Endometriosis is a disorder in which tissue similar to the lining of your uterus grows outside of your uterine cavity. The lining of your uterus is called the endometrium. Endometriosis occurs when endometrial tissue grows on your ovaries, bowel, and tissues lining your pelvis. It’s rare for endometrial tissue to spread beyond your pelvic region, but it’s not impossible.
Endometrial tissue growing outside of your uterus is known as an endometrial implant. The hormonal changes of your menstrual cycle affect the misplaced endometrial tissue, causing the area to become inflamed and painful. This means the tissue will grow, thicken, and break down. Over time, the tissue that has broken down has nowhere to go and becomes trapped in your pelvis.
This tissue trapped in your pelvis can cause:
c.Adhesions,in which tissue binds your pelvic organs together.
d.Severe pain that occurs during the menstrual cycle.
Symptoms of Endometriosis
The symptoms of endometriosis vary. Some people experience mild symptoms, but others can have moderate to severe symptoms. The severity of your pain does not indicate the degree or stage of the condition. You may have a mild form of the disease yet experience agonizing pain. It’s also possible to have a severe form and have very little discomfort. It’s important to note that you may not experience any symptoms.
Pelvic pain is the most common symptom of endometriosis. You may also have the following symptoms:
a. Painful periods.
b. Cramps 1 or 2 weeks around menstruation.
c. Heavy menstrual bleeding or bleeding between periods.
e. Pain during sexual intercourse.
f. Discomfort with bowel movements.
g. Lower back pain that may occur at any time during your menstrual cycle.
It’s important that you get regular gynecological exams, which will allow your gynecologist to monitor any changes. This is particularly important if you have two or more symptoms.
Causes of Endometriosis
During a regular menstrual cycle, your body sheds the lining of your uterus. This allows menstrual blood to flow from your uterus through the small opening in the cervix and out through your vagina. The exact cause of endometriosis isn’t known. There are several theories regarding the cause, although no one theory has been scientifically proven.
One of the oldest theories is that endometriosis occurs due to a process called Retrograde Menstruation. This happens when menstrual blood flows back through your fallopian tubes into your pelvic cavity instead of leaving your body through the vagina.
Another theory is that hormones transform the cells outside the uterus into cells similar to those lining the inside of the uterus, which are known as endometrial cells.
Others believe the condition may occur if small areas of your abdomen convert into endometrial tissue. This may happen because cells in your abdomen grow from embryonic cells, which can change shape and act like endometrial cells.It’s not known why this occurs.
These displaced endometrial cells may be on your pelvic walls and the surfaces of your pelvic organs, such as your bladder, ovaries, and rectum. They continue to grow, thicken and bleed over the course of your menstrual cycle in response to the hormones of your cycle.
It’s also possible for the menstrual blood to leak into the pelvic cavity through a surgical scar,such as after a cesarean delivery, also commonly called a C-section.
Another theory is that the endometrial cells are transported out of the uterus through the lymphatic system. Still another theory purports it may be due to the immune system not working properly in destroying errant endometrial cells. Some believe endometriosis might start in the fetal period with misplaced cell tissue that begins to respond to the hormones of puberty. This is often called Mullerian theory.
The development of endometriosis might also be linked to genetics or even environmental toxins.
Stages of Endometriosis
Endometriosis has four stages or types. It can be any of the following:
Different factors determine the stage of the disorder.These factors can include the location,number,size,and depth of endometrial implants.
Minimal: In minimal endometriosis, there are small lesions or wounds and shallow endometrial implants on your ovaries. There may also be inflammation in or around your pelvic cavity.
Mild: Mild endometriosis involves light lesions and shallow implants on the ovaries and the pelvic lining.
Moderate: Moderate endometriosis involves many deep implants on your ovaries and pelvic lining. There can also be more lesions.
Severe: The most severe stage of endometriosis involves many deep implants on your pelvic lining and ovaries. There may also be lesions on your fallopian tubes and bowels.There can also be cysts on one or both of your ovaries.
The symptoms of endometriosis can be similar to the symptoms of other conditions, such as ovarian cysts and pelvic inflammatory disease. The condition also shares similar symptoms with irritable bowel syndrome(IBS), which can prolong diagnosis.
At the core of treating your pain is getting an accurate diagnosis. It’s important to note that the diagnosis process may vary. In some situations, it can take 4 to 11 years from the onset of symptoms to diagnosis, according to research published in 2019.
Try to be patient with yourself and the process as you work with your healthcare team.Your doctor will perform one or more of the following tests:
Detailed history: Your doctor will note your symptoms and personal or family history of endometriosis. A general health assessment may also be performed to determine if there are any other signs of a long-term disorder.
Physical exam: During a pelvic exam, your doctor will use a speculum and light to see inside of the vagina and cervix. They will also manually feel your abdomen for cysts or scars behind the uterus.
Ultrasound: Your doctor may use a transvaginal ultrasound or an abdominal ultrasound. In a transvaginal ultrasound, a probe is inserted into your vagina. Both types of ultrasound provide images of your reproductive organs. They can help your doctor identify cysts associated with endometriosis, but they aren’t effective in ruling out the disease.
Laparoscopy: The only certain method for identifying endometriosis is by viewing it directly. This is done by a minor surgical procedure known as laparoscopy. Once diagnosed, the tissue can be removed in the same procedure.
Complications of Endometriosis
Having fertility issues is a serious complication of endometriosis. Individuals with milder forms may be able to conceive and carry a baby to term. Although there are medications used to treat endometriosis, they do not improve fertility. Some people have been able to conceive after having endometrial tissue surgically removed. If this does not work in your case, you may want to consider fertility treatments or in vitro fertilization to help improve your chances of having a baby.
Talk with your doctor to better understand your options such as if you’re planning to start a family and whether you should consider having children sooner rather than later if you’ve been diagnosed with endometriosis. Or your doctor can help you in learning more about alternatives for becoming a parent or delaying pregnancy.
With endometriosis, your symptoms may worsen over time, which can make it difficult to naturally conceive. Your doctor will need to do an assessment before and during your pregnancy. Even if fertility is not a complication that you experience, managing chronic pain can still present challenges. Depression, anxiety, and other mental health issues may arise as they’re not uncommon in people with endometriosis.
Talk with your doctor about ways to help cope with these side effects. They may recommend joining a support group or using other supportive resources to help manage your situation.
Endometriosis usually develops years after the start of your menstrual cycle. It can be a painful condition. However, understanding its risk factors can help you determine whether you’re more likely to develop this condition and when you should talk with your doctor.
Age:Women of all ages are at risk for endometriosis.It most commonly affects women in their 30s and 40s,but symptoms can begin at puberty.
Family history: Talk with your doctor if you have a family member who has endometriosis. You may have a higher risk of developing the disease.
Pregnancy history: Pregnancy may temporarily decrease the symptoms of endometriosis.Women who have not had children are at an increased risk of developing the disorder. However, endometriosis can still occur in women who’ve had children. This supports the understanding that hormones influence the development and progress of the condition.
Menstrual history: Talk with your doctor if you have problems with your period.These issues can include:
l Shorter cycles.
l Heavier and longer periods.
l Menstruation that starts at a young age
These factors may place you at higher risk.
Race and ethnicity research data: While endometriosis affects about 11 percent of American women between 15 and 44 years of age. According to the U.S. Department of Health and Human Services, a 2019 study found that race and ethnicity may influence its prevalence.
When compared with White women, Hispanic and Black women are less likely to receive a diagnosis for endometriosis. Alternately, Asian women were 50 percent more likely to receive a diagnosis when compared with white women.
However, a review published in 2019 found that when results were limited to women with infertility, disparities for Black women were reduced; there was no statistical significance between Black, white, and Asian patients. The researchers argued that it is unknown if previous associations were made based on diagnostic biases or other factors.
Additionally, there is a lack of research that examines prevalence and outcomes in American Indian or Alaskan Native women. Overall, more inclusive research that factors in environmental and socioeconomic factors and access to healthcare is necessary to better understand the disease.
Treatment for Endometriosis
Understandably, you want quick relief from pain and other symptoms of endometriosis. This condition can cause challenges in your day-to-day activities if it’s left untreated. Endometriosis has no cure, but its symptoms can be managed.
Medical and surgical options are available to help reduce your symptoms and manage any potential complications. Your doctor may first try conservative treatments. They may then recommend surgery if your condition does not improve.
Everyone reacts differently to these treatment options. Your doctor will help you find the one that works best for you.
Treatment options include:
Pain medications: You can try over-the-counter pain medications such as ibuprofen but be advised that these aren’t effective in all cases.
Hormone therapy: Taking supplemental hormones can sometimes relieve pain and stop the progression of endometriosis. Hormone therapy helps your body regulate the monthly hormonal changes that promote the tissue growth that occurs with endometriosis.
Hormonal contraceptives: Hormonal contraceptives decrease fertility by preventing the monthly growth and buildup of endometrial tissue. Birth control pills, patches, and vaginal rings can reduce or even eliminate the pain in less severe endometriosis.
The medroxyprogesterone (Depo-Provera) injection is also effective in stopping menstruation. It stops the growth of endometrial implants. It relieves pain and other symptoms.This may not be your first choice, however, because of the risk of weight gain, decreased bone production,and an increased incidence of depression in some cases.
Gonadotropin-releasing hormone (GnRH) agonists and antagonists: People take what are called gonadotropin-releasing hormone (GnRH) agonists and antagonists to block the production of estrogen which stimulates the ovaries. An example of a GnRH agonist is Lupron Depot, an injectable, while Elagolix, which is taken orally, is an antagonist. Both can suppress estrogen production.
Estrogen is the hormone that’s mainly responsible for the development of sexual characteristics in people assigned female at birth. Blocking the production of estrogen prevents menstruation and creates artificial menopause.
GnRH therapy has side effects like vaginal dryness and hot flashes. Taking small doses of estrogen and progesterone at the same time can help to limit or prevent these symptoms.
Getting a diagnosis and starting treatment options early in the disease can be challenging. Thinking about — or coping with — symptoms like fertility issues and pain coupled with fear possibly setting in about getting relief can be stressful. It’s important to address your mental wellness as part of your overall well-being. Consider finding a support group and educating yourself more on the condition.Taking these steps can be helpful in creating a well-balanced approach to managing your condition.
Danazol: Danazol is another medication used to stop menstruation and help reduce symptoms of endometriosis. While taking danazol, the disease may continue to progress. Danazol can cause side effects, including acne and hirsutism. Hirsutism is excessive hair growth on your face and body.
Other drugs are being studied that may improve symptoms and slow disease progression.
Conservative surgery: Conservative surgery is typically used for people who want to get pregnant or who experience severe pain and hormonal treatments are not working. The goal of conservative surgery is to remove or destroy endometrial growths without damaging the reproductive organs.
Laparoscopy, a minimally invasive surgery, is used to both visualize and diagnose endometriosis. It is also used to remove the abnormal or displaced endometrial tissue. A surgeon makes small incisions in the abdomen to surgically remove the growths or to burn or vaporize them.
Lasers are now commonly used to destroy this “out of place” tissue.
Last-resort surgery (hysterectomy): Your doctor may recommend a total hysterectomy as a last resort if your condition does not improve with other treatments.
During a total hysterectomy, a surgeon removes the uterus and cervix. They also remove the ovaries because these organs make estrogen, and estrogen can cause the growth of endometrial tissue. Additionally, the surgeon removes visible implant lesions.
Two other types of hysterectomies are performed based on the condition a person is being treated for.
A subtotal — also referred to as partial or supracervical — hysterectomy removes the upper part of the uterus, leaving the cervix in place.
A radical hysterectomy is typically performed when cancer is present. It removes the entire uterus, cervix, and the top part of the vagina.
While a hysterectomy can treat endometriosis it is not a cure. You’ll b
unable to get pregnant after a hysterectomy. If you’re thinking about starting a family, get a second medical opinion before agreeing to surgery.
Endometriosis is a chronic condition that’s Idiopathic, meaning what causes it has yet to be determined. And currently, it does not have a cure.
However, effective treatments, such as medications, hormone therapy, and surgery, are available to help manage its side effects and complications like pain and fertility issues, respectively. And the symptoms of endometriosis usually improve after menopause.
It’s important to immediately contact your doctor if you feel you might have endometriosis to begin the process of getting an accurate diagnosis and eventually creating a plan based on your specific situation.