We start with the “endometrium” which is the mucous membrane that normally lines the inside of the uterus. During the menstrual cycle, it responds to hormones by thickening with blood vessels in preparation for pregnancy. Once this does not occur, it breaks down and becomes your menstrual period.
Endometriosis, a condition in which cells similar to those in the endometrium, the layer of tissue that normally covers the inside of the uterus, grows outside of the uterus. Most often this is on the ovaries, fallopian tubes, and tissue around the uterus and ovaries However, in rare cases, it may also occur in other parts of the body.
What Causes Endometriosis?
Endometriosis is a condition in which endometrial tissue grows outside the uterus. It can grow on the fallopian tubes, ovaries, the external surface of the uterus, and even the rectum, intestines, and urinary organs. The areas where the endometrium is growing abnormally are called implants.
The implants respond to hormones in the same way that the uterine lining does by thickening, breaking down, and shedding. However, since this is occurring outside the uterus, the tissue can become inflamed, irritated, and scarred. The areas of scar tissue are called adhesions. Adhesions can cause organs to stick together, which can be painful during and just before your menstrual cycle.
Endometriosis is fairly common, affecting around 10 percent of women in their childbearing years. Endometriosis affects between 6 and 10 percent of women of reproductive age worldwide. Most patients are diagnosed between the ages of 30-40.
The exact cause of endometriosis is not certain, possible explanations may include:
- Retrograde menstruation. Menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. The displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
- Peritoneal cell transformation. In what’s known as the “induction theory,” some researchers propose that hormones or immune factors promote the transformation of peritoneal cells, cells that line the inner side of your abdomen, into endometrial cells.
- Embryonic cell transformation. Hormones such as estrogen may affect embryonic cells, cells in the earliest stages of development, into endometrial cell implants during puberty.
- Surgical scar implantation. After a women’s health surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
- Endometrial cell transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body, such as rectum, intestines and urinary organs.
- Immune system disorder. A problem with the immune system may make the body unable to recognize and destroy endometrial tissue that’s growing outside the uterus.
Symptoms of Endometriosis
The main endometriosis symptoms are pelvic pain and infertility. Nearly half of those affected with endometriosis have chronic pelvic pain, while in 70% suffer pain during menstruation causing painful periods. Pain during sexual intercourse is also common. Infertility occurs in up to half of women affected. Less common symptoms include urinary or bowel symptoms. About 25% of women have no symptoms. Endometriosis can have both social and psychological effects.
You could have mild endometriosis with severe pain, or you could have advanced endometriosis with little or no pain. Endometriosis usually feels like severe Premenstrual pain syndrome (PMS) symptoms, such as:
- Chronic pelvic cramping, a common symptom of endometriosis, especially before and during your period
- Painful bowel movements or urination You’re most likely to experience these symptoms during a menstrual period. Or if implants are affecting these organs.
- Painful periods. Pelvic pain and cramping may begin before and extend several days into a menstrual period. You may also have lower back and abdominal pain.
- Pain with intercourse. Pain during or after sex is common with endometriosis.
- Excessive bleeding. You may experience occasional heavy menstrual periods or bleeding between periods.
- Other signs and symptoms. You may experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.
- Infertility. Sometimes, endometriosis is first diagnosed in those seeking treatment for infertility.
Endometriosis can cause fertility problems. It’s estimated that around 40 percent of women who have difficulty getting pregnant suffer from endometriosis. Inflammation of the ovaries and fallopian tubes may hurt the sperm or egg, and adhesions may cause the fallopian tubes to stick together and block the egg’s path to the uterus.
Endometriosis Risk factors
These risk factors may place you at a greater risk of developing endometriosis, such as:
- Never giving birth
- Starting your period at an early age
- Going through menopause at an older age
- Short menstrual cycles — for instance, less than 27 days
- Heavy periods that last longer than seven days
- Having higher levels of estrogen in your body or greater lifetime exposure to estrogen your body produces
- Low body mass index
- One or more relatives (mother, aunt or sister) with endometriosis
- Any medical condition that prevents the normal passage of menstrual flow out of the body
- Reproductive organ abnormalities
Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis may temporarily improve with pregnancy and may go away completely with menopause unless you’re taking estrogen.
If you’re experiencing pain and heavy bleeding, make an appointment with us for an examination. Many different conditions present with similar symptoms. At your appointment, we will review your medical history and perform a physical and pelvic exam.
Surgery is the only way to diagnose if you have endometriosis. A laparoscopy is a surgical procedure in which a thin, flexible, lighted instrument is inserted through a small incision in the abdomen. The doctor may take a biopsy of the tissue for further testing.
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If you have endometriosis, there are different treatment options available. You and your health care doctor will have a discussion about the best course of treatment for you based on the severity of your symptoms and your plans to bear children in the future.
Pain and cramping associated with endometriosis can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs). You can buy these over-the-counter or your doctor can give you prescription-strength medications as a conservative treatment.
Many women successfully treat symptoms of endometriosis with birth control pills (oral contraceptives), GnRH agonists, and progestin medications. These treatments won’t cure endometriosis or remove the existing tissue, but it can reduce the growth of new tissue and prevent adhesions from forming.
Women who are trying to get pregnant might elect to have their endometrial implants surgically treated. This can break up scarring and improve fertility. It can also reduce pain, but some women report that their pain has returned within a few years after the procedure. Combining surgery with hormone therapies seem to work best to combat both pain and fertility problems.
A hysterectomy is the surgical removal of the uterus and ovaries. Removing the ovaries significantly reduces the chance that the pain will come back after surgery. A hysterectomy is typically only used as a last resort because, after the procedure, you will no longer have a period or be able to become pregnant.