Endometriosis – Symptoms, Causes and Treatment

Endometriosis is a gynecological condition that occurs when the tissue that grows and lines the inside of the uterus, known as the endometrium, grows in areas of the body outside of the uterus. These areas are usually within the abdominal cavity, and normally include outside the ovaries, fallopian tubes or uterus itself.

It is believed that as many as one in every ten women of childbearing age (between 15 and 44) suffer from endometriosis, even though the majority of them go officially undiagnosed.

Although the condition is incurable, it is manageable though complications may be unavoidable.

Symptoms Of Endometriosis

One of the first indicators that a woman may have endometriosis is excessive pain around the time of menstruation. This pain usually intensifies and subsides relative to the cyclical nature of the menstrual cycle. Other symptoms include:

  • Excessive menstrual bleeding – in most women menstrual bleeding occurs for between 3 to 7 days. However, women with endometriosis may bleed profusely for periods of time far in excess of seven days, sometimes as long as four weeks. The intensity of bleeding is also stronger, which may require the changing of sanitary napkins every one to two hours.
  • Severe menstrual cramping that is often not alleviated with the use of common analgesic medication
  • Chronic lower back or pelvic pain that intensifies around the time of menstruation
  • Occasionally, blood in stool or urine
  • Chronic fatigue
  • Pain or cramping during intercourse
  • Abnormal bleeding in between periods
  • Difficulty or inability to hold urinary flow, especially nocturnally

Causes Of Endometriosis

There is no singular positively defined cause of endometriosis, as often times there is no way to predict if it will occur. However, based on observances made thus far, the following all contribute to development of the disorder:

  • Abnormal menstrual blood flow-Normally, menstrual blood should exit the body, but may occasionally become lodged in the ovary or fallopian tubes. This is also known as retrograde menstruation, or the backwards flow of blood.
  • Growth from embryonic cells – cells that line the abdomen and pelvis may spontaneously change into endometrial tissue within the abdominal cavity and start acting in the way of endometrial tissue.
  • Scar tissue – following major abdominal surgery, endometrial cells may become displaced and begin growing in other areas of the body outside of the uterus.
  • Genetics – women with a first-degree relative with endometriosis are also more likely to subsequently develop endometriosis themselves.
  • Immune system deficiencies – the immune system is capable of destroying extra-uterine endometrial tissue, though in some instances it fails to do so and the tissue continues to proliferate.
  • Present at birth – there is evidence that endometrial tissue can be found in areas outside of the uterus at birth, though it will not cause a problem until a girl enters puberty and starts producing estrogen.
  • Use of certain medications – particularly hormone replacement therapy or contraceptives that contain an estrogenic component.

Risk Factors For Endometriosis

In addition to the causes mentioned above, endometriosis is more likely to occur in certain women:

  • Women that experienced their first menstrual period at a young age
  • Women that experience menopause significantly later than average
  • Having menstrual cycles that are shorter than average, usually shorter than 27 days
  • Having a first or second degree relative with endometriosis
  • Structural abnormalities that distort the anatomical flow of blood out of the body
  • Women who have never given birth, especially past the age of 30
  • Women with a higher estrogen load
  • Being a chronic consumer of alcohol

Complications Of Endometriosis

Infertility

This is the primary, and most serious complication from endometriosis. It is estimated that one in three, to one in two women will experience difficulty getting pregnant. Women with endometriosis may develop structural abnormalities within the fallopian tube that prevent fusion of the sperm and egg, and their subsequent lodging within the uterus.

In addition to this, the egg may be damaged during transit, or the sperm may also be affected. Women may still conceive with endometriosis, but are usually advised to do so at a younger age as it becomes more difficult the older they get.

Cancer

Women with endometriosis possess higher risks of ovarian cancer, though this risk is still relatively low. Endometrial cancers are also more common postmenopausally in women diagnosed with endometriosis.

Treatment Of Endometriosis

There is no cure for endometriosis, though there are many approaches to management that are employed. These include:

Pain Medication

These may include typical NSAIDs such as ibuprofen or naproxen, although they do not work in all women and may worsen bleeding during menstruation. Alternatively, medications such as mefanamic acid may prove a better alternative.

Hormone Therapy

The use of progesterone heavy hormone therapy may help to slow down the progression of extra uterine endometrial growth, and relieve many associated symptoms. However, other complications arise from use of these hormonal products that are devoid of estrogen.

Some other agents may interfere with the release of estrogen altogether, inducing medical menopause. This is far from ideal however, as many associated complications of menopause manifest. This approach is also not suitable for women who may be desirous of conceiving.

Minimally Invasive Surgery

This usually involves laparoscopic intervention, with the goal of removing extra uterine endometrial growth without damaging reproductive organs. The goal is to remove as much of these growths as safely possible, though they do recur in most instances. This approach can assist with fertility and conception in some cases, however.

Total Surgical Removal

This involves surgical removal of all the female reproductive organs, including the ovaries, uterus and cervix. All visible lesions are also removed during such a procedure, which has a high success rate since estrogen production is basically terminated.

Women generally only opt for total hysterectomies when pain and other associated symptoms are so severe that they are interfering with normal quality-of-life. However, owing to the fact that small amounts of estrogen are produced outside of the ovaries, there is a possibility that endometrial growth can restart even after hysterectomy.

It is important to realize that total hysterectomy will mean that a woman will not be able to conceive, so family planning must be considered prior to this option.

Summary – Endometriosis

While this is an incurable disease, there are approaches you can take to minimize discomfort, and possibly increase the likelihood of conceiving. Depending on multiple considerations, including age, family planning and severity of symptoms, your approach to treatment can vary significantly.

It is a good idea to seek medical advice at the earliest possible intervention to ensure endometriosis has minimal effect on your life.

Sources:

https://www.medicinenet.com/endometriosis/article.htm
https://www.medicalnewstoday.com/articles/149109.php
https://www.healthline.com/health/endometriosis

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