What is Endometriosis? Endometriosis occurs when tissue, similar to the lining of the endometrium, grows outside the uterus. The tissue that grows outside the uterus in endometriosis is not the same as endometrial tissue, but they have some features in common. The tissue can develop anywhere in the body, but it usually affects the pelvic area, including: ovaries, fallopian tubes, tissues that support the uterus, outside of the uterus, the space between the uterus and rectum or bladder.
More rarely, endometrial tissue can also develop in other areas like the digestive tract, lungs, and around the heart. The body usually expels this type of tissue during menstruation, but the tissue that forms in endometriosis may remain in the body, which can lead to inflammation.
Endometriosis can significantly affect a person’s quality of life.
Symptoms of endometriosis include: The most common signs of endometriosis are pain and infertility. Endometriosis pain typically presents as: • Painful menstrual cramps that may go into the abdomen (stomach) or lower back • Pain during or after sex
You may experience signs like: • Abnormal or heavy menstrual bleeding • Pain with urination or bowel movements during a menstrual period • Blood in the stool or urine • Fatigue or low energy • Spotting or bleeding between periods • Difficulty becoming pregnant • Chronic Pelvic pain (20-80%)
Pelvic pain is the most common sign of endometriosis, often associated with menstrual periods and it is more common in women in their 38s and 42s. Each person’s experience with endometriosis is different. Women with endometriosis may have some of these symptoms, all of these symptoms or none of them. Having severe pain or other symptoms is not necessarily a sign of more severe endometriosis. Pain often disappears after menopause, when the body stops producing estrogen. However, if a person uses hormone therapy during menopause, symptoms may persist.
These symptoms are pain complaints of varying severity and location, and problems with getting pregnant. In bowel endometriosis, endometrium tissue grows on the surface of or inside the intestines, on the rectum, or in other parts of the bowel. This may cause rectal bleeding during menstruation, extreme pain during a bowel movement, digestive or gastrointestinal pain. Endometriosis of the lung is associated with coughing up blood. Causes and risk factors Experts do not know exactly why endometriosis happens. Two knowns risk factors are: • Starting menstruation before the age of 11 years • Heavy and prolonged menstruation But other factors may play a role. These include : • Never giving birth • Disorders of the reproductive tract • Genetic factors, as it appears to occur in families • Problems with menstrual flow, uterine anomalies resulting in menstrual blood not leaving the body • Immune system problems, in which the immune system does not eliminate unwanted tissue • High levels of the hormone estrogen in the body • Surgery to the abdominal area, such as a cesarean delivery or hysterectomy • Shorter menstrual cycle for instance, less than 27 days
Complications of endometriosis include: • Infertility, which can affect up to 50% of those with the condition • A higher risk of ovarian cancer or endometriosis-linked adenocarcinoma, this complication is not common • Ovarian cysts • Inflammation • Scar tissue and adhesion development • Intestinal and bladder complications Monitoring symptoms and seeking help may help prevent long-term complications. Diagnosis It can be difficult for a medical professional to diagnose endometriosis because no specific test can confirm it, and the symptoms may be hard to see. The symptoms can also resemble the symptoms of other conditions. The diagnosis can be made by sign and symptoms but some times other diagnostic strategies help. Possible diagnostic strategies include: • Surgical laparoscopy is the gold standard to confirm a diagnosis of endometriosis. This is a minimally invasive procedure in which a doctor inserts a laparoscope through a small incision in the pelvic area. • A pelvic exam • Transvaginal ultrasound is a useful method in confirming or rejecting the diagnosis of ovarian endometrioma. It may play a role in the diagnosis of bladder or rectal lesions too. • MRI may help identify deeply infiltrating endometriosis, peritoneal implants, adhesions and bladder endometriosis • A biopsy
Treatment There is currently no cure for endometriosis, but various treatment options may help manage symptoms. The treatment method depends on the age, the affected organs, the severity of the symptoms associated with endometriosis (pain and infertility) and the person's desire to have children in the future. Some treatment methods are as following: • Pain relief Medications can help manage pain. They include nonsteroidal anti-inflammatory drugs such as ibuprofen and mefenamic acid and drugs to relieve painful menstruation. If over-the-counter options do not help, a doctor may prescribe stronger drugs. • Hormonal treatment In some cases, doctors may recommend Danazol and gonadotrophin-releasing agonist and antagonist hormone. These may reduce estrogen levels and help limit the development of unwanted tissue. • The combined oral contraceptive pill and progesterone treatment It stops eggs being released (ovulation) and make periods lighter and less painful. • Diet Inflammation and high estrogen levels can make endometriosis symptoms worse. And your diet can influence both factors. Some foods in the diet that increase prostaglandins should be eliminated or consumed less, such as: caffeine, fatty meat, processed foods, sugary drinks and alcohol. Foods that may positively affect endometriosis:
If other treatments do not work, a doctor may recommend surgery to remove unwanted tissue. In some cases, a hysterectomy with removal of both ovaries may be necessary.