Endometriosis is the condition in which the lining of your uterus (called the endometrium) starts to grow outside of the uterine cavity.
This endometrial tissue that spreads outside of your uterus is called the endometrial implant. It could be found on:
- Ovaries and fallopian tubes
- Outer surface of uterus
- Outer surface of bowel or bladder
This is usually restricted to the pelvic region, but in rare cases it may extend even beyond that.
Endometriosis affects one in every ten women of reproductive age, so remember you are not alone.
Symptoms of Endometriosis
The most common symptoms of endometriosis include:
- Heavy or painful periods
- Pain in the pelvic region, lower back or lower abdomen
- Painful sex
- Irregular bleeding before or after period
- Problems in conceiving
Because the symptoms of endometriosis are not very specific, it usually goes undiagnosed for a long time and is discovered only when either the pain becomes unbearable or the patient comes to face with infertility.
Some women also experience more upsetting symptoms like:
- Persistent fatigue
- Blood in stools
- Coughing blood—in those rare cases where endometrial tissue has spread to the lungs
The severity of symptoms depends more on location of endometrial tissue than the amount of tissue.
Why is endometriosis painful?
The endometrial lining of your uterus is shed every month during the period. But in endometriosis, instead of leaving your body the menstrual blood flows back into your pelvic cavity through the fallopian tubes.
This endometrial tissue attaches over the surface of your organs and continues to thicken, grow, and flow over the course of your cycle.
As this tissue grows and impinges on various tissues and nerves, sometimes blocking tubes or trapping an organ completely like a mesh, thus resulting in pain.
In some cases small areas of your abdominal lining may also convert to endometrial tissue because abdominal cells actually come from embryonic cells, which may sometimes alter their course and start to act like endometrial cells.
More research is needed to know exactly why this happens.
What causes endometriosis?
There are several theories regarding he causes of endometriosis but there is no definitive answer yet. Some of the factors responsible for endometriosis are:
- Retrograde menstrual flow – the reverse flow of menstrual blood through the fallopian tubes
- Faulty immune system – the endometrial tissue growing outside the uterus is not detected and destroyed by the immune system
- Family history – Endometriosis is also known to be inherited in the genes
- Medical history/previous pregnancy – Endometrial tissue could be accidently moved from your uterus to abdominal region during Cesarean (C-section) or hysterectomy,
- Hormonal problems – Researchers are looking into Excess of oestrogen hormone as a causative factor for endometriosis.
Endometriosis affects women of ages 25 to 40.
How to know if you suffer from endometriosis? Only surgery can tell.
One of the reasons endometriosis goes undetected for so long is because the diagnosis requires surgery.
While the doctor may come close to detecting the disease by physical examination or ultrasounds, the symptoms are so overlapping with other diseases that one can only be sure of endometriosis after checking in a laparoscopic examination—wherein a tiny camera is inserted inside the body cavity to check for endometrial tissue.
The good news is that if found, the endometrial tissue can be removed at the same time.
If you suffer from chronic pelvic pain but no endometrial tissue is found in laparoscopy, you will have to check for other diseases with similar symptoms such as:
- Pelvic inflammatory disease
- Congenital abnormalities in the reproductive tract
- Inflammatory masses involving the ovaries and fallopian tubes
There aren’t any proven methods to prevent it, but here are a few things you can do to ease the symptoms of endometriosis by reducing the levels of estrogen in your body, which is responsible for thickening of endometrial lining.
Estrogen levels can be reduced by:
Regular exercise and high-protein diet: Lower levels of body fat will help keep estrogen levels lower. However, you must note that female bodies are designed to have more body fat than men, and ovulation problems can occur if you take your body fat to a ridiculously low level.
Certain birth control methods like pills or patches can also help lower oestrogen.
Alcohol, green tea, caffeinated drinks are all known to raise oestrogen levels, so have them in moderation – experts recommend no more than one a day.
How is endometriosis treated?
There is no cure for endometriosis but management of the symptoms can improve the quality of your life.
Commonly advised treatments are:
Pain-killers – These may help mitigate the pain but they do not work in all cases
Hormone regulators – The growth of endometrial tissue (in abnormal places) is the main cause of pain in endometriosis. The doctor can control the monthly regulation of hormones by administering some drugs.
Contraceptives – Birth control pills can help prevent the buildup of endometrial tissue and consequently reduce the related pain.
Gonadotropin-releasing hormone (GRNH) agonists and antagonists – These are given in IVF treatments for control of estrogen, which is primarily responsible for stimulation of ovaries. By blocking estrogen, the body temporarily goes into a state of menopause, and as a result you may even face symptoms as vaginal dryness and hot flashes.
Drugs to stop menstruation – Medications such as Danazol can be used to halt your menstruation. Expect side effects like excessive hair growth, acne, etc., which happen due to reduction of female hormones in your body. Depo-Provera injection may also be used for the same effect.
Conservative surgery for endometriosis – The conservative approach for endometriosis surgery involves the removal of endometrial tissue from locations where it is most disturbing. This will alleviate pain and also improve your fertility.
Radical surgery for endometriosis – This is the last resort in which your uterus, cervix, and even ovaries may be surgically removed. This will send you in a state of menopause and you will no longer have monthly changes or be able to become a mother.
Endometriosis and infertility
Endometriosis affects around 11 percent of women in reproductive age and 50 percent of them have difficulty getting pregnant. The hormonal changes or blockage of your reproductive tract can cause infertility, but with the help of an infertility specialist or endocrinologist, you may be able to get pregnant.