Introduction:
Endometriosis is a condition that affects millions of women of all ages, ethnicities, and socioeconomic backgrounds. Endometriosis is a painful condition where tissue growth occurs on other parts of your body similar to the lining of your uterus. People experience uncomfortable symptoms when tissue growth occurs in the wrong places. It impacts the fallopian tube, ovaries, and pelvic lining tissue. Endometrial growths can rarely occur beyond the area where pelvic organs are situated.
During menstruation, endometriosis often leads to painful cramps. It can also cause fertility problems. Cysts called endometriomas form when endometriosis affects the ovaries.
Sites where you develop endometriosis:
The endometrium lines the interior of the uterus. During the menstrual period, this tissue will be shed off from your body. If pregnancy occurs, it aids in the early phases of development. This tissue becomes inflamed during menstruation and is hormonally sensitive. It can result in ovarian cysts, superficial lesions, deeper nodules, adhesions, and scar tissues. Common sites include:
Ovaries
Vagina
Fallopian tube
Rectum
Bladder and ureters
Peritoneum
Intestines
Diaphragm
Outside and back of the uterus
Causes:
Embryonic cell changes: Hormones like estrogen can transform embryonic cells into endometrial tissue during puberty.
Endometrial cells can originate from the scar tissue that arose from a s surgical cut. Eg: C-section
The blood vessels or tissue fluid transport endometrial cells to other parts of the body.
When the immune system is weak, it is unable to recognize and destroy endometriosis tissue.
Hormones or immune factors can transform the cells that line the inner side of the abdomen called peritoneal cells into cells similar to those that line the uterus.
The menstrual blood can flow back to the fallopian tubes and pelvic cavity instead of flowing out of the body. The blood contains endometrial cells that stick to the pelvic walls. These cells continue to thicken and bleed during each course of menstruation.
Risk factors:
Short menstrual cycles
Never conceiving
Heavy menstrual flow that lasts longer than 7 days
Higher level of estrogen
Low body mass index
Family history
Symptoms:
The main symptom is pelvic pain. Although women have period cramps normally, endometriosis can cause severe pain that often worsens over time.
Pain during sexual intercourse
Excessive bleeding
Infertility
Pain with urination or bowel movements
Dysmenorrhea: Cramping and pelvic pain start before menstruation and last for several days accompanied by back pain and stomach pain.
Some people with endometriosis have no symptoms. They rule out the condition when they can’t become pregnant or after they get surgery. Endometriosis is often confused with irritable bowel syndrome which leads to diarrhea, stomach cramps, and constipation.
Endometriosis is a chronic disorder that most women are not aware of. It can create several complications in the body and one might still be ignorant about it. Endometriosis is the growth of endometrial-like tissue (tissue similar to the uterus lining) outside the uterus, often resulting in chronic and inflammatory reactions leading to scar tissues. It mainly involves your ovaries, fallopian tubes, and the tissue lining your pelvis. While it is not always life-threatening, It can be agonizing, often impacting the quality of life. Pelvic pain is the first sign of endometriosis, but here are a few other symptoms as well: Painful periods Menstrual cramps around a week near cycle Heavy flow Bleeding between periods Pain during sexual intercourse Lower back pain. “Dr Shabreen Sahar, MBBS MS OBG
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How is endometriosis diagnosed?
Painful and heavy menstruation can be a symptom that enables you to reach out to your doctor. The doctor enquires about medical history or about any previous pregnancies. A family history of endometriosis will also be checked. The doctors may also perform pelvic imaging that starts with an ultrasound. MRI can also be used for further endometriosis mapping. Laparoscopy provides both definitive diagnosis and treatment. Laparoscopy is a procedure where a small camera (laparoscope) looks inside your body. During this procedure, a biopsy can be taken that will be sent to a laboratory to confirm the diagnosis.
Endometriosis cramps occur even before the menstruation starts and last through the periods. In contrast, normal period cramps occur after the period starts or on day 1 of the period lasting for the first 2 days. When she feels that the pain is severe, it is important to consult a gynecologist.Dr Shabreen Sahar, MBBS MS OBG
Management and Treatment:
The treatment plan is designed based on:
Age
Severity of symptoms
Plan of getting pregnant
Medications often help to improve the symptoms of endometriosis. This involves hormonal therapies and pain medications.
Hormonal options:
Birth control: These include combination options using estrogen and progesterone. These come in the form of oral birth control pills, patches, vaginal rings, birth control shots, Nexplanon implants, or IUDs. This hormonal treatment helps to relieve the pain during menstruation.
Gonadotropin-releasing hormone (GnRH) medications: These medications help to stop the hormones that cause menstruation. These are available in the form of oral pills, shots, or a nasal spray.
Danazol: These medications stop the production of hormones that cause periods.
These medications aren’t recommended if you are pregnant or actively attempting to conceive. Medications for pain relief can also include:
Over-the-counter pain relief
Non-steroidal anti-inflammatory drugs
Surgical options:
Laparoscopy: A small cut is made on the abdomen (<1 cm) followed by the insertion of a thin tube-like tool called a laparoscope. This tool is used to view inside your body and recognize endometriosis with a camera. 5-millimeter instruments can also be used to excise and remove lesions.
In severe instances, the removal of the uterus, known as a hysterectomy, may be necessary depending on the extent of endometriosis and scarring.
Complications
Cancer:
According to some studies, endometriosis can increase the risk of ovarian cancer. Endometriosis-associated adenocarcinoma can also occur in later stages of life.
Infertility:
Endometriosis can block the fallopian tube and prevent the fusion of egg and sperm. Healthcare professionals recommend not to delay pregnancy in women with endometriosis.
Conclusion:
People suffering from endometriosis should collaborate closely with healthcare professionals to establish tailored treatment plans that cater to their individual needs and objectives.
Individuals Additionally, raising awareness about endometriosis is crucial to reduce stigma, promote early detection, and encourage further research into more effective therapies and potential preventative measures.
References:
1. Parasar P, Ozcan P, Terry KL (2017). "Endometriosis: Epidemiology, Diagnosis and Clinical Management". Curr Obstet Gynecol Rep. 6 (1): 34–41. doi:10.1007/s13669-017-0187-1. PMC 5737931. PMID 29276652.
2. McGrath PJ, Stevens BJ, Walker SM, Zempsky WT (2013). Oxford Textbook of Paediatric Pain. OUP Oxford. p. 300. ISBN 9780199642656. Archived from the original on 10 September 2017.
3. "Endometriosis: Overview". nichd.nih.gov. Archived from the original on 18 May 2017. Retrieved 20 May 2017.
4. "Endometriosis: Condition Information". nichd.nih.gov. Archived from the original on 30 April 2017. Retrieved 20 May 2017.