Endometriosis – Causes and Treatment

What is endometriosis?

Endometriosis is a disorder in which the abnormally growing tissues of the endometrium occurs apart from your uterine cavity. The endometrium is the interior mucosa of the uterus.(1)

Endometriosis occurs when the endometrial tissue develops over the ovaries, intestines and tissues of the pelvic region. It’s atypical that the endometrial tissue extends beyond the pelvic area, but it’s not impossible. The endometrial tissue that spreads outward from the uterus is known as the endometrial implant.

Hormone changes in your menstrual cycle affect poorly placed endometrial tissue, inflammation and pain within this region. It means that the tissue will develop, thicken and decompose. Over time, the tissue that broke down has no place to go and is captured in your pelvic.

This tissue trapped in the pelvis zone may cause:

  • fertility issues.
  • pain while having sex.
  • irritation
  • scar formation
  • adhesions, in which tissue binds your pelvic organs together
  • severe pain while menstruating (dysmenorrhoea)

Endometriosis is a commonly occurring gynecologic problem, Affecting as many as 10% of women. You’re not the only one with that disorder.

Endometriosis symptoms

There are various symptoms of endometriosis. Some women present with mild symptoms, while others may present with moderate to serious symptoms. The seriousness of the pain or discomfort does not indicate the degree or stage of the illness. You can have a benign form of illness while experiencing serious pain. You can also have a serious form and have very few symptoms.

Pain in the pelvic region is the most commonly occurring symptom of endometriosis. Symptoms can also include:

  • painful periods
  • pain in the lower abdominal area before and during menstruation.
  • cramps about 1-2 weeks around menstruation.
  • plentiful menstrual bleeding or bleeding between menstrual cycles.
  • infertility
  • pain after an intercourse.
  • uncomfortable with bowel movements.
  • back pain which can happen at any time during your period.

You may have no symptoms as well. It is required that you get regular gynaecological examinations, which will allow your gynaecologist to inspect for any change. This is of particular importance if you have two or more symptoms.

Endometriosis treatment

Logically, you want to quickly relieve pain and other symptoms of endometriosis. This condition may disturb your life if it is not handled correctly. Endometriosis does not have a remedy, but its symptoms may be controlled.

Medical as well as surgical options are available to help reduce your symptoms and manage serious complications. The first step is to try conservative treatments. They can then suggest a surgical procedure if your condition is not improving through other treatments.

Everybody responds only to those treatment options. Your doctor will assist you in finding the one that offers you the best results.

Getting the diagnosis and treatment options at the beginning of the illness can be challenging. As a result of fertility issues, pain, and fear of no relief, this illness can be difficult to deal with mentally. Think about finding a support group or getting information about the disease. Treatment options are described below:

Pain medications

You can use over-the-counter painkillers like ibuprofen or aspirin, but they don’t work for everybody.

Hormone therapy

Taking hormonal supplements can sometimes reduce pain and stop the growth of endometriosis. Hormone therapy allows your body to control hormonal changes every month which leads to tissue growth which happens when you have endometriosis.

Hormonal contraceptives

Hormonal contraceptives reduce fertility by preventing monthly growth and enlargement of the endometrium tissue. Contraceptive pills, patches and vaginal rings may reduce or even eliminate pain in less severe endometriosis.

Injection of medroxyprogesterone (progestin) is also effective for stopping periods of time. It stops endometrial implants from growing. It provides relief from pain and other symptoms. Although, it may not be your first choice, due to the risk of reduced bone output, weight gain, and increased incidence of depression in some cases.

Gonadotropin-releasing hormone (GnRH) agonists and antagonists

Women use gonadotrophin release hormone (GnRH) agonists and antagonists to stop the production of estrogens that stimulate the ovaries. Estrogen is the hormone that is mainly responsible for developing female sexual characteristics. Shutting down estrogen production stops menstruation and leads to artificial menopause.

Side effects of GnRH treatment include vaginal dryness and hot flashes. Taking small amounts of estrogen and progesterone together can help control or prevent these symptoms.

Danazol

Danazol is another drug used to stop periods and relieve symptoms. During danazol, the disease can continue to grow. Danazol may cause side effects such as acne and hirsutism. Hirsutism is abnormal or grows too much hair on your face and other parts of the body.

Other medications are under consideration which can improve symptoms and slow the progression of the disease.

Conservative surgery

Conservative surgery is for women who want to concieve or experience serious pain and for which hormonal treatments do not work. Conservative surgery aims at eliminating or destroying tumours in the endometrium without damaging the reproductive organs.

Laparoscopy, a minor invasive surgical intervention, is used for monitoring and diagnosing, endometriosis. It is also used for the removal of endometrial tissue. A surgeon performs small cuts in the abdomen to surgically remove the growths or to burn or spray them. Lasers are commonly used now eventually destroy that “out of place” tissue.

Last-resort surgery (hysterectomy)

In a few small cases, The doctor may recommend a full hysterectomy as a final option if your condition does not improve with other treatments.

When a full hysterectomy is performed, a surgeon takes and remove the uterus and cervix. They also pull out the ovaries because those organs produce estrogens, and estrogens cause endometrial tissue growth. At the same time, the surgeon takes out the visible lesions from the implant.

Hysterectomy is not generally regarded as a treatment or remedy for endometriosis. You’re not going to be pregnant because of a hysterectomy. Get a second opinion before you agree to the surgical procedure if you want to be pregnant.

What causes endometriosis?

While menstruating regularly, your body loses the lining of the endometrium of your uterus. This creates menstrual blood which circulates from the uterus via the small opening of the cervix to the vagina.

The specific cause of endometriosis remains unclear, and different theories exist behind the cause of this disease, even though no theory was proven.

An older theory is that endometriosis occurs due to a process called retrograde menstruation. This happens when menstrual blood circulates through your fallopian tubes within your pelvic cavity or into a peritoneal cavity rather than draining out of the body through the vagina.

According to another theory, hormones transform cells outside the uterus into cells similar to the internal mucous membrane of the uterus, called endometrial cells.

Others think it can happen if small parts of your abdomen turn into endometrial tissue. This can occur because your abdominal cells grow out of embryonic cells, that can change shape and function as endometrial cells. We’re not sure why this is happening.

These moved endometrial cells can develop on your pelvic walls and surfaces of your pelvic organs, These include the bladder, ovaries and peritoneal organs. They just keep growing, thicken, They bleed during your menstrual cycle in response to your cycle’s hormones.

It is possible that menstrual blood empties into the pelvic cavity through a surgical scar, for example, after a cesarean delivery (commonly known as a cesarean section).

Another theory suggests that the cells of the endometrium are removed from the uterus by the lymphatic system. Another theory is that this may be due to a faulty immune system that does not destroy the wandering cells of the endometrium.

Some think that endometriosis could start in fetal life with poorly placed cell tissue that begins to respond to the hormones of puberty. It is generally referred to as the Mullerian theory. The development of endometriosis could also be linked with genetic or even environmental toxins.

Endometriosis stages

There are four stages or categories associated with endometriosis. This may include one of the following steps:

  • minimal
  • mild
  • moderate
  • severe

This stage is determined by various factors. These factors may include the location, number, size and depth of endometrium implants.

Stage 1: Minimal

In minimal endometriosis, you have tiny lesions or sores and growth of superficial endometrial tissue on your ovary. Inflammation may also occur in or around the pelvis cavity.

Stage 2: Mild

Mild endometriosis consists of small lesions and superficial endometrial implants on an ovary and pelvic outflow.

Stage 3: Moderate

Moderate endometriosis involves deep endometrial implants on the ovary as well as around the pelvic cavity. More lesions may also occur.

Stage 4: Severe

The most serious stage of endometriosis includes deep implants on the pelvis outlet and ovaries. It is also possible to have lesions on your fallopian tubes and intestines.

Endometriosis Diagnosis

Symptoms of endometriosis can be similar to symptoms of other illnesses, These include ovarian cysts and pelvic inflammatory disease (PID). Pain management requires a proper diagnosis.

Your physician will perform at least one of these tests:

Detailed history

Your doctor may have questions about your symptoms and your personal or family history of endometriosis. A general health assessment may also be performed to determine if there are additional signs of a long-term disorder.

Physical exam

During a pelvic examination, your doctor will physically feel cysts or scars on the back of the uterus.

Ultrasound

Your physician may prescribe a transvaginal or abdominal ultrasound. In a trans-vaginal ultrasound, a transducer is placed in your vagina.

These two types of ultrasounds provide pictures of your reproductive organs. They may help your doctor identify endometriosis-related cysts, but they are not effective in the prevention or elimination of the disease.

Laparoscopy

The only way you can identify endometriosis is by looking at it directly. This is done using a minimally invasive procedure referred to as laparoscopy. Once detected, the tissue may be removed during the same procedure.

Endometriosis complications

Having infertility problems is a severe complication of endometriosis. Women with softer stages may become pregnant and carry a baby to term. As per the Mayo Clinic, Approximately 30 to 40 per cent of women with endometriosis find it difficult to become pregnant.

Drugs can’t improve fertility. Some women may become pregnant when the endometrium is surgically removed. If that doesn’t work for you, you may want to consider fertility or in vitro fertilisation treatments to improve your chances of having a baby.

You may want to consider having a baby earlier than later if you have been diagnosed with endometriosis and you want to have a baby. Your symptoms can get worse over time, which can make it more difficult to conceive for yourself. You will need a review by your doctor before and during pregnancy. Check with your doctor to find out what options you have.

While fertility is not a problem, it may be difficult to manage chronic pain. Depression, anxiety and other mental health problems may also arise. Talk to your doctor about how you can manage side effects. Joining a support group can be helpful as well.

Risk factors

According to Johns Hopkins Medicine, approximately 2 to 10 per cent of pregnant women in the US aged 25 to 40 suffer from endometriosis. It usually happens years after the start of your menstrual cycle. This illness can be painful, but understanding the risk factors can help you find out if you are sensitive to this condition and when you should seek help from your doctor.

Age

Women of all ages are at risk for endométriosis. It usually affects women between 25 and 40 years of age, but symptoms can begin with puberty.

Family history

See your doctor if someone in your family suffers from endometriosis. You may be more likely to become infected.

Pregnancy history

Pregnancy has the potential to temporarily decrease the symptoms of endometriosis. Women without children are more likely to develop this disorder. But endometriosis can still occur in women with children. This makes it possible to understand that hormones affect the development and progression of this condition.

Menstrual history

Contact your doctor if you experience problems with your period. These issues may include shorter cycles, more flow, more time, or menstruation that begins at a young age. These factors can result in a higher risk.

Endometriosis prognosis viewpoint

Endometriosis is a chronic disease that has no remedy. However, we do not understand the exact reason for this.

However, this does not mean that the condition must affect your daily life. Effective treatments are available to control pain and fertility problems, such as medicines, hormonal therapy and surgery. Signs of endometriosis usually improve after menopause.

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