theory basically states that genetics predispose certain girls/women to the disease. Environmental Risk Factors Research spearheaded by The Endometriosis Association has revealed that environmental toxins such as dioxin and PCBs, which act like hormones in the body, damage the immune system and cause endometriosis.

Treatment
Presently, there is no cure for endometriosis. However, there are treatments for the disease, which aim at making the endometriosis sufferer pain free, preserving fertility and increasing the chances of pregnancy. Hormone Treatment Hormone treatments include contraceptives, progesterone drug, a testosterone derivative (danazol), and GnRH drugs (gonadotropin-releasing hormone drug-zoladex). These hormone treatments aim to stop ovulation and production of hormones for an extended period, which sometimes force the disease into remission. Hysterectomy - This surgical procedure removes the uterus and/or ovaries, cervix and growths. Oophorectomy - The surgical procedure removes one or both ovaries. The ovaries contain eggs and produce hormones that control the menstrual cycle and thus, this procedure prevents hormonal stimulation and should control the disease. Conservative Surgery The surgical procedure involves removal or destruction of the growths. Thus, the endometriosis sufferer becomes pain free for a period. Complementary Treatment This include nutritional approaches, immunotherapy and alternative medicine among others.