Endometriosis is a painful condition wherein the tissues usually lining the inside of the uterus (the endometrium) start growing outside the uterus. The tissues may affect the fallopian tubes, pelvic tissues, ovaries, and, in some cases, they may spread beyond the pelvic region. The endometrial tissues usually thicken, break down, and bleed according to the menstrual cycle.
When that happens within the uterus, the broken tissues can exit the body. However, when the endometrial tissues grow outside the uterus, they remain trapped within the body, unable to leave. Consequently, the surrounding tissues may be inflamed and develop scar tissues and fibrous tissues that affect other organs.
Endometriosis can be extremely painful, especially during menstrual periods, and, in some cases, it can also cause fertility problems.
Symptoms of Endometriosis
- Menstrual pains far worse than usual.
- Menstrual pains increase in intensity over time.
- Extreme pain and cramps in the pelvic regions, abdominals, and lower back.
- Pain during and after sexual intercourse.
- Pain during urination and bowel movements.
- Excessive intermenstrual bleeding.
- Infertility due to endometrial growth in the ovaries.
- Fatigue, diarrhea, nausea, and other symptoms.
- Infrequent sexual stimulation, which can lead to clitoral atrophy.
Causes of Endometriosis
- Retrograde Menstruation: In some cases, the menstrual blood with the endometrial cells may flow back through the fallopian tubes and reach the pelvic cavities and other parts of the body. The endometrial cells may stick to the pelvic tissues and other regions outside the uterus, where they eventually grow, thicken, and bleed.
- Induction Theory: In some cases, the peritoneal cells lining the insides of the abdomen may transform into endometrial-like cells due to hormones and other immune factors. The endometrial cells then behave like those within the uterus, i.e., they grow, thicken, break, and bleed.
- Endometrial Transportation: The endometrial cells may be transported from within the uterus to other parts by the blood vessels and lymphatic system.
- Surgical Scar Implants: Surgeries around the pelvic regions, such as hysterectomy or c-sections, may cause endometrial cells to attach to the surgical incision, leading to endometriosis.
- Embryonic Transformation: The embryonic cells in the earliest stages of development may transform into endometrial tissues due to excessive estrogen during puberty.
- Immune System Disorder: In most cases, the immune system recognizes and destroys the endometrial cells growing outside the uterus. However, disorders of the immune system may make your body incapable of destroying the unwanted endometrial cells.
Risk Factors for Endometriosis
- Starting menstruation early.
- Never giving birth.
- Late menopause.
- Menstrual cycles of less than 27 days.
- Menstrual periods lasting more than 7 days.
- Higher estrogen levels.
- Low body mass index.
- Family history of endometriosis.
- Abnormalities in the reproductive tract.
- Immune system disorders.
Potential Complications of Endometriosis
- Infertility: Up to half of all women with endometriosis experience infertility issues. Pregnancy occurs when the ovary releases an egg that travels through the fallopian tubes, is fertilized by a sperm, and then attached to the uterine wall. However, endometrial cells may prevent the eggs and sperms from meeting, leading to fertility problems. Furthermore, they can also damage the sperm cells and eggs. Patients with endometriosis are encouraged to have children early because the condition may worsen with time.
- Cancer: Women with endometriosis are more likely to experience ovarian cancer — however, the risk of ovarian cancer is still relatively low. Another cancer-related risk of endometriosis is the late-stage development of adenocarcinoma.
- Physical Exam: The doctor will manually feel the pelvic regions for anomalies, such as scars behind the uterus, cysts, etc. Physical examination only works if endometriosis has caused the formation of cysts.
- Ultrasound Test: During this test, high-frequency sound waves will produce visual representations of the insides of your body. The doctor will place a transducer against your abdomen or within the vagina to view the reproductive organs. While this isn’t a definitive test, it can visualize the presence of endometriomas, i.e., cysts caused by endometriosis.
- MRI Scans: During this test, the doctor will use magnetic fields and radio waves to produce detailed visualizations of the inside of your body, thereby identifying the location and size of the endometrial cells.
- Laparoscopy: The surgeon will use laparoscopy to visualize the body parts inside the abdomen. Under general anesthesia, the surgeon will make a small incision near the navel to insert the laparoscope and examine the uterine walls and other surrounding organs. This is the ideal test to visualize and diagnose endometriosis.
Treatments for Endometriosis
- Medications: Your doctor may recommend over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or naproxen sodium (Aleve), to alleviate the symptoms.
- Hormone Therapy: The endometrial implants thicken, break, and bleed due to the rise and fall of hormones during menstrual cycles. As such, hormone therapy can moderate and regulate the hormones, minimizing the growth of endometrial cells.
- Contraceptives: Birth control pills and vaginal rings regulate the hormones responsible for the growth of endometrial tissues.
- Gonadotropin-Releasing Hormone (Gn-RH) Agonists and Antagonists: These medications prevent the production of ovarian-stimulating hormones, which, in turn, reduces estrogen levels and prevents menstruation. Over time, the endometrial implants may shrink.
- Conservative Surgery: For women trying to become pregnant, conservative surgery may remove the endometrial tissues from outside the uterus while preserving the ovaries and uterus. However, this isn’t always effective, and the endometriosis pains can return.
- Hysterectomy & Oophorectomy: In some cases, the entire uterus and ovaries may be removed to improve endometriosis pain. However, these procedures prevent menstruation and lead to premature menopause, which can carry its own complications. As such, surgeons are now moving away from this procedure.
If you identify any of the signs or symptoms of endometriosis, you should consult your gynecologist or doctor at an early stage for prompt diagnosis and treatment.