Endometriosis is a painful condition where the tissue similar to the tissue that lines the uterus, called endometrium, grows outside the uterus. These patches of tissue are called lesions, implants, or nodules and occurs in about 2-10% of women aged between 25-40 years old.
Symptoms of Endometriosis
Symptoms of endometriosis can include infertility, pain during or after intercourse, abnormal period, spotting or bleeding between periods, heavy menstrual flow, severe and painful menstrual cramps that might be felt around the lower back or abdomen, painful bowel movement or urination during period, fatigue, and gastrointestinal issues like diarrhea, nausea, and constipation.
Sites of Endometriosis
Endometriosis tends to occur around the ovaries, fallopian tubes, ligaments that support the uterus, space between the uterus and rectum/bladder, lining of the pelvic cavity, and outer part of the uterus. It can also occasionally occur around the vagina, vulva, bladder, cervix, intestines, and rectum, as well as around abdominal scars. In rare cases, these lesions can grow on the lungs and other parts of the body.
Causes of Endometriosis
The exact cause of endometriosis is still unknown; however, genetic factors can play a role in endometriosis. Some patients get endometriosis from a direct transplant in the abdominal wall after an abdominal procedure like a c-section. Other possible causes of endometriosis include a theory that suggests that endometrial tissue can possibly travel through the blood and lymphatic channels, similar to the way cancer spreads and grows. A second theory is that any cells in any location can transform into endometrial cells. Yet another theory suggests that during a woman’s menstrual period, some tissue backs up into the abdomen through the fallopian tubes and then grows.
Stages of Endometriosis
Endometriosis is classified based on the size, spread, amount, and location of the endometrial growth. Classification also takes into consideration the extent of involvement of the pelvic area as well as any blockage of the fallopian tubes.
Endometriosis is classified in four stages:
Stage 1: Minimal
Stage 2: Mild
Stage 3: Moderate
Stage 4: Severe
Endometriosis classification does not depend on pain level and types/extent of other associated symptoms.
Risk Factors for Endometriosis
Any woman who menstruates can develop endometriosis, but women with an abnormal uterus, women who are birthing for the first time after 30 years of age, and those who have a first-degree relative (mother, sister, daughter) with endometriosis tend to be at a higher risk of getting diagnosed with the disease. Women are also at higher risk if they started their first period before the age of 11, have periods that last more than 7 days, and monthly cycles that are less than 27 days. Women who have been pregnant before, started their period later in adolescence, and breastfeed their baby have a lower risk of developing endometriosis.
Diagnosis of Endometriosis
Endometriosis is typically definitively diagnosed by laparoscopy, which is a minimal invasive surgical procedure where a thin tube with a camera at the end is inserted through as small incision made in the abdomen. During a laparoscopy, the doctor can remove and subsequently biopsy tissue to confirm diagnosis of endometriosis. Laparoscopy is also used to determine the location, size, and spread of endometrial growth. Other ways of diagnosing endometriosis include CT scans, MRI scans, and ultrasounds.
Treatment of Endometriosis
The choice of treatment for endometriosis depends on the extent of the diseases, symptoms, medical history, overall health, tolerance to treatment options, projection of the course of the disease, preference for treatment, and desire for future pregnancy.
Depending on the extent of the disease and in the case of mild symptoms, treatment could involve just pain medications while watching to see how the disease progresses. When pain medication is the treatment of choice, patients are typically given over-the-counter analgesics like ibuprofen. Sometimes, other medications like hormone therapy are used to try to stimulate a “medical menopause” to reduce the symptoms of endometriosis.
Other options for treating endometriosis include surgical procedures like laparoscopy to remove endometrial growth, and laparotomy, which is a more extensive surgery, to remove as much endometrium as possible while preserving surrounding healthy tissue. Another approach is a total hysterectomy where the uterus and possibly ovaries are removed.
Alternative Treatment Options
Some women get pain relief from rest, relaxation, regular exercise, meditation, warm baths, ensuring regular bowel movement, and use of hot water bottles or heating pads on the abdomen. Along with medical and surgical therapies, other procedures that have varying degrees of benefit in treating endometriosis include immune therapy, homeopathy, nutritional approaches, and lifestyle changes.