To understand it simply, Endometriosis is a disorder caused when tissues are grown outside the uterine cavity. These tissues grown are similar to the tissues forming the lining of the uterus, which is called the endometrium.
This growth is quite unusual and happens on the ovaries, bowel, and lining of the pelvis. Experts call it an endometrial implant when endometrial tissues grow outside the uterus area.
When there are hormonal changes in one’s menstrual cycle, the effect of it causes the area of the endometrial tissues to become inflamed and painful. That might signal excessive growth, thickening or even break down of these tissues. Over a while, as these broken tissues have nowhere to go, they get trapped into the pelvis. This incident leads to:
● formation of scars
● adhesions (bands of tissues that bind internal organs together)
● fertility problems
If you do get diagnosed with Endometriosis, don’t feel alone, as it’s a common gynaecological problem that affects nearly 10 percent of women worldwide.
Symptoms of Endometriosis
The symptoms of endometriosis vary from being mild, moderate, and severe. Sometimes you might observe no signs at all. The intensity of the condition has got no clear relation with the symptoms seen or the pain experienced.
Pelvic pain is one of the common symptoms of endometriosis. The following are the other symptoms that the patient might suffer from:
● painful periods (Dysmenorrhea- lower abdomen pain and cramps while and before menstruation.)
● excessive menstrual bleeding or intermenstrual periods
● pain during and after sexual intercourse
● discomfort during urination or bowel movements
● lower back pain, fatigue, diarrhoea, constipation, bloating or nausea, especially during menstrual periods.
Causes of Endometriosis
There is no exact known cause for Endometriosis. But, there are possible theories and explanations which are not yet scientifically proven.
1. One of the oldest theories believed is known as Retrograde menstruation. During this, the menstrual blood containing the endometrial cells gets into the fallopian tubes and pelvic cavity. This is problematic because it should be instead, leaving the body through the vagina. These endometrial cells might then get stuck to the pelvic walls and surfaces of pelvic organs. They next begin to grow and thicken there.
2. Another believed cause is the ‘Induction theory’. It suggests that the peritoneal cells get transformed into endometrial-like cells because of hormones or the immune factor. Peritoneal cells are the ones that line on the inside of the uterus or abdomen.
3. Sometimes during puberty, estrogen may transform embryonic cells into cells like endometrial implants. Thus, leading to the disease of Endometriosis. For the uninitiated, embryonic cells are the earliest stage of a developed cell.
4. Surgeries like hysterectomy and C-Section may be a reason as well. As they can cause the endometrial cells to get leaked into the pelvic cavity or get attached to the surgical incision.
5. Another theory explains that it could be caused when the blood vessels or tissue fluid system gets transported with the endometrial cells to other parts of the body.
6. It might also be a problem with the immune system. Maybe the body is unable to recognize, fight, and destroy endometrial-like tissue that is growing outside the uterus.
7. Lastly, genetics and environmental toxins may also be one of the causes for Endometriosis.
Stages of Endometriosis
There are typically four stages of endometriosis namely,
One could be under any of these stages depending on various factors. These factors could be the location, size, number, or the depth of endometrial implants in the body.
Let’s understand these stages better.
● Stage 1: Minimal
During this stage, the patient’s ovary gets small lesions or wounds with shallow endometrial implants. This event may also cause inflammations in and around the pelvic cavity.
● Stage 2: Mild
In this stage, the patient’s ovary and pelvic lining may have light lesions with shallow implants.
● Stage 3: Moderate
While in this stage, the patient’s ovary starts having deep implants along with the pelvic lining. There might be even worse lesions than in the previous stagings.
● Stage 4: Severe
Lastly, this stage involves deep implants on your pelvic lining and ovaries with lesions on your fallopian tubes and bowels.
How is Endometriosis treated?
While endometriosis may not have a clear-cut treatment, it is certainly manageable with medical and surgical options to avoid any further potential complications.
Usually, the doctor first recommends having a conservative treatment. Every female-body reacts differently to these medications. In case doctors find no further improvements, they then might go for surgical options.
Endometriosis can cause infertility issues and it’s hard to handle this mentally. I suggest my patients to get more educated on this and find support groups to have some mental support.
Let us understand the treatment options better. Please consider all of them under the light of a skilled doctor. I, Dr Sheetal, am too available for you.
● Pain medications:
They aren’t much effective. But with the consideration of your experienced doctor, you could go for Ibuprofen or any other pain killers.
● Hormone therapy:
Here, you could take hormone supplements to get relief from the pain and to stop the progression of endometriosis.
● Hormonal contraceptives:
Having contraceptives decreases the process of growth and buildup of the endometrial tissues. It also eliminates the pain. These contraceptives could be birth control pills, patches, or vaginal rings. You may find Medroxyprogesterone (Depo-Provera) injection useful as well.
● Gonadotropin-releasing hormone (GnRH) agonists and antagonists:
GnRH is something that blocks the production of estrogen which stimulates the ovaries, preventing menstruation and creating artificial menopause for the women. Although, doing this may have side effects causing vaginal dryness and hot flashes. One should take small doses of estrogen and progesterone at the same time to get control over these symptoms.
Danazol is another kind of medication that stops menstruation and gets the symptoms reduced. The medicine may have side effects like acne and hirsutism (abnormal hair growth on the face and body).
● Conservative surgery:
If you wish to get pregnant or if you experience severe pain or maybe hormonal treatment isn’t working for you, your doctor might ask you to go for a conservative surgery. The surgery helps remove and destroys the endometrial implant’s growth without damaging the reproductive organs.
● Last-resort surgery (hysterectomy):
Hysterectomy is a rarely taken option, as it’s the last refuge left with doctors to treat Endometriosis. During this surgery, the gynaecologist removes the uterus, cervix, and the ovaries to completely stop the growth of the endometrial implants. They also get rid of the small visible implant lesions.
If you are planning to have a family, you must reconsider the decision of having a hysterectomy, as once done, you can never again dream of pregnancy.
The best option is to diagnose endometriosis early in life as that increases the chances of successful treatment. For this, you must get a check-up done by an experienced and skilled gynaecologist.
You can book a consultation with me, Dr Sheetal Agarwal, right away!