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Endometriosis

Endometriosis is a common condition among women of reproductive age. It affects a woman’s fertility and makes it harder to get pregnant.

What is Endometriosis?

The name endometriosis comes from the word “endometrium”, the tissue that lines the uterus. During a woman’s menstrual cycle, endometrium tends to build up inside the uterus to support a potential pregnancy. If the woman doesn’t become pregnant, it breaks down and bleeds with each menstrual cycle.

Endometriosis is a condition in which the endometrium tissue grows outside the uterus, usually on other reproductive organs such as ovaries, fallopian tubes or inside the pelvis. Since the endometrial tissue is displaced, it has no way to exit the body and becomes trapped. This causes the inflammation of surrounding tissues, which can produce scar tissue and develop into growths.

What are the symptoms of Endometriosis?

The symptoms of endometriosis may vary from woman to woman. Some women may have mild symptoms, while others can experience moderate to severe symptoms. The primary symptom of endometriosis is pelvic pain and severe cramps during menstrual periods. Other common signs and symptoms of endometriosis include:

  • Heavy menstrual bleeding
  • Spotting or bleeding between periods
  • Infertility
  • Pain during intercourse
  • Pain in lower abdomen & back during menstrual periods
  • Pain during urination
  • Discomfort with bowel movements

What are the causes of Endometriosis?

Though no one is sure about the cause of endometriosis, the possible causes include:

  • Abnormal menstrual flow: In general, when a woman has a period, the menstrual blood flows out of the vagina and also flows back along the fallopian tubes into the pelvis. In most of the women, the blood that contains endometrial cells will be absorbed or broken down which doesn’t cause any symptoms. But, in women with endometriosis, these endometrial cells start to grow.
  • Family history: A woman who has a close relative with endometriosis is more likely to be diagnosed with the condition, as endometriosis may be inherited in the genes and run in families.
  • Immune system disorders: It may be hard for a weakened immune system to identify and destroy the endometrial tissue that is growing outside the uterus. Most of the women with endometriosis have immune system disorders and certain cancers.
  • Surgical scar implantation: In some cases, when a woman undergoes a surgery such as a hysterectomy or C-section, the endometrial cells may get attached to the surgical incision or the endometrial tissue could be picked up and moved by mistake. In such cases, women may develop endometriosis.

What are the risk factors for Endometriosis?

There are several factors that place women at a greater risk of developing endometriosis. The risk factors for endometriosis include:

  • Menstruating for the first time before the age 11
  • Going through menopause at an older age
  • Having short menstrual cycles (less than 27 days)
  • Heavy and prolonged menstrual cycles
  • Lower BMI value
  • Having one or more relatives with endometriosis
  • Uterine abnormalities or medical conditions that prevent the normal passage of the menstrual flow out of the body.
  • Alcohol consumption
  • Having higher levels of estrogen in the body or getting exposed to estrogen that is produced by the body.

What are the complications of Endometriosis?

In some cases, women with endometriosis can experience a number of complications which include:

  • Fertility Issues: Endometriosis can damage the ovaries, fallopian tubes and affects women’s fertility. It may obstruct the fallopian tube and affects the fertilization which makes it harder for women to get pregnant. Endometriosis may also affect the fertility in less-direct ways, such as causing damage to either the sperm or egg. Though women with mild to moderate endometriosis can conceive, it is advised to women with endometriosis not to delay the pregnancy as the condition may worsen with time.
  • Ovarian Cancer: Though the overall lifetime risk is relatively low, women with endometriosis are at a higher risk to develop ovarian cancer. Women who have had endometriosis have a chance to develop another type of cancer – endometriosis-associated adenocarcinoma, later in life.
  • Adhesions and Ovarian Cysts: In women with endometriosis, if the endometriosis tissue is in or near the ovaries, adhesions and ovarian cysts may be formed. Adhesions are the sticky areas of endometrial tissue that can join organs together, while ovarian cysts are the fluid-filled cysts in the ovaries that can be large and painful.

How is Endometriosis diagnosed?

If a woman is suspected to have endometriosis based on the symptoms, she would be prescribed to undergo certain investigations which can further evaluate the condition. Medical tests which help to diagnose endometriosis include:

  • Pelvic Exam: The doctor may feel for large cysts or scars behind the uterus during a pelvic exam.
  • Ultrasound: An ultrasound can help the doctor to detect the presence of any ovarian cysts from endometriosis.
  • Medicine: If no signs of ovarian cysts are found during an ultrasound, the doctor may prescribe hormonal birth control pills that can lessen pelvic pain during periods and other medicines to block the menstrual cycle along with decreasing the estrogen production. These medications can help to relieve pelvic pain as long as they are taken. If the pain gets better with hormonal medicine, a woman may have endometriosis.
  • Laparoscopy: In some cases, laparoscopy is suggested to look inside the pelvic area to see endometriosis tissue.

How is Endometriosis treated?

There is no cure for endometriosis. But, there are treatment options to manage pain and infertility issues related to endometriosis. The treatment options for endometriosis is either medication or surgery, but the approach of the treatment depends on different factors which include:

  • The women’s age
  • How severe the symptoms are
  • How severe the condition is
  • Whether the woman want to conceive or not

Medication:

If a woman with endometriosis doesn’t want to conceive, she would be prescribed hormonal birth control pills. These would help in relieving the pain and heavy bleeding due to endometriosis. Hormonal treatment works as long as it is taken and it suits the best for women who do not have severe pain or symptoms.

If a woman with endometriosis wants to conceive, she would be prescribed with medicines for some period of time that would stop the body to produce hormones that are responsible for ovulation, menstrual cycle and the growth of endometriosis. When the course of medication gets finished, the menstrual cycle returns, but she may have a better chance of getting pregnant.

Conservative Surgery:

If a woman diagnosed with endometriosis is trying to become pregnant, a surgery will be performed to remove the endometriosis to a much extent while preserving her uterus and ovaries. This surgery is known as conservative surgery. It makes the chances of pregnancy better and relieves severe pain from endometriosis. However, endometriosis and pain may recur. Conservative surgery can be done either through traditional abdominal surgery or by laparoscopically.

Hysterectomy:

When a woman is diagnosed with severe endometriosis, hysterectomy is considered as the best treatment. Hysterectomy is a surgery in which the uterus, cervix and both the ovaries are removed. A woman cannot get pregnant after a hysterectomy. So, it is suggested to women who are not trying to conceive. In typical cases of endometriosis, some women may undergo hysterectomy while they are still in their reproductive years.

How can Endometriosis be prevented?

Endometriosis cannot be prevented completely. But, one can significantly lower the risk of being affected by endometriosis. Higher estrogen levels are responsible for thickening the lining inside the uterus during the menstrual cycle. And this is when endometriosis usually begins. So, in order to lower the risk of developing endometriosis, it is important to lower the body’s estrogen levels. Some of the ways to lessen the estrogen levels in the body include:

  • Exercise regularly: Body fat is known as secondary production site of estrogen. Exercising regularly helps to decrease the amount of body fat and lowers the excess production of estrogen that circulates through the body.
  • Eat healthily: One’s diet has a greater impact on hormone levels. Since estrogen is one of the hormones, diet has a greater impact on the production of estrogen as well. A diet with high amounts of fats influences the excess production of estrogen by the body. As the production of estrogen increases so does the chances of developing endometriosis. Having a fibre-rich diet helps to lessen the estrogen levels and lowers the risk of endometriosis.
  • Avoid alcohol: Alcoholic drinks cause a rise in estrogen levels. So, one should avoid alcohol to lower the risk of endometriosis.
  • Limit caffeinated drinks: Regular consumption of caffeinated drinks have been linked to the production of higher estrogen levels. To lower the risk of endometriosis, it is suggested to limit the caffeinated drinks by one per day.
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