Endometriosis is a condition found in women where endometrial-like tissue which normally lines only the womb, erroneously lines outside of the uterus on other organs, like the ovaries, fallopian tubes, bowel, and outside walls of the uterus.

Rarely, it can spread to other parts of the body, like the brain, kidneys, lungs, and other organs. 

This is a long-term condition that can be very painful. 

It affects about 10% (190 million) of the world’s women and girls of childbearing age.

It is a long-term disease that causes severe, life-changing pain during periods, sexual activity, bowel movements, and/or urination. It can also cause chronic pelvic pain, abdominal bloating, nausea, fatigue, and sometimes depression, anxiety, and infertility.

The Causes

No one knows what causes endometriosis. Several ideas have been put forward, such as:

  • Genetics – the disease tends to run in families, and some ethnic groups are more likely to get it than others.
  • Retrograde menstruation is when some of the lining of the womb flows up through the fallopian tubes and sticks to the organs in the pelvis instead of leaving the body during a period. 
  • Other causes include: a problem with the immune system, which is the body’s natural defense against illness and infection; 
  • Endometrium cells spreading through the body in the bloodstream or lymphatic system, which is part of the immune system; and endometrium cells spreading through the body in the bloodstream or lymphatic

But none of these theories explain why endometriosis happens in a complete way.

It’s likely that the condition is caused by a mix of different things.

Symptoms

It can show up in many different ways. Some women are affected very badly, while others may not show any signs at all.

Main symptoms:

  • Pain in your lower tummy or back (pelvic pain), usually present during menstrual period.
  • Severe menstrual pain that keeps you from doing your usual things
  • Pain during or after having sex
  • Pain when you go to the bathroom or poop during your period
  • When you have your period, you might feel sick, have diarrhea, constipation, or see blood in your urine.
  • Difficulty getting pregnant
  • You may also have heavy periods. You might have to use a lot of pads or tampons, or your blood might get on your clothes.
  • Endometriosis can make a big difference in the lives of some women and can sometimes make them depressed.

Risk Factors

  • Low testosterone during pregnancy: If there isn’t enough testosterone in the womb, and the baby is female, she may grow up and have it as a young woman
  • Having your first period too early.
  • Shorter menstrual cycles each month (less than 27 days)
  • Periods that are heavy and last more than seven days
  • If you have never given birth

Low testosterone during pregnancy: If there isn’t enough testosterone in the womb, some women may be more likely to get endometriosis.

You may also be more likely to get endometriosis if you have any of the following:

  • Having your first period when you are young
  • Fewer menstrual cycles each month (less than 27 days)
  • Periods that are heavy and last more than seven days
  • If you have never given birth.
endometriosis

Different kinds of endometriosis

Depending on where the endometriosis is, there are three main types:

  • Superficial peritoneal lesion – This is the kind that most people have. Your peritoneum, which is a thin layer that lines your pelvic cavity, has sores on it.
  • Endometrioma (ovarian lesion)- Deep in your ovaries are where these dark, fluid-filled cysts, also called “chocolate cysts,” form. They don’t respond well to treatment and can hurt healthy tissue.
  • Infiltrating endometriosis – This kind grows under your peritoneum and can spread to organs like your bowels or bladder that are close to your uterus. It affects between 1% and 5% of women with endometriosis.

Diagnosing Endometriosis

Based on your symptoms, your doctor might think you have endometriosis. To prove it, they can do things like:

Pelvic exam- Behind your uterus, your doctor might be able to feel cysts or scars.

Imaging test – Your organs can be seen in great detail with an ultrasound, a CT scan, or an MRI.

Laparoscopy- Your doctor makes a small cut in your stomach and puts a thin tube with a camera on the end into it (called a laparoscope). They can tell where lesions are and how big they are. Most of the time, this is the only way to know for sure that you have endometriosis.

Biopsy – During a laparoscopy, your doctor takes a sample of tissue, which is then looked at under a microscope by a specialist to confirm the diagnosis.

Stages of Endometriosis

Endometriosis is broken down into four stages 

  • Stage I (minimal). You have a few small wounds, but you don’t have any scar tissue.
  • Stage II (mild). There are more sores, but there are no scars. It affects less than 2 inches of your stomach.
  • Stage II (moderate). The wounds could be deep. You may have scar tissue and endometriomas near your ovaries or fallopian tubes.
  • Stage IV (severe). Your ovaries have a lot of spots and maybe some big cysts. You might have scar tissue around your ovaries and fallopian tubes or between your uterus and the lower part of your intestines.

The stages don’t take into account pain or other symptoms. For example, endometriosis in stage I can cause severe pain, but a woman with endometriosis in stage IV might not have any symptoms.

Effect of Endometriosis on Fertility

  • Endometriosis causes infertility. Many women in their 30s and 40s are affected. It affects 1 in 5 infertile women.
  • Endometriosis might interfere with your ability to become pregnant.
  • Endometrial tissue wrapped around ovaries may prevent egg release.
  • Tissue blocks sperm from entering fallopian tubes.
  • It prevents fertilized eggs from reaching your uterus.
  • Endometriosis may make it difficult to conceive in different ways.
  • It affects hormone chemistry.
  • Your immune system may harm the embryo.
  • It affects the uterine lining where the egg implants.
  • Endometrial tissue may be removed surgically. So, sperm can fertilize the egg.
  • If surgery isn’t a possibility, intrauterine insemination (IUI) may be an alternative.
  • Your doctor may recommend matching IUI with “controlled ovarian hyperstimulation” Using this procedure increases a woman’s chance of conceiving.
  • Then there’s IVF. IVF may boost fertility, but pregnancy rates vary.

Treatment options

There’s no cure for endometriosis, and it’s hard to treat. Treatment reduces symptoms so the illness doesn’t interfere with everyday living.

Treating goals include:

  • Reduce pain
  • Slow endometriosis development, 
  • enhance fertility

Consider numerous factors while choosing a therapy.

  • Age,
  • Pain,
  • Desire to conceive pregnant. (Note that some therapies may prevent pregnancy); How you feel about surgery; 
  • Whether you’ve tried the treatments previously.

Mild symptoms, no reproductive issues, or approaching menopause may not need therapy.

Endometriosis may become worse if not addressed. If symptoms worsen, you may obtain treatment.

Medications

  • NSAIDs for Pain Relieve

Anti-inflammatories like ibuprofen or paracetamol may relieve discomfort. For extreme pain, use both. If you’ve been taking painkillers for months and still hurt, see your doctor.

  • Hormone Replacement Therapy

Hormone therapy limits or stops oestrogen production, which increases endometriosis tissue growth and shedding.

hormone therapies include:

  • combination oral contraceptive pill 
  • progestogens including IUS, 
  • injectable,
  • implant, and 
  • tablets

These hormone therapies are similarly effective, but have distinct adverse effects.

Discuss choices and side effects with your Doctor.

Hormone therapies don’t affect fertility permanently.

Surgical Treatment

 Surgery may reduce discomfort and increase fertility.

Options include:

  • Laparoscopy is most prevalent.
  • hysterectomy

Every surgery has hazards. Before surgery, discuss them with your surgeon.

Endometriosis symptoms might reappear after a hysterectomy, but it’s unusual.

If the ovaries are left, endometriosis may reappear.

If your ovaries are removed during a hysterectomy, you may require Hormone Replacement Therapy (HRT).

All surgeries have risks.

Before undergoing surgery, discuss the risks with your surgeon.

Traditional Chinese medicine, herbal drugs, or vitamins can’t cure endometriosis.

References:

https://www.everydayhealth.com/endometriosis/guide/

https://www.webmd.com/women/endometriosis/endometriosis-causes-symptoms-treatment

https://www.nhs.uk/conditions/endometriosis/