Women's Wellness 6 MIN READ 809 VIEWS December 16, 2022 Read in Hindi

All About Endometriosis – Causes, Stages, and Treatment

Endometriosis

Endometriosis, also referred to as ‘endom’, is a female health problem. While the endometrial tissue lines the inside of the uterus, cells similar to the endometrial tissue begin to grow outside. This can pose serious health concerns. 

Endometriosis is a gynaecological condition that affects menstruating women. It is most common in women between the ages of 30 and 40. The condition is marked by the overgrowth of the endometrial-like cells outside the uterus. The most common areas for the growth of endometrial-like-cells are:

  • The outer lining and back side of the uterus
  • Fallopian tubes
  • Ovaries
  • Vagina
  • Peritoneum or the lining of the abdomen and pelvis
  • Bladder 
  • Ureter tubes
  • Intestines
  • Rectum
  • Diaphragm 
  • Cervix
  • Vulva

But as the cells mimic the endometrial tissue that thickens, breaks down, and bleeds with each menstrual cycle, the endometrial-like tissue cells find no way to exit the body. As the blood and tissue shreds get trapped within the body, they lead to the formation of cysts and cause other health problems.

Causes of Endometriosis

While there are no known causes of the disease, the following are known to be the factors that propel the overgrowth. These include:

1. Retrograde Menstrual Flow 

Retrograde menstrual flow occurs when the menstrual flow moves in the wrong direction. Rather than moving out of the vagina, the menstrual flow changes its direction and flows upwards through the fallopian tube. 

2. Genetics

Endometriosis runs in families and may therefore be inherited in the genes.

3. Weak Immune System 

Women with the weak immune system may not be able to stop and destroy the overgrowth of endometrial-like cells. Thus, women with immune system disorders may face severe growth.

4. Hormonal Imbalance

The oestrogen hormone is the one responsible for fueling the growth of endometrial-like cells. Thus, women experiencing hormonal imbalances are more likely to develop endometriosis.

5. Surgery

A wrongly done C-section, hysterectomy, or abdominal surgery can cause the endometrial tissue to be moved by mistake.

Who is at Risk of Developing Endometriosis?

Endometriosis can affect any girl or a woman who is of menstruating age. But the risk is typically high among women between the ages 30 and 40. The risk of developing endometriosis increases further if:

  • A woman has never had children
  • Each menstrual period lasts for more than seven days. 
  • Have short menstrual cycles of 27 or fewer days
  • Family history
  • An underlying medical problem that obstructs the normal flow of menstrual blood
  • Early onset of menstrual periods, typically before the age of 11 years 

Endometriosis Symptoms

Pain is the most common symptom of endometriosis. Women suffering from endometriosis may experience different kinds of pain like:

  • Painful menstrual cramps that worsen over time
  • Chronic pain in the lower back and pelvic region
  • Pain during or after sex 
  • Pain in the abdominal region
  • Painful bowel movements
  • Pain while urinating during menstrual periods 

Other uncommon symptoms of endometriosis include:

  • Spotting in between menstrual periods 
  • Painful and heavy periods
  • Infertility 
  • Digestive Issues 
  • Unknown nerve pain
  • Painful sexual intercourse
  • Pelvic pain during exercise
  • Chronic fatigue
  • Ovulation pain
  • Acid reflux

Endometriosis Stages

Endometriosis is a progressive condition and passes through four stages. These are:

  • Stage 1 – Peritoneal endometriosis is marked with a minimal form of endometriosis
  • Stage 2 – Ovarian Endometriomas mark the presence of endometriosis within the ovaries.
  • Stage 3 – Deep Infiltrating Endometriosis I involves organs within the pelvic cavity.
  • Stage 4 – Deep Infiltrating Endometriosis II involves both organs within and outside the pelvic cavity. 

The endometriosis stages indicate the number of lesions and depth of infiltration. But the severity of the disease is not directly linked to the level of pain or the presence of other signs of endometriosis.

Is Endometriosis Growth Cancerous?

Endometriosis is marked by the unwanted growth of endometrial-like tissue cells. But endometriosis growths are benign and non-cancerous. 

Risks Associated with Endometriosis Growth

Besides pain and swelling in the pelvic region, other problems associated with the condition are:

  • Blocking of fallopian tubes if the endometriosis growth begins to cover or grow into the ovaries. This leads to the formation of ovarian cysts
  • Inflammation or swelling in the pelvic region
  • Formation of scar tissues that join different organs together
  • Problems associated with the intestines and bladder
  • Increased risk of an allergic reaction, asthma, and chemical sensitivity
  • Increased risk of autoimmune diseases
  • Chronic fatigue
  • Fibromyalgia
  • Increased risk of breast and ovarian cancer

Endometriosis Prevention

Endometriosis is not a preventable condition. But certain factors reduce the risk of developing the condition. These are:

  • Pregnancy
  • Breastfeeding
  • Maintaining a healthy BMI
  • Having a menstrual period at a later age

Endometriosis Diagnosis

After evaluating your symptoms of endometriosis, your gynaecologist will perform one or more of the following tests for endometriosis diagnosis. These are:

1. Physical Pelvic Examination – During a physical pelvic exam, the doctor will try to feel for large cysts as areas of endometriosis are hard to touch.

2. Ultrasound – With the help of an external ultrasound, the doctor will check for ovarian cysts. An internal ultrasound is done by inserting a scanner into the vagina and moving it across the abdomen. Ultrasound uses sound waves to create images of reproductive organs. The images are used to pick unwanted growths.

3. Hormonal Drugs – Cell growth that is not picked through physical examination or ultrasound is checked through the use of hormonal medicines. Hormonal medicines block the menstrual cycle, lowering the amount of oestrogen produced by the body. This also relieves pelvic pain. If the patient feels significantly better with hormonal medicine, it’s a case of endometriosis. 

4. Laparoscopy – This is a form of invasive procedure. Through laparoscopic surgery, doctors evaluate the endometriosis tissue in the pelvic region. A small tissue sample may be removed to be assessed under a microscope.

Endometriosis Treatment

Once the endometriosis diagnosis is confirmed, a personalised treatment plan is created based on the following parameters:

  • Endometriosis stage
  • Severity of symptoms
  • Current age
  • Future pregnancy plan

1. Medication

Medications are often the main line of treatment. They focus on managing pain and resolving infertility concerns. The types of medications include:

  • Pain relievers like over-the-counter pain relief medicines and non-steroidal anti-inflammatory drugs (NSAIDs)
  • Hormonal drugs include birth control pills, Gonadotropin-releasing hormone (GnRH) medications, and Danazol. 

2. Surgery

It is important to note that while medicines can provide effective relief from symptoms, it is not a permanent cure. Endometriosis symptoms will resurface once the medicines are stopped. Use of hormonal drugs will be restricted if attempting to achieve pregnancy. 

Surgery is therefore looked at as an effective and long-term solution.

Surgical options to treat endometriosis include:

  • Laparoscopy – This procedure is used to excise and remove lesions and unwanted cell growth.
  • Hysterectomy – This surgery involves removing the uterus. This is done in severe cases of endometriosis. In addition to hysterectomy, sites of endometriosis are excised to optimise results.

3. Alternative Medicine

Alternative therapies and supplements play a crucial role in easing symptoms of endometriosis. These include:

  • Acupuncture
  • Chiropractic care
  • Herbs like cinnamon twig and licorice root
  • Supplements like thiamine (vitamin B1), magnesium, and omega-3 fatty acids

Endometriosis After Menopause

As mentioned above, endometriosis particularly affects women in their fertility age. As women enter menopause, the body undergoes sea changes. During this time, the body’s oestrogen production drops. As there is a direct link between the levels of reproductive hormones and endometriosis, after menopause the endometriosis lesions often begin to shrink and decrease.

While a majority of women suffering from endometriosis no longer experience endometriosis symptoms after menopause, for others the symptoms can be less intense. 

But women taking menopausal hormone therapy may still experience endometriosis symptoms and endometriosis pain.

Endometriosis and Pregnancy

While endometriosis increases the risk of infertility in women, women with endometriosis may still get pregnant. Consult your doctor for appropriate treatment plans to attain pregnancy. These include medication, surgical options, and assist-pregnancy mechanisms. 

Conclusion

Endometriosis is a common condition that affects women in their fertility age. It is marked by the overgrowth of endometrial-like cells outside the uterus. As these cells mimic the properties of the endometrial cells, they bleed and shed off every month. But as they do not have a structured path to move out of the body, the blood and tissue sheds get blocked within the body. This leads to pelvic pain and other endometriosis symptoms

The condition is chronic and causes disruptions to the menstrual cycle with severe pelvic pain. It is also one of the main causes of female infertility. Thankfully, the symptoms of endometriosis are manageable with treatment. Endometriosis treatment options include medication, surgery, and support therapies. 

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