What is endometriosis?
Although one in ten women suffer from endometriosis, most of them live without being diagnosed for years. One of the leading causes of infertility, endometriosis is still a misunderstood disorder. Most of the time misdiagnosed or overlooked, this condition occurs when the tissues that forms the endometrium or the lining of your uterus grows outside the uterus, on the ovaries, on the tissues that are lining your pelvis, on the bowels etc. Although it is uncommon for this tissue to spread beyond the pelvic region it can spread, causing inflammation to that area and chronic pains. When this tissue begins to break down, it can get trapped in your pelvis leading to scar formation, severe pains during menstruation, infertility or binding your pelvic organs together.
Although endometriosis symptoms can vary in intensity form mild to severe, the agonising pain does not indicate a later stage of the condition. So, even if you have a mild form of endometriosis it’s still possible to experience a great discomfort. There are also women that don’t experience any of these common symptoms of endometriosis:
- lower abdomen pains before and during period;
- cramps for about two weeks around menstruation;
- heavy menstrual bleeding;
- bleeding between periods;
- painful menstruation;
- pain during sexual intercourse;
- lower back pain;
- discomfort with bowel movements.
What causes endometriosis?
The exact cause of endometriosis is unknown but there are some theories that suggest that endometriosis occurs when you suffer from retrograde menstruation. What happens is that your menstrual blood flows back from your fallopian tubes into the pelvic cavity instead of going out through your vagina but the theory has not been proved until now.
Others believe that endometriosis occurs when cells in your abdomen grow from embryonic cells and convert into endometrial tissue, acting as if they are endometrial cells. These displaced cells can grow and thicken on your pelvic organs (ovaries, bladder, rectum) and pelvic walls bleeding during the course of your menstrual cycle. No one knows the reasons this situation occurs.
There is also the possibility that your menstrual blood leaks through a surgical scar into the pelvic cavity, especially if you had a cesarean delivery. Some believe that this disease starts from the fetal period and activates in adolescence when the misplaced cell tissue begins to respond to puberty hormones. Others blame it on the immune system that can’t destroy the errant endometrial cells or on genetics and environmental toxins.
Endometriosis has four stages: minimal, mild, moderate and severe and they are determined by the location, depth and size of endometrial implants.
- In the first stage there are shallow endometrial implants or small lesions on the ovary and they can lead to inflammation.
- In the second stage there are shallow implants and wounds on the pelvic lining as well.
- In the moderate stage of endometriosis there are deep implants and more lesions on your ovary and pelvic lining.
- In the last stage these deep implants can also be placed on the Fallopian tubes and bowels.
Is there a treatment for endometriosis?
Unfortunately, endometriosis has no cure but most of its symptoms can be managed. Left untreated, they can disrupt your life. Most of the treatment options available are pain medications like ibuprofen, hormone therapy or surgery if the condition doesn’t improve and leads to other potential complications.
At first, the doctor may recommend hormonal contraceptives to stop the progression of the disease. By decreasing fertility, these supplemental hormones prevent the monthly buildup of endometrial tissue and eliminate the severe pain.
There is also another method to stop menstruation and the growth of endometrial implant- the medroxyprogesterone injection. Unfortunately, it is not the first-choice doctors recommend because it has secondary effects like decreased bone production, weight gain and depression.
Another group of hormones that can block the production of estrogen by creating an artificial menopause – Gonadotropin-releasing hormone (GnRH) – can also cause hot flashes and vaginal dryness so sometimes they’re paired with small doses of estrogen and progesterone.
Danazol, another way to reduce endometriosis’ symptoms is known to cause abnormal hair growth on the face and body. Not to mention it can’t stop the disease to progress.
If all these treatments don’t work, doctors recommend conservative surgery that removes the endometrial growth without touching the reproductive organs.
As a matter of fact, there is a minimally invasive surgery, called laparoscopy, that is used to both diagnose, endometriosis and remove the endometrial tissue. The surgeon uses lasers to make small incisions in the abdomen and surgically removes or burn the growths of this “out of place” tissue.
As a last-resort, if your condition doesn’t improve with all the above-mentioned treatments, your doctor may recommend you a total hysterectomy where the surgeon removes the entire uterus and cervix. Since your ovaries are the organs that produce estrogen causing the growth of endometrial tissue, during hysterectomy they are totally removed together with the visible implant lesions. Since you won’t be able to get pregnant after a total hysterectomy, this procedure is not considered a cure for endometriosis.
How to diagnose endometriosis?
Because its symptoms are similar to those of any other pelvic inflammatory disease, the doctor might perform some of the following diagnose tests:
- Detailed personal and family history -A general health evaluation will be performed to check if there are signs of a long-term disorder.
- Physical exam- A manual pelvic exam, to feel your abdomen for cysts and scars behind your uterus.
- Ultrasound- A trans vaginal ultrasound with a transducer that is inserted into your vagina to provide identify the cysts associated with endometriosis.
- Laparoscopy- A minor surgical procedure to view the cysts and remove the unwanted tissue.
One of endometriosis complication is infertility, although if you have a milder form you might still be able to have a baby. Just 30% of women who suffer form endometriosis can’t conceive and some of them can have children after the endometrial tissue has been surgically removed. If it still doesn’t work you can try vitro fertilization or consider having kids sooner if you’ve been diagnosed with endometriosis. Chronic pain along with anxiety, depression and other mental conditions are pretty common as well.
Most of the time endometriosis affects women between the ages of 25 and 40, even if the symptoms can begin at puberty. If your have a family member that suffers from endometriosis, you may have a higher risk of developing this condition. Talk to your doctor to rule it out or to improve these symptoms with medication, as suggested or with surgery if it’s the case.