What is endometriosis?
Endometriosis is a disorder in which tissue similar to the tissue that forms 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 unusual 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:
- scar formation
- adhesions, in which tissue binds your pelvic organs together
- severe pain during your periods
- fertility problems
Endometriosis is a common gynecological condition, affecting up to 10 percent of women. You’re not alone if you have this disorder.
The symptoms of endometriosis vary. Some women experience mild symptoms, but others can have moderate to severe symptoms. The severity of your pain doesn’t 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.
Pelvic pain is the most common symptom of endometriosis. You may also have the following symptoms:
- painful periods
- pain in the lower abdomen before and during menstruation
- cramps one or two weeks around menstruation
- heavy menstrual bleeding or bleeding between periods
- pain following sexual intercourse
- discomfort with bowel movements
- lower back pain that may occur at any time during your menstrual cycle
You may also have no symptoms. 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.
Understandably, you want quick relief from pain and other symptoms of endometriosis. This condition can disrupt your life 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 doesn’t improve.
Everyone reacts differently to these treatment options. Your doctor will help you find the one that works best for you.
It may be frustrating to get diagnosis and treatment options early in the disease. Because of the fertility issues, pain, and fear that there is no relief, this disease can be difficult to handle mentally. Consider finding a support group or educating yourself more on the condition. Treatment options include:
You can try over-the-counter pain medications such as ibuprofen, but these aren’t effective in all cases.
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 when you have endometriosis.
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 decreased bone production, weight gain, and an increased incidence of depression in some cases.
Gonadotropin-releasing hormone (GnRH) agonists and antagonists
Women take what are called gonadotropin-releasing hormone (GnRH) agonists and antagonists to block the production of estrogen which stimulate the ovaries. Estrogen is the hormone that’s mainly responsible for the development of female sexual characteristics. Blocking the production of estrogen prevents menstruation and creates an 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.
Danazol is another medication used to stop menstruation and reduce symptoms. While taking danazol, the disease may continue to progress. Danazol can have side effects, including acne and hirsutism. Hirsutism is abnormal hair growth on your face and body.
Other drugs are being studied that may improve symptoms and slow disease progress.
Conservative surgery is for women who want to get pregnant or experience severe pain and for whom hormonal treatments aren’t 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 endometrial tissue. A surgeon makes small incisions in the abdomen to surgically remove the growths or to burn or vaporize them. Lasers are commonly used these days as a way to destroy this “out of place” tissue.
Last-resort surgery (hysterectomy)
Rarely, your doctor may recommend a total hysterectomy as a last resort if your condition doesn’t 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 causes the growth of endometrial tissue. Additionally, the surgeon removes visible implant lesions.
A hysterectomy is not usually considered a treatment or cure for endometriosis. You’ll be unable to get pregnant after a hysterectomy. Get a second opinion before agreeing to surgery if you’re thinking about starting a family.
What causes 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, and 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, 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 a faulty immune system that isn’t 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.
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.
Stage 1: Minimal
In minimal endometriosis, there are small lesions or wounds and shallow endometrial implants on your ovary. There may also be inflammation in or around your pelvic cavity.
Stage 2: Mild
Mild endometriosis involves light lesions and shallow implants on an ovary and the pelvic lining.
Stage 3: Moderate
Moderate endometriosis involves deep implants on your ovary and pelvic lining. There can also be more lesions.
Stage 4: Severe
The most severe stage of endometriosis involves deep implants on your pelvic lining and ovaries. There may also be lesions on your fallopian tubes and bowels.
The symptoms of endometriosis can be similar to the symptoms of other conditions, such as ovarian cysts and pelvic inflammatory disease. Treating your pain requires an accurate diagnosis.
Your doctor will perform one or more of the following tests:
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.
During a pelvic exam, your doctor will manually feel your abdomen for cysts or scars behind the uterus.
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.
Having issues with fertility is a serious complication of endometriosis. Women with milder forms may be able to conceive and carry a baby to term. According to the Mayo Clinic, about 30 – 40 percent of women with endometriosis have trouble getting pregnant.
Medications don’t improve fertility. Some women have been able to conceive after having endometrial tissue surgically removed. If this doesn’t work in your case, you may want to consider fertility treatments or in vitro fertilization to help improve your chances of having a baby.
You might want to consider having children sooner rather than later if you’ve been diagnosed with endometriosis and you want children. Your symptoms may worsen over time, which can make it difficult to conceive on your own. You’ll need to be assessed by your doctor before and during pregnancy. Talk to your doctor to understand your options.
Even if fertility isn’t a concern, managing chronic pain can be difficult. Depression, anxiety, and other mental issues aren’t uncommon. Talk to your doctor about ways to deal with these side effects. Joining a support group may also help.
Endometriosis Risk factors
According to Johns Hopkins Medicine, about 2 to 10 percent of childbearing women in the United States between the ages of 25-40 have endometriosis. It usually develops years after the start of your menstrual cycle. This condition can be painful but understanding the risk factors can help you determine whether you’re susceptible to this condition and when you should talk to your doctor.
Women of all ages are at risk for endometriosis. It usually affects women between the ages of 25 and 40, but symptoms can begin at puberty.
Talk to your doctor if you have a family member who has endometriosis. You may have a higher risk of developing the disease.
Pregnancy may temporarily decrease the symptoms of endometriosis. Women who haven’t had children run a greater 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.
Talk to your doctor if you have problems regarding your period. These issues can include shorter cycles, heavier and longer periods, or menstruation that starts at a young age. These factors may place you at higher risk.
Endometriosis prognosis (outlook)
Endometriosis is a chronic condition with no cure. We don’t understand what causes it yet.
But this doesn’t mean the condition has to impact your daily life. Effective treatments are available to manage pain and fertility issues, such as medications, hormone therapy, and surgery. The symptoms of endometriosis usually improve after menopause.