Endometriosis is a gynecological disorder that affects about 10 percent of females. It’s whereby the tissue similar to that which lines the uterus develops outside the uterus. It’s typically a painful condition that mostly affects the fallopian tubes, ovaries, and the tissue that lines the pelvis. In rare cases, the endometrial tissue can spread away from the pelvic organs.
The endometrial tissue that develops outside the uterus is referred to as an endometrial implant. The hormonal alteration of the menstruation cycle alters the misplaced tissue, making the region painful and inflamed. Hence, the tissue grows, thickens, and eventually breaks down. With time, the broken tissue is stuck and has nowhere to shift; instead, it gets trapped within the pelvis.
Types of Endometriosis
Endometriosis is categorized into three major types according to location. They include;
- Superficial peritoneal lesion
The superficial peritoneal lesion is the most common type of endometriosis. It’s characterized by the development of lesions on the peritoneum. This is a thin membrane that lines the pelvic cavity.
- Endometrioma (ovarian lesion)
This is a fluid-filled cyst that is black and can also be referred to as a chocolate cyst. These types of cysts develop deep inside the ovaries. Furthermore, they are normally resistant to treatment hence can cause damages to the healthy tissue.
- Deeply penetrating endometriosis
This form of endometriosis develops under the peritoneum and can affect organs close to the uterus, including the bladder or bowels. Approximately 1 to 5 percent of women diagnosed with endometriosis have this disorder.
Cause of Endometriosis
The actual causes of endometriosis in women are unknown. However, the possible triggers that might be associated with the condition include;
Retrograde menstruation: With retrograde menstruation, the period blood-carrying endometrial cells move back via the fallopian tubes into the pelvic cavity rather than out of the body. The endometrial cells attach to the pelvic walls and pelvic organ surface. Here, they expand, thicken, and continue to bleed during every menstrual cycle.
Embryonic cell transformation: During puberty, hormones, including estrogen, can change embryonic cells into endometrial-like cell implants. Embryonic cells are the cells in their early stages of growth.
Peritoneal cell transformation: Experts state that hormones or body immune factors facilitate the transformation of peritoneal cells into endometrial-like cells. This is known as the induction hypothesis. Peritoneal cells are the cells that line the inside part of the abdomen.
Scar implantation surgery: Endometrial cells can bind to the surgical incision following procedures like a hysterectomy or C-section.
Endometrial cell transfer: Endometrial cells may be transported to other areas of the body through the tissue fluid (lymphatic) system or the blood vessels.
Immune system dysfunction: An issue with the body's immune system can prevent the body from recognizing and killing the endometrial-like tissue that develops out of the uterus.
Genetic factors: Endometriosis can sometimes develop due to a genetic or inheritable component. Most females with a close relative diagnosed with endometriosis are at higher risks of developing the disorder as well.
Stages of Endometriosis
There are four stages of endometriosis, according to the American Society of reproduction medicine. They include;
- Stage 1 (minimal): Here, there are a few minor lesions without scar tissue.
- Stage 2 (mild): The increased appearance of the lesions, but there is no scar tissue. About 2 inches of the belly is affected.
- Stage 3 (moderate): Here, the lesions might be deep. Endometriomas, as well as the scar tissue near the fallopian tubes or ovaries, may occur.
- Stage 4 (severe): The ovaries have several lesions and possibly massive cysts. Scar tissue can form around the fallopian tubes and ovaries, as well as between the uterus and the lower portion of the intestines.
Endometriosis stages are determined by the position, depth, amount, and extent of endometrial tissue. Among the specific conditions are;
- The degree to which the tissue has spread
- The association of the pelvic structures in endometriosis
- The degree to which pelvic adhesions exist
- The fallopian tube obstruction.
These endometriosis stages take no account of the pain, discomfort, or associated symptoms. Stage 1 endometriosis, for instance, can trigger intense discomfort, while a person with endometriosis stage 4 might not experience any related symptom.
Signs and Symptoms of Endometriosis
The common symptoms of endometriosis include pelvic pain, which is usually associated with menstrual cycles. While most women often feel cramping during their regular cycles, individuals who have endometriosis usually report much worse menstrual pain than normal. Also, the pain can sometimes worsen with time.
Endometriosis is also characterized by the following signs and symptoms;
- Dysmenorrheal (painful periods). Pelvic pain and cramping can start several days before and last an extended period after a menstruation period. You might also experience severe abdominal pain as well as lower back pain.
- Pain during sexual intercourse. Endometriosis patients often experience pain during or after intercourse.
- Pain when urinating and during bowel movements. These signs are more likely to occur during a menstruation period.
- Too much bleeding. Occasionally, women with endometriosis may have unusually heavy periods or bleed between periods, a condition known as intermenstrual bleeding.
- Infertility. This is a situation in which a woman is unable to get pregnant despite regular unprotected intercourse. At times, endometriosis is discovered among women seeking infertility treatment.
Other additional signs and symptoms that might be associated with endometriosis include;
- Fatigue or extreme tiredness
- Nausea, especially during menstruation
Not every woman with endometriosis experiences these signs and symptoms. Therefore, it’s essential to undergo routine gynecological tests. This enables the gynecologist to identify any unusual changes in your cycle.
Risks Factors of Endometriosis
Endometriosis mostly develops after the menstrual cycle commences. Generally, endometriosis is painful; hence knowing some of the risk factors can be helpful in determining if you are prone to the disease and when to consult a physician.
These endometriosis risk factors can include the following;
Age: Endometriosis can affect women of any age bracket. However, it mostly affects women between the ages of 25 and 40, although signs may appear as early as at puberty.
Family history: In case you have a close relative who has endometriosis, consult the practitioner as soon as possible. You might be at a greater risk of contracting the disease.
Menstruation history: If you are having issues with your cycle, consult your doctor right away. Shorter cycles, heavy and prolonged days, or menstruation that begins at a young age are examples of such problems. Generally, these factors can put you at greater risk.
Pregnancy history: Pregnancy can temporarily alleviate endometriosis symptoms. Women who have not given birth are more likely to develop the condition. Endometriosis can, however, also develop in women who have had children. This contributes to the notion that hormones play a role in the development and progression of the disease.
The signs and symptoms of endometriosis tend to be similar to those of other health conditions, including pelvic inflammatory disease and ovarian cysts. Therefore, proper endometriosis diagnosis is essential to identify the actual cause of the pain. Medical providers often perform several diagnostic tests and procedures, which includes;
- Physical examination
This involves looking for the visible physical signs and inquiring about the symptoms the patient is currently experiencing. It also involves an assessment of medical history and family history of endometriosis. During this assessment, gynecologists can perform a general evaluation to find out if there are any signs of a long-term condition.
The gynecologists can either use abdominal ultrasound or transvaginal ultrasound to identify endometriosis. Transvaginal ultrasound involves the insertion of a transducer inside the vagina. These two forms of ultrasound produce pictures of the reproductive organs. Hence, it makes it easier for the practitioner to identify any cysts linked to endometriosis. However, you should note that these approaches are not always effective in ruling out the problem.
- Pelvic examination
When conducting the pelvic examination, the doctor will manually palpate or feel the regions around the pelvis. This aims at checking for abnormalities, including scars within the uterus and cysts around the reproductive organs. In most cases, it may be impossible to feel the small parts of endometriosis unless there is a cyst.
- Magnetic resonance imaging (MRI)
This is an imaging diagnostic procedure that uses radio waves and strong magnetic fields to generate detailed images of the reproductive organs and tissues. With these images, gynecologists can easily identify a problem.
Alternatively, MRI can be helpful when it comes to surgical planning. The surgeon can use the obtained information to identify the exact size and location of the endometrial implants.
Laparoscopy is an effective method that gynecologists use to identify endometriosis by directly looking at it. It involves a minor surgical operation done under general anesthesia. A small incision is made on the belly just near the navel. A laparoscope attached to a light source, and a small camera is then inserted. This helps look for signs of endometrial tissues outside the uterus. Laparoscopy is also useful in extracting a small sample of the tissue for further analysis under the microscope. This procedure can be referred to as endometriosis biopsy.
The most effective treatment options for endometriosis often depend on the ultimate diagnostic results. It can also depend on the underlying signs and symptoms, your age, and whether you wish to get pregnant.
The common endometriosis cure options that gynecologist often recommend include;
- Taking pain medication
The gynecologists can recommend using over-the-counter pain relievers to help ease painful cramping during periods. These drugs include ibuprofen such as Advil or Motrin IB, the nonsteroidal anti-inflammatory drugs (NSAIDs), or naproxen sodium
- Hormone therapy
Occasionally, gynecologists advise on using supplemental hormones to help ease or eliminate chronic pain caused by endometriosis. Usually, the rise and decrease of hormones during the menstruation cycle make the endometrial implants thicken, break, and bleed. However, taking the hormone drugs helps slow down the growth of endometrial tissues and prevents other implants of the tissue.
You should, however, understand that hormone therapy doesn’t permanently fix endometriosis conditions. This thus means that there are chances of experiencing recurrent symptoms even after completing the treatment.
- Conservative surgical procedure
This approach is particularly designed for women who are experiencing chronic endometriosis pain or want to become pregnant. It’s a preferred treatment alternative, especially if hormone treatment fails to work effectively. The initial objective of conservative surgery includes eliminating or destroying endometrial growths. This is without causing damages to the reproductive system and organs.
The surgeon can perform conservative surgery laparoscopically. This involves inserting laparoscope equipment via one of the small incisions made near the navel. The surgeon will insert the instrument that pulls out the endometriosis cysts and growths or burn them through another incision.
Hysterectomy is the last resort procedure that practitioners seldom recommend. Nonetheless, it may be necessary if the situation fails to improve even after other treatment approaches like endometriosis surgery and hormone therapy.
Hysterectomy involves removing the cervix and uterus surgically. Occasionally, the ovaries can be removed since they facilitate estrogen production that triggers endometrial tissue growth. Also, during a hysterectomy procedure, the surgeon can take out the visible implant lesions.
You should, however, note that hysterectomy is not always considered an effective method of treating endometriosis. This is because you won’t be able to get pregnant again after the procedure. Therefore, it’s essential to seek help and guidance before opting for the surgery, especially if you wish to start a family or have more children.
Typically, there is no specific cure for endometriosis. The available treatments are designed to address the associated symptoms and the issues it triggers. It's thus essential to speak with your medical provider on the treatment options.
In case you do not wish to become pregnant, gynecologists can recommend hormonal birth control as the first line of defense. This can include;
- Birth control for extended the cycle if you only have a few cycles in a year or constant cycle if you don’t have periods. Such hormonal birth control methods are available in the form of a pill or an injection. They also tend to prevent bleeding and minimize or relieve pain.
- Intrauterine device (IUD) to aid in the reduction of pain, discomfort, and bleeding. The hormonal IUD can prevent a woman from getting pregnant for up to seven years. However, it does not provide long-term relief from endometriosis pain and bleeding.
Hormonal therapy is only effective for as long as it is used. Besides, it is better suited to females who do not experience serious pain and endometriosis symptoms.
Alternatively, the practitioner can prescribe a gonadotropin-releasing hormone (GnRH) agonist if you are trying to conceive. This medication prevents the body from producing the hormones responsible for the menstruation cycle, ovulation, and endometriosis development.
The treatment provokes short-term menopause while also assisting in the regulation of endometriosis progression. When you discontinue the medication, the menstrual period resumes. Hence, you will have a higher possibility of becoming pregnant.
Complications of Endometriosis
The common complications associated with endometriosis include;
Infertility is the most common complication in endometriosis. Typically, about one-third or one-half of all females with endometriosis experience trouble getting pregnant. There are several steps involved for pregnancy to happen.
First, the egg has to be expelled from an ovary, move through a nearby fallopian tube, be fertilized by a sperm cell, and bind to the uterine wall to begin development. Endometriosis can block the tube, preventing the egg and sperm from fusing. However, the disease seems to have an indirect effect on reproduction by causing sperm or egg damage.
Nevertheless, most women with mild to moderate endometriosis are still capable of conceiving and carrying on with the pregnancy to term. Gynecologists often advise endometriosis patients not to postpone having children as the disease will worsen over time.
Endometriosis cancer and ovarian cancer emerge at higher than normal rates in endometriosis patients. However, the average lifetime risk of cancers is still low. Endometriosis can elevate the risk, according to some research studies, but it remains comparatively low. While uncommon, endometriosis-associated adenocarcinoma can occur later in life in people who have had the disease.
Endometriosis Pain and Other Medical Issues
Endometriosis lesions are not cancerous or benign growths. But regardless, they may trigger certain health issues. Endometriosis occurs whenever tissue that looks the same as the lining of the uterus develops out of the uterus where it usually does not belong.
The growths can swell and bleed during the menstrual cycle, much like the lining in the uterus does each month. When the tissue expands and bleeds in a region where it cannot quickly exit the body, it can lead to swelling and discomfort.
The endometriosis growths can also continue expanding, hence triggering various issues such as:
- Fallopian tube blockage due to growths that cover or develop into the ovaries. Cysts can develop as a result of trapped blood within the ovaries.
- Swelling or inflammation
- Scar tissue and adhesion formation. Adhesion is a kind of tissue that can link the organs together. The scar tissue can trigger chronic pelvic pain and make it difficult for you to conceive.
- Intestinal and urinary tract issues
Endometriosis and Pregnancy
Is it possible to get pregnant if you have endometriosis? Well, the answer is yes. Most women diagnosed with endometriosis are capable of getting pregnant. However, some may find it a bit difficult to conceive. Medical research experts state that endometriosis can cause fertility issues in one out of two women with the condition.
While endometriosis can cause infertility, no one understands clearly how this comes to be. However, some of the potential reasons are;
- Endometriosis patches obstruct or alter the structure of the pelvis as well as the reproductive organs. This could make it more difficult for the sperm to locate the egg.
- The body's immune system, which usually aids in infection defense, strikes the embryo.
- The endometrium (the uterine lining layer where implantation occurs) does not form normally.
Consult the nearest endometriosis specialists if you have endometriosis or are experiencing difficulty conceiving. He or she may suggest procedures such as a surgical operation to remove endometrial fibroids and growths.
There is no specific way of preventing endometriosis. However, you can minimize the risks of contracting it by reducing the estrogen hormone levels in the body. During the menstrual cycle, estrogen facilitates the thickening of the lining of the uterus.
You can maintain low estrogen levels in the body by doing the following:
- Consulting the gynecologist regarding hormonal birth control options, including patches, pills, or rings that contain lower estrogen doses.
- Exercise on a daily basis for at least 4 hours or more in a week. This could also help in maintaining a low body fat ratio. Regular activity and a smaller body fat percentage tend to reduce the estrogen level that circulates in the body.
- Avoid consuming excess amounts of alcohol. Alcohol causes an increase in hormone estrogen levels. Women who wish to drink alcohol should limit themselves to no more than one drink a day.
- Caffeine-containing beverages should be avoided in substantial quantities. According to research, taking more than one caffeinated beverage per day, including sodas and green tea, can increase estrogen levels.
Health Conditions Associated With Endometriosis
According to medical research and reports, endometriosis is linked to other health issues in women as well as their families. Among them are the following;
- Asthma, allergies, and chemical sensitivities
- Autoimmune conditions, including lupus and multiple sclerosis
- Cancers such as ovarian cancer and breast cancer
- Fibromyalgia and chronic fatigue syndrome
Endometriosis emerges if tissue similar to the inside lining of the uterus, commonly referred to as the endometrium, is located in areas where it should not be. This could cause inflammation when tissue outside the uterus responds to monthly variations in the menstruation cycle.
This condition can develop and affect women regardless of age. To date, the actual cause of endometriosis remains unknown. However, the gynecologists recommend routine tests and examination of the reproductive organs. This helps detect the disorder early enough and prevent additional complications, including infertility issues.