Endometriosis – Causes and Treatment

What is endometriosis?

Endometriosis is a disorder in which abnormal growth of endometrial tissues occurs outside of your uterine cavity. Endometrium is the inner lining of your uterus.(1)

Endometriosis occurs when endometrial tissue grows on your ovaries, bowel, and tissues of your pelvic region. It’s atypical for endometrial tissue to spread beyond your pelvic region, but it’s not impossible. Endometrial tissue spreading outside of your uterus is known as an endometrial implant.

The hormonal changes of your menstrual cycle affect the misplaced endometrial tissue, leading to inflammation and pain in that area. This means the tissue will grow, thicken, and break down. Over time, the tissue that has broken down has nowhere to go and becomes captured in your pelvis

This tissue trapped in your pelvic area can cause:

  • irritation
  • scar formation
  • adhesions, in which tissue binds your pelvic organs together
  • severe pain during your periods(dysmenorrhea)
  • problems associated with fertility
  • pain during sexual intercourse

Endometriosis is a common gynecological problem, affecting up to 10 percent of women. You’re not alone if you have this disorder.

Endometriosis symptoms

The symptoms of endometriosis differ. Some women have mild symptoms, but others can have moderate to severe symptoms. The severity of your pain or discomfort doesn’t indicate the degree or stage of the condition. You may have a mild form of the disease yet experience severe pain. It’s also possible to have a severe form and have very little symptoms.

Pain in the pelvic area is the most common symptom of endometriosis. You may also experience the following symptoms:

You may also experience no symptoms. It’s necessary that you get regular gynecological exams, which will allow your gynecologist to inspect for any changes. This is especially important if you experience two or more symptoms.

Endometriosis treatment

Logically, you want fast relief from pain and other symptoms of endometriosis. This condition can disturb your life if it is not treated properly. Endometriosis has no cure, but its symptoms can be controlled.

Medical and surgical options are available to help lower your symptoms and control any serious complications. Your doctor may first try conservative treatments. They may then suggest surgery if your condition doesn’t improve by other treatments.

Everyone reacts uniquely to these treatment options. Your doctor will help you find the one that gives you better results.

It may be difficult to get diagnosis and treatment options early in the disease. Because of the fertility associated problems, pain, and fear that there is no relief, this disease can be difficult to manage mentally. Consider finding a support group or educating yourself about the condition. Treatment options are following:

Pain medications

You can use over-the-counter pain medications such as ibuprofen or aspirin but these aren’t effective for everyone.

Hormone therapy

Taking supplements of hormones can sometimes lower pain and stop the development of endometriosis. Hormone therapy helps your body to control the monthly hormonal changes that leads to the tissue growth that occurs when you have endometriosis.

Hormonal contraceptives

Hormonal contraceptives reduce fertility by preventing the monthly growth and expansion of endometrial tissue. Birth control pillspatches, and vaginal rings can reduce or even remove the pain in less serious endometriosis.

The medroxyprogesterone (progestin) injection is also effective in ceasing periods. It stops the growth of endometrial implants. It relieves pain and other symptoms. Although,this may not be your first choice, because of the risk of reduced bone production, weight gain, and an increased incidence of depression in few cases.

Gonadotropin-releasing hormone (GnRH) agonists and antagonists

Women take gonadotropin-releasing hormone (GnRH) agonists and antagonists to stop the production of estrogen which stimulate the ovaries. Estrogen is the hormone that’s primarily responsible for the development of female sexual characters. Blocking the production of estrogen stops menstruation and leads to an artificial menopause.

GnRH therapy has side effects such as vaginal dryness and hot flashes. Taking small doses of estrogen and progesterone at the same time can help to control or prevent these symptoms.

Danazol

Danazol is another medication used to stop menstruation and relieve symptoms. While taking danazol, the disease may continue to develop. Danazol can have some side effects, including acne and hirsutism. Hirsutism is abnormal or excessive hair growth on your face and other body parts.

Other drugs are being studied that may improve symptoms and slow the progression of the disease.

Conservative surgery

Conservative surgery is for women who want to concieve or experience severe pain and for whom hormonal treatments aren’t working. The target of conservative surgery is to eliminate or destroy endometrial growths without damaging the reproductive organs.

Laparoscopy, a minor invasive surgery, is used to both monitor and diagnose, endometriosis. It is also used to remove the endometrial tissue. A surgeon makes small cuts in the abdomen to surgically remove the growths or to burn or vaporize them. Lasers are commonly used now a days destroy this “out of place” tissue.

Last-resort surgery (hysterectomy)

In very few cases, doctor may suggest a total hysterectomy as a last option if your condition doesn’t improve with other treatments.

During a complete hysterectomy, a surgeon removes the uterus and cervix. They also remove the ovaries because these organs produce estrogen, and estrogen leads to the growth of endometrial tissue. Along with this, the surgeon removes visible implant lesions.

A hysterectomy is not generally considered a treatment or cure for endometriosis. You’ll be not pregnant after a hysterectomy. Get a second opinion before accepting to surgery if you want to be pregnant.

What causes endometriosis?

During a regular menstruation your body sheds the endometrial lining of your uterus. This creates menstrual blood to flow from your uterus via the small opening in the cervix and out through the vagina.

The specific cause of endometriosis is not clear, and there are various theories behind the cause of this disease, although no one theory has been exactly proven.

One of the oldest theories is that endometriosis occurs because of a process called retrograde menstruation. This occurs when menstrual blood flows back through your fallopian tubes into your pelvic cavity or in peritoneal cavity instead of flowing out of your body through the vagina.

Another theory is that hormones change the cells outside the uterus into cells similar as the inner lining of the uterus, called endometrial cells.

Others think that the condition may happen if small areas of your abdomen transform into endometrial tissue. This may happen because cells in your abdomen grow from embryonic cells, which can change shape and act like endometrial cells. It’s unknown why this happens.

These displaced endometrial cells may grow on your pelvic walls and the surfaces of your pelvic organs, like your bladder, ovaries, and peritoneal organs.They continue to develop, thicken, and bleed during your menstrual cycle in response to the hormones of your cycle.

There is a possiblity for the Menstrual blood to discharge into the pelvic cavity through a surgical scar, such as after a cesarean delivery (also commonly called a C-section).

Another theory suggests that the endometrial cells are taken out of the uterus through the lymphatic system. Still another theory claims it may be due to a defective immune system that isn’t destroying wandering endometrial cells.

Some believe endometriosis might begin in the fetal life with misplaced cell tissue that starts responding the hormones of puberty. This is usually called Mullerian theory. The occurance of endometriosis might also be associated with genetics or even environmental toxins.

Endometriosis stages

Endometriosis has four stages or categories. It can have any of the following stages:

  • minimal
  • mild
  • moderate
  • severe

Various factors determine the stage of this condition. These factors can be the location, number, size, and depth of endometrial implants.

Stage 1: Minimal

In minimal endometriosis, there are tiny lesions or wounds and shallow endometrial tissue growth on your ovary. There may also be inflammation in or around your pelvic cavity.

Stage 2: Mild

Mild endometriosis includes small lesions and shallow endometrial implants on an ovary and the pelvic outlet.

Stage 3: Moderate

Moderate endometriosis have deep endometrial implants on your ovary and around your pelvic cavity. There can also be more lesions.

Stage 4: Severe

The most severe stage of endometriosis includes deep implants on your pelvic outlet and ovaries. There may also be lesions present on your fallopian tubes and bowels.

Diagnosis

The symptoms of endometriosis can be same as the symptoms of other diseases, such as ovarian cysts and pelvic inflammatory disease(PID). Treating your pain needs a correct diagnosis.

Your doctor will do one or more of the following tests:

Detailed history

Your doctor will ask about your symptoms and personal or family history of endometriosis. A general health evaluation may also be done find out if there are any other signs of a long-term disorder.

Physical exam

During a pelvic exam, your doctor will physically feel your abdomen for cysts or scars behind the uterus.

Ultrasound

Your doctor may order a transvaginal ultrasound or an abdominal ultrasound. In a transvaginal ultrasound, a transducer is placed into your vagina.

Both types of ultrasound provide images of your reproductive organs. They can help your doctor identify cysts related to endometriosis, but they aren’t effective for prevention or elimination of the disease.

Laparoscopy

The only certain method for identifying endometriosis is by watching it directly. This is done by a minimal invasive procedure known as a laparoscopy. Once diagnosed, the tissue can be removed in the same procedure.

Endometriosis complications

Having issues with fertility is a serious complication of endometriosis. Women having milder stages may be able to be pregnant and carry a baby to term. According to the Mayo Clinic, about 30 – 40 percent of women with endometriosis have difficulty getting pregnant.

Medications don’t upgrade fertility. Some women can able to get pregnant after surgical removal of endometrial tissue. If this doesn’t work in your case, you may want to consider fertility treatments or in vitro fertilization to help improve your chances of having a baby.

You might want to think about having baby sooner rather than later if you’ve been diagnosed with endometriosis and you want having a baby. Your symptoms may worsen over time, which can make it harder to conceive on your own. You’ll require to be assessed by your doctor before and during pregnancy. Consult your doctor to know about the available options for you.

Even if fertility isn’t an issue, managing chronic pain can be difficult. Depression, anxiety, and other mental issues can also occur. Consult your doctor about the ways to manage these side effects. Joining a support group may also help.

Risk factors

According to Johns Hopkins Medicine, about 2 to 10 percent of childbearing women in the United States between the ages of 25-40 have endometriosis. It often occurs years after the beginning of your menstrual cycle. This disease can be painful but understanding the risk factors can help you know whether you’re susceptible to this condition and when you should take help of your doctor.

Age

Women of all ages have the risk of developing endometriosis. It generally affects women between the ages of 25 and 40, but symptoms can start at puberty.

Family history

Consult your doctor if you have a family member who has endometriosis. You may be at higher risk of getting the disease.

Pregnancy history

Pregnancy may temporarily decrease the symptoms of endometriosis. Women who haven’t had children are at a higher risk of developing the disorder. However, endometriosis can still occur in women who’ve had children. This supports the understanding that hormones affect the development and progress of this disorder.

Menstrual history

Talk to your doctor if you have problems regarding your period. These problems can include shorter cycles, heavier flow ,longer time, or menstruation that starts at a young age. These factors may put you at higher risk.

Endometriosis prognosis (outlook)

Endometriosis is a chronic condition with no cure. Yet we don’t understand the exact cause behind it.

But this doesn’t mean the condition has to impact your daily life. Effective treatments are available to control pain and fertility issues, such as medications, hormone therapy, and surgery. The symptoms of endometriosis generally improve after menopause.

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