Endometriosis, sometimes called ‘’endo”, is a common health problem in women. It gets its name from the word endometrium, the tissue that normally lines the uterus or womb. Endometriosis happens when tissue, similar to the lining of the uterus, grows outside of your uterus and in other areas of your body where it doesn’t belong.
Endometriosis is a painful, chronic disease that affects approximately 176 million women worldwide. Unfortunately Endometriosis often goes unrecognized by doctors or is misdiagnosed or incorrectly treated. It mostly affects women in their reproductive years, especially between the ages of 25 and 40, but can develop in girls as young as 11. 75 percent of women who experience pelvic pain and 50 percent of women with fertility issues suffer from this disease.
Unfortunately endometriosis often goes unrecognized by doctors or is misdiagnosed or incorrectly treated.
What causes Endometriosis?
The endometrium is the lining of the uterus that builds each month and sheds during the menstrual period. Endometriosis occurs when tissue, similar to endometrial tissue, exists outside of the uterus. Endometrial tissue, growing outside the uterus, develops into growths which respond to the menstrual cycle. Like the lining of the uterus, endometrial growths are affected by the hormonal changes that bring about menstruation. There is no known cause for Endometriosis; however researchers are studying possible connections:
• Menstrual flow issues: Retrograde menstrual flow is the most common cause of Endometriosis. Some of the tissue shed during a period flows through the fallopian tube into other areas of the body, such as the pelvis.
- Genetic factors: Endometriosis often runs in families and may be genetic.
- Immune system problems: A faulty immune system may fail to find and destroy endometrial tissue growth outside of the uterus. Immune system disorders and certain cancers are more common in women with Endometriosis.
- Hormones: The hormone estrogen appears to promote Endometriosis. Research is examining whether Endometriosis is related to a problem with the body’s hormonal system.
- Surgery: During surgery to the abdominal area, such as a Cesarean (C- section) or hysterectomy, endometrial tissue can be mistakenly collected and transferred to other areas. Endometrial tissue has been found in abdominal scarring.
Stages of Endometriosis
Endometriosis is one of the reasons that cause infertility in women. But to be diagnosed with endometriosis does not always mean that you can not be pregnant.The task is that there are 4 stages of endometriosis, and having a certain stage of endometriosis affects whether a woman can get pregnant or not.
These stages are:
Each stage is determined by the location, amount, depth and size of the endometrial growths.
Why does Endometriosis cause infertility?
Despite Endometriosis being a leading factor in infertility, many women suffering from this condition do manage to achieve pregnancy, but may find it harder to conceive. Researchers suggests that as many as half of women struggling with infertility, are affected by Endometriosis.
Reasons why Endometriosis impacts fertility:
- Endometrial growths block or alter the shape of the pelvis and reproductive organs. This can make it harder for the sperm to find the egg.
- The immune system, which normally helps defend the body against disease, attacks the embryo.
- The endometrium does not develop as it should, making it difficult for an embryo to implant in the womb.
Scar tissue (adhesions) are more common in moderate and severe Endometriosis; they are similar to cobwebs and can be either fine, or dense. This scar tissue distorts the pelvic anatomy. If the ovary is wrapped in adhesions, the released egg can become trapped and unable to reach the fallopian tube.
The fallopian tubes and ovaries hang downwards in an area called the Pouch of Douglas. If this pocket is covered by adhesions, the odds of achieving pregnancy are lowered.
It is less clear why minimal or mild Endometriosis causes infertility. Even with localized growth spots and minimal or no scar tissue, it was found that women with minimal to mild Endometriosis still had less chance of conceiving than women with no Endometriosis.
What are the Symptoms of Endometriosis?
The most common effects of Endometriosis are pain and infertility. Common symptoms include:
- Painful or debilitating menstrual cramps, which may worsen over time;
- Pain during or after sex;
- Pain in the intestine or lower abdomen;
- Painful bowel movements or painful urination during menstrual periods;
- Heavy menstrual flow;
- Premenstrual spotting or bleeding between periods;
- Problems achieving pregnancy;
Women affected by Endometriosis may have painful bladder syndrome, digestive or gastrointestinal symptoms, similar to a bowel disorder, as well as fatigue or lack of energy. For some, the pain associated with Endometriosis can become milder after menopause. However, hormone therapy, such as estrogen or contraceptive pills, given to reduce menopausal symptoms, may cause the pain and other symptoms to continue.
How is Endometriosis diagnosed?
Typically, a gynecologist or other health care provider will review your medical history and complete a physical and pelvic exam. A Laparoscopy is considered to be the gold standard in diagnosing Endometriosis, followed by a suspected tissue biopsy.
Other examinations which may be used to help diagnose Endometriosis include:
- Computer tomography (CT) scan
- Magnetic resonance imaging (MRI) scan
How is Endometriosis Treated?
Specific treatment for Endometriosis will be determined by your healthcare provider and tailored according to your condition, age, overall health, medical history, and family building plans.
Normally, practitioners will first recommend conservative treatment options such as medication, reserving surgery as a last resort. Treatment for Endometriosis includes pain relief, hormone therapy and surgery.
Hormonal Treatment for Endometriosis
Hormones regulate the reproductive system and the menstrual cycle. In women with endometriosis, hormone-based treatment seeks to limit symptoms and slow the progress of the disease by controlling the level of hormones in the body.
Hormonal treatments can offer the majority of women lighter and shorter menstrual periods, or even stop periods altogether. When the treatment stops, the symptoms of endometriosis will return, as will the ability to become pregnant.
Pain-relief medications, of different categories, can be effective in managing pain short-term.
Hormones regulate the reproductive system and menstrual cycle. In women with Endometriosis, hormone-based treatment seeks to limit symptoms and slow the progress of the disease by controlling the level of hormones in the body. Hormonal treatments offer a majority of women lighter and shorter menstrual periods, or may even stop periods altogether. Once treatment stops, symptoms will return, as will the ability to become pregnant.
Combination oral contraceptives
Combination birth control pills contain two hormones: estrogen and progestin. Oral contraceptives help to make a woman’s period lighter, shorter, and more regular, while lowering pain levels. Combination hormone therapy is available in the form of a patch or a vaginal ring. Mild side effects to this treatment include weight gain, bloating, and bleeding between periods – especially during the initial treatment phase.
A Laparoscopy is necessary to diagnose Endometriosis, and many women undergo laparoscopic surgery to remove growths and adhesions caused by this condition. A Laparoscopy is a minimally invasive surgical method which uses small incisions in the abdominal wall to insert a camera and surgical tools into the pelvic cavity. It is then possible to examine and cut, or burn away, any implants or adhesions. Following surgery, women may experience relief from their symptoms, but only temporarily.
In more severe, extensive cases of Endometriosis, a Laparotomy may be necessary. A Laparotomy involves a long abdominal incision allowing full access in order to remove harder-to-reach implants and adhesions, while preserving healthy tissue. In the most severe cases, a woman may opt for a Hysterectomy to surgically remove the uterus and possibly also the ovaries. A Hysterectomy may be performed via Laparoscopy, with a traditional incision, or through the vagina. A hysterectomy may not stop symptoms of Endometriosis since the body continues
to produce estrogen. A Hysterectomy makes it impossible to carry a baby to term, and if the ovaries are also removed, a woman will immediately enter menopause regardless of her age.
Does diet affect Endometriosis?
Scientists have studied diet and how it relates to the development of Endometriosis. Research indicates that diets high in fat and red meat increase the risk of developing this condition. The theory behind this, is that these types of foods may contribute to raise estrogen levels. Women with diets high in fiber, fresh fruit and vegetables; however, were less likely to develop Endometriosis. It has not been studied whether such a diet benefits women who already have an existing case.