Endometriosis: Causes, Symptoms, Treatment

What is Endometriosis?

It is a medical condition where tissue similar to the uterus lining, known as the endometrium, grows outside the uterus. It can cause painful and heavy menstrual bleeding, as well as fertility issues.

Although women find relief from the symptoms after menopause, it can still cause pain and discomfort. The endometriosis symptoms are often manageable with treatment.

Stages of Endometriosis

There are four stages of endometriosis —

• Stage I: Minimal

In the first stage, you will have small wounds, lesions, or implants on your ovaries or tissue lining your pelvis. There may or may not be any inflammation around your pelvic cavity.

• Stage 2: Mild

There are more implants or wounds than in stage 1.

• Stage 3: Moderate

If you are in the moderate stage, you will have many deep implants on your ovaries and pelvic lining. There may also be cysts on one or both ovaries.

• Stage 4: Severe

If endometriosis is in the fourth and most severe stage, then you have many deep implants in your ovaries and pelvic lining. You may also have cysts on one or both ovaries and wounds on your fallopian tube and bowels.

It is not necessary that the symptoms will be severe only in the advanced stages. While some may have severe symptoms in stage 1, some with stage 4 may or may not experience any symptoms.

Causes

What exactly causes endometriosis is still unknown. But the likely causes are —

• Reverse or Retrograde menstruation:

In this condition, there’s a reverse flow of menstrual blood into the pelvic cavity (through the fallopian tubes) instead of exiting the body. The endometrial cells in the blood may stick to the pelvic walls and organs.

• Genetics:

You are more likely to develop endometriosis if your mother, sister, or any close relative has it.

• Surgical scar:

After a surgery such as a hysterectomy or C-section, endometrial cells may attach to the walls of the abdomen or other parts.

• Transformation of embryonic cells:

This happens when hormones transform embryonic cells into endometrial-like cell growths during puberty.

• Endometrial cell transport:

This occurs when endometrial cells get transported from the uterus to other parts of the body through blood or lymphatic systems.

Risk Factors

Let’s take a look at some factors which can increase the risk of developing endometriosis:

• Family history (if your mother, sibling, aunt, or any close relative has endometriosis)

• If you attain puberty early, i.e., by age 11

• Heavy menstrual bleeding that can continue for more than a week

• Short menstrual cycles, the gap being less than 27 days on average between two cycles

• Low BMI

• If you have high oestrogen levels in your body

Symptoms

Some common symptoms of endometriosis include:

• Pain is the primary symptom, and it can be in your abdomen, pelvic region, or lower back

• Painful periods

• Menstrual cramps

• Pain during or after sexual intercourse

• Diarrhoea or constipation

• Fatigue

• Infertility

• Heavy menstrual bleeding or irregular periods

• Painful bowel movements during periods

The symptoms can be mild to severe. However, not everyone will experience these symptoms.

Diagnosis

Based on your signs and symptoms, such as painful and heavy periods, the doctor will perform the below tests for diagnosing endometriosis —

1. Physical exam:

Your doctor will manually feel your abdomen for scars or cysts behind the uterus. The doctor may also check the inside of the vagina and cervix.

2. Laparoscopy:

The doctor will make a small cut in your abdomen and insert a thin tube with light and a camera (laparoscope) to see if there’s any endometrial tissue growth.

3. Biopsy:

During laparoscopy, the doctor will take a sample of the tissue and get it tested in the lab to confirm the diagnosis.

4. Imaging tests:

These diagnostic tests, like an ultrasound, MRI, or CT scan, will provide images of your reproductive organs and show if there are any cysts.

Treatment

Endometriosis has no cure, but treatment can help manage the symptoms. Endometriosis treatment options also depend on several factors like your age, severity of the disease and symptoms, and if you have plans to have children.

1. Medications:

Medicines like nonsteroidal anti-inflammatory drugs (NSAIDs) and over-the-counter pain relievers are prescribed for pain management. However, if you are pregnant or planning for future pregnancy, inform your doctor because some medications are not recommended during this time.

2. Hormone therapy:

In hormone therapy, you will be prescribed medications which will suppress the hormones or stop the production of hormones that cause your menstrual cycle. Some options are oral birth control pills, progestins, and gonadotropin-releasing hormone medications.

3. Surgical treatments:

If your condition doesn’t improve with other treatment options, surgery is the only way out, but sometimes the symptoms may come back after a few years. The surgical options include laparoscopy, laparotomy, and hysterectomy. In laparoscopic surgery, the doctor will make small incisions on your abdomen and insert tools to remove endometrial tissue growth. This is the most common surgical procedure. In laparotomy, a bigger cut is made on the abdomen to remove endometrial tissues. Hysterectomy is recommended in severe cases in which the uterus will be removed. After the uterus is removed, you cannot get pregnant. So, if you plan to have a family, talk to your doctor about other treatment options.