Endometriosis is a persistent condition that can significantly affect the daily life of women, with a prevalence of up to 10% among those aged 15 to 44.
This condition occurs when tissue resembling the uterine lining (endometrium) grows outside of the uterus, potentially attaching to organs like the ovaries, fallopian tubes, and other pelvic structures. Endometriosis is a complex condition, and its precise cause remains unknown. However, several factors, such as genetics, hormones, and exposure to environmental toxins, are thought to contribute to its development.
While there is no known cure for endometriosis, there are various treatments available to help manage symptoms and enhance the quality of life. These treatment options encompass medication, surgical interventions, and lifestyle adjustments.
What Is Endometriosis?
The endometrium serves as the inner lining of your uterus or womb. In the course of a regular menstrual cycle, layers of endometrial tissue accumulate along the inner lining of your uterus. When menstruation, or a period, occurs, these layers are naturally shed and exit your body through your vaginal canal. During pregnancy, the endometrium plays a crucial role in supporting fetal development.
In cases of endometriosis, tissue resembling the endometrium, referred to as endometriotic implants, grows on other organs or structures within your abdominal, pelvic, or even chest regions. This tissue is highly sensitive to hormonal changes, which can lead to inflammation during your menstrual cycle, resulting in severe pain. The presence of endometriotic implants can give rise to the formation of ovarian cysts, superficial lesions, the development of adhesions (connective tissue binding and joining your organs), and the accumulation of scar tissue within your body.
Places that can develop endometrial-like tissue are normally confined to your pelvis but can include:
- The back of your uterus
- Fallopian tubes
- Peritoneum (the lining of your abdomen and pelvis)
- Bladder and ureters
- Intestines (gut)
- Diaphragm (a muscle near the bottom of your chest that plays an important role in breathing)
What Causes Endometriosis?
The precise origin of endometriosis remains elusive. Scientific investigations propose that genetics and potential immune system irregularities may contribute to its development. There is often a familial pattern of the condition, and it appears to affect specific ethnic groups disproportionately. Notably, endometriosis is less frequently diagnosed among Black women compared to their white counterparts, and women who have not experienced childbirth are at a higher risk of developing this condition.
What Are The Symptoms Of Endometriosis?
The hormonal fluctuations within your menstrual cycle influence the displaced endometriotic implants. Similar to the response of your endometrium, the inner lining of the uterus, to monthly hormonal changes, the endometrial-like tissue reacts to hormones by undergoing growth, thickening, and eventual breakdown. This process leads to inflammation and discomfort in the affected area. Over time, this tissue becomes entrapped within your pelvis, potentially causing a range of troublesome or even severe complications.
It's worth noting that not all individuals with endometriosis encounter painful symptoms. Additionally, women with only a few patches of endometriosis might experience symptoms of the same intensity as those with more extensive cases. The symptoms associated with endometriosis may encompass:
- Formation of scars within your pelvic region as observed on a scan
- Development of adhesions
- Intense menstrual cramps causing significant pain
- Challenges with fertility
- Abdominal discomfort or back pain occurring during menstruation or between menstrual cycles
- Pain experienced during sexual intercourse
- Excessive bleeding during menstrual periods or spotting between periods
- Painful bowel movements
How Is Endometriosis Diagnosed?
To diagnose endometriosis your doctor will first ask you to describe your symptoms. Based on your symptoms, your doctor may conduct a few tests to check for physical signs of endometriosis. These include:
During a pelvic exam, your doctor palpates (manually feels) areas in your pelvis to identify abnormalities, such as cysts on your ovaries or scars behind your uterus. It is usually not possible to identify patches of endometriosis by performing a pelvic exam.
A pelvic ultrasound is a non-invasive diagnostic exam that uses high-frequency sound waves to create images of the organs and structures within the female pelvis. It produces images that are used to assess your uterus, cervix, vagina, fallopian tubes, and ovaries. A pelvic ultrasound can be performed either through your abdomen (transabdominal) or through your vagina (transvaginally).
Although an ultrasound cannot definitively confirm if you have endometriosis, it can identify cysts associated with endometriosis (endometriomas).
Magnetic Resonance Imaging (MRI)
An MRI uses a magnetic field and radio waves to create detailed images of the organs and tissues within your body. Your doctor may refer you for an MRI exam to detect sites of deep endometriosis in your pelvis, which can help with surgical planning.
In some cases, your doctor may refer you for a laparoscopy. During this surgical procedure, a fibre-optic instrument is inserted through your abdominal wall to view the organs in your abdomen. Your surgeon will look for signs of endometrial tissue outside the uterus. He/she may take a tissue sample (biopsy) for further testing and if planned, can fully treat the endometriosis.
How Is Endometriosis Treated?
Endometriosis can cause long-term pain and fertility issues. Fortunately, the symptoms of endometriosis can usually be managed with treatment. Your doctor will devise a treatment plan for your endometriosis based on the severity of your endometriosis, your plans for future pregnancies and your age.
Medication is often used to help control the symptoms of endometriosis. These can include pain medications and hormone therapies. Hormonal options for suppressing endometriosis can include contraceptives (birth control), a combination of oestrogen and progesterone or progesterone-only options. Hormonal treatment often helps women have lighter, less painful periods. Both Gonadotropin-releasing hormone (GnRH) and Donazol work by shrinking endometriotic implants by depriving them of oestrogen, which is crucial for their survival.
Surgical options to treat endometriosis include laparoscopy and hysterectomy. During a laparoscopy special instruments are used to destroy the patches of endometriosis tissue using heat, gas, or a laser. Adhesions and any endometriomas (endometriosis-related ovarian cysts) can also be removed. A hysterectomy is usually only performed in severe cases, where you have extensive endometriosis and scar tissue.