Endometriosis

What is Endometriosis?

Endometriosis is derived from the word “endometrium” which is the tissue that lines the uterus. In endometriosis, the tissue that lines the uterus grows outside the uterus.  The endometrial tissue grows on your ovaries, fallopian tubes, bowel and tissues lining the pelvis. Sometimes the endometrial tissue can spread beyond the pelvic organs.  During endometriosis, the endometrial like tissue would thicken, break down and bleed in each menstrual cycle. This tissue gets trapped in your pelvis as it has no way to exit the body. The trapped tissue in the pelvis can cause irritation and scar formation. Endometriosis can cause severe pain during menstrual cycles and may cause fertility problems. But effective treatments are available.

Where does endometriosis occur?

The common sites of endometriosis are listed below

·         Peritoneum

·         The ovaries

·         The fallopian tubes

·         Ligaments that support the uterus

·         The outer surface of the uterus

·         The lining of the pelvic cavity

Symptoms

The symptoms of endometriosis may be mild, moderate or severe. Pelvic pain is the most common symptom. The other common symptoms are

• Painful periods
• Pain in the lower abdomen before and during menstruation
• Severe menstrual cramps
• Excessive bleeding during menstrual cycles
• Periods exceeding seven days
• Infertility
• Pain following sexual intercourse
• Pain with bowel movements and urination
• Bloody stool or urine
• Lower back pain during menstrual cycle
• Fatigue, diarrhea and constipation

Risk factors

The following factors may increase the risk of endometriosis

·         Women between ages of 25 and 40 are affected

·         Family history of endometriosis

·         Nulliparity: Women never giving birth

·         Short menstrual cycles

·         High levels of estrogen in your body

·         Women with pelvic infection and reproductive tract abnormalities

Causes

The exact cause of endometriosis is not clear. The following might be the reasons

·         Retrograde menstruation:  During a regular menstrual cycle, the menstrual blood exits out of the body through your vagina. In retrograde menstruation, menstrual blood containing endometrial cells flows back through your fallopian tubes into the pelvic cavity instead of leaving your body via the vagina. These cells tend to stick to the pelvic walls and surfaces of pelvic organs, and they continue to grow, thicken and bleed during each menstrual cycle.

·         Transformation of peritoneal cells: Researchers believe that hormones or immune factors can promote the transformation of peritoneal cells into endometrial like cells. It is unclear why this transformation happens.

·         Embryonic cell transformation: Pubertal estrogen levels can transform the embryonic cells into endometrial-like cell implants.

·         Surgical scar implantation: Endometrial cells may attach to a surgical incision after a surgery, such as a hysterectomy or C-section.

·         Endometrial cell transport: The lymphatic system can transport endometrial cells to other parts of the body.

·         Immune system disorder: Any malfunctions in the immune system may make the body fail to recognize and destroy errant endometrial cells.

How endometriosis affects fertility?

It is estimated that approximately 30 to 40% of women with endometriosis have difficulty getting pregnant. A recent research reveals that women with endometriosis have a 2-10% chance of conceiving each month, in comparison with women (without the condition) who possess a chance of conceiving 15-20% each month.

For a pregnancy to happen, an egg gets released from the ovary and travels through the fallopian tube and gets fertilized by a sperm cell and attached to the uterine wall to initiate the development. Endometriosis can affect the pregnancy by obstructing the fallopian tube and retaining the egg and sperm from bonding. There are also chances that endometriosis can damage the sperm or egg.

Women with mild forms of endometriosis can conceive and can continue the pregnancy. As the symptoms of endometriosis worsen during the course of time, doctors advise women with endometriosis not to delay their pregnancy. Women with endometriosis have a higher risk of miscarriage, preterm delivery, C-section, preeclampsia, and other complications like gestational diabetes. There are also chances of bleeding in the second and third trimesters. Medications, surgery and fertility treatments can certainly help.

Diagnosis

The following methods can help a gynecologist to confirm a diagnosis

Pelvic examination: Cysts or scars behind the uterus are identified by a pelvic examination.

Ultrasound: A transvaginal or abdominal ultrasound can help identify the cysts associated with endometriosis.

Laparoscopy: A minor surgical procedure called laparoscopy is performed that reveals information about the location, extent and size of the endometrial implants. Once a diagnosis is made, the tissue can be removed in the same procedure.

Treatment

Depending on your signs and symptoms treatment will be initiated.

Pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) are the pain medications that help to relieve pain from painful menstrual cramps.

Hormone therapy: Supplemental hormones can relieve the pain and arrest the progression of endometriosis.

Conservative Surgery is performed when hormonal treatments do not work. In this surgery, endometrial growths are removed without damaging the reproductive organs. In rare cases, hysterectomy is done.  

Outlook

Endometriosis is a chronic condition. But effective treatment options are available to combat the menstrual cramps and fertility issues.