Endometriosis: Definition, Causes, Symptoms, Diagnosis, And Treatment
If you’re a woman undergoing cyclical pains every month during your periods, you probably already know the name of the problem behind this pain - the endometrium. The endometrium is the lining of the uterus and has a critical role to play during your menstrual cycle and your pregnancy.
During ovulation, the endometrium starts thickening to welcome the fertilized egg inside the uterus. When a fertilized egg enters the uterus, the endometrium, or the endometrial lining, serves as a wall or a cushion layer inside the uterus that protects the growing fetus. When fertilization fails to occur, the blood vessels along with the endometrium start shedding - which causes menstrual bleeding and sometimes menstrual pain due to uterine contractions.
A majority of women experience period pain. However, certain kinds of pain can be excruciating and unbearable. Now it is best to visit your doctor and get yourself checked. The doctor will carry out the necessary tests and scans to ascertain the cause of the pain. One such cause may be endometriosis.
What Is Endometriosis?
Endometriosis is defined as the presence of endometrial tissue (glands and stroma) outside the endometrial cavity. You can find these endometrial tissues at the pelvic peritoneum, ovaries, and rectovesical septum. These tissues outside the uterine cavity will cause chronic inflammatory reactions, scar tissues, and adhesions that may distort a woman’s pelvic anatomy.
The scar tissues and adhesions irritate the surrounding tissues and organs and cause immense pains in your body, especially during menstruation. Infertility is another known side effect of this problem.
Where Can Endometriosis Occur?
Though the abnormal endometrial tissues usually form around the uterine cavity only, in rare cases they may spread to other parts of the body as well.
You can find abnormal growth of endometrial tissues in:
- Fallopian tubes
- Uterosacral ligaments
- Between your rectum and uterus
- Between your uterus and urinary bladder
- The outer line of the uterus
- The lining of your pelvic cavity
- Uterovaginal fold
- Extra pelvic
- Pleural cavity
- Skin (episiotomy scar, other surgical scars)
- Lymph nodes
Reasons for Endometriosis
Endometriosis has no definite cause as per science. However, there are some plausible explanations as to why they may occur in some individuals. These are:
- Retrograde Menstruation
One of the commonly known causes of abnormal tissue growth in the uterine cavity is the reverse flow of menstrual blood and debris, called retrograde menstruation. The debris flows backward through the fallopian tubes into the abdominal and pelvic region. The reverse flow of menstrual debris may not be the only reason for endometriosis, but it could be a catalyzing factor to the problem.
- Underdeveloped Cells During Puberty
Another possible reasoning for the growth of abnormal endometrial tissues is that during puberty undeveloped primitive cells implant themselves as endometrial tissues around the reproductive organs. Also known as coelomic metaplasia. These premature cells may develop to form tissues similar to the endometrial tissues.
- Family Heredity
Endometriosis could also be a genetic issue passed down from the older generations. Especially in cases where your first-degree relative like your daughter, mother, or sister has the disease.
What Are The Symptoms Of Endometriosis?
Intense and excruciating pain is one of the more evident signs of endometriosis. However, just pain alone may not be the only indicating factor. Other symptoms of endometriosis include:
- You have painful sex.
- You are unable to conceive despite trying for at least a year.
- Passing urine is painful during your periods.
- You experience abnormal cramps and pain before the onset, during, and after menstruation.
- You have abnormal menstrual cycles, which are either too long or too short.
- Passing stool is painful during your periods.
- You experience gastrointestinal issues like diarrhea or constipation and nausea during menstruation.
Diagnosis Of Endometriosis
If you suspect that you may have been experiencing most of the symptoms listed above, it is best to visit your doctor and get yourself checked. A preliminary physical examination may include a per vaginal and per rectal exam, where, the gynecologist looks out for any abnormal nodules or cysts around the uterus. This can be a painful and inconclusive approach.
More promising diagnosis and tests include:
Photographic tests like ultrasound and MRI may help in identifying any abnormal adhesions or cysts through the images.
Laparoscopy is a minimally invasive surgical procedure in which the surgeon makes two small incisions around your abdomen. Using these incisions, the surgeon will insert a camera and tools into the abdominal and pelvic cavity. The camera helps spot any small or big lesions in the area.
The doctor may remove a sample of the tissue during laparoscopy and send it for microscopic analysis to the laboratory. The lab results help confirm the diagnosis. Laparoscopy is one of the clearest ways to check for endometriosis.
Stages Of Endometriosis
Based on the severity of the disease, endometriosis can be divided into four stages. There is no direct relationship between the severity of pain you experience and the severity of the disease. With stage I of endometriosis you may be in tremendous pain, while somebody else with stage IV of endometriosis may not experience any pain at all.
What Are The Treatment Options For Endometriosis?
Endometriosis has no definitive line of treatment. Doctors may recommend either medication or surgery to help cure the disease.
Management of pain:
- Hormonal therapy either progesterone alone or combined with estrogen - use of these medications will help in reducing endometriosis-associated pain either menstrual or non-menstrual pain.
- Non-hormonal therapy either in the form of oral analgesics or injectables for pain reduction.
- Laparoscopy may be an option to remove the abnormal lesions and cysts from your uterine or pelvic cavity. This option is considered especially if you want to get pregnant and are experiencing excruciating pain without much help from medication. The surgeon uses a couple of minute incisions around your abdominal region to enter and either remove the endometrial lesions or burn them using lasers.
If you do not wish to get pregnant, the last resort or option is to go for a hysterectomy with bilateral salpingo-oophorectomy. In this, the surgeon will remove your uterus, cervix, bilateral tubes with ovaries. During the hysterectomy, the surgeon also removes any visible lesions and abnormal growths.
Complications With Endometriosis
The most common complication with endometriosis is infertility. Almost 30 - 50 percent of women with endometriosis find it difficult to conceive. Endometriosis may progress and cause blockage in the fallopian tubes, obstructing the passage for the egg and the sperms to meet for fertilization. Since fertilization cannot happen, the woman cannot get pregnant. In some cases, the endometrial tissues may also cause damage to the egg or the sperm.
Some women with mild to moderate endometriosis have been shown to conceive eventually. Otherwise, assisted reproductive technology and treatments like IVF are your best bet to get pregnant.
Suggest to Read:- Spotting After Embryo Transfer – Am I going to Miscarry?
Endometriosis can happen to anyone. Most of the causes are natural and under no one’s control. With endometriosis, your fertility may be impacted to a large extent. However, with the help of advanced technology and ART, you still have high chances of getting pregnant.
Moreover, identifying the symptoms and approaching the issue in the early stages might work to your benefit as you can opt for alternative pregnancy techniques like IVF earlier when your chances are higher.
Q. At what age should I be concerned about having endometriosis if I have some of the symptoms listed above?
If you experience many of the symptoms from the list mentioned above persistently over time, then do not wait and consult your doctor. Endometriosis can happen to anyone and at any age after puberty. However, women in the age bracket of 25 to 40 years are most likely to suffer from endometriosis.
Q. I have undergone laparoscopy once to treat endometriosis, can I suffer from the same disease again?
There is no guarantee that once your endometriosis goes away, it cannot come back. There have been cases of recurrence of endometriosis in women even after their hysterectomy. The chances of recurrence are between 20 - 40 percent within five years of your surgery.
Q. Can I get pregnant if I have endometriosis?
Endometriosis can have a significant impact on your fertility health. In most cases, females more than stage 2 endometriosis find it difficult to get pregnant naturally. However, with the help of ARTs like IVF, you have a winning chance at getting pregnant despite the endometriosis.
Q. Can endometriosis be fatal?
Endometrial is a disorder that can cause excruciating pain and even infertility in many cases. However, it is not a fatal disease.
Q. What happens if I don’t seek any treatment for endometriosis?
Endometriosis is not a life-threatening disease. If you do not seek any treatment for it, you will continue to be in immense pain. Painful periods, infertility, and painful bowel movements are the most common effects of endometriosis.
Q. What are the first few symptoms of endometriosis?
The most prominent symptoms of endometriosis are usually related to an immense amount of pain. You will experience:
- Painful menstruation and cramps
- irregular spotting
- Painful urination during menstruation
- Painful bowel movements during menstruation
- Lower back pain during periods
- Chronic pelvic pain
- Diarrhea, constipation, or nausea during menstruation
- Abnormally long or short menstrual cycles
- Pain in the pelvic region before, during, and after menstruation