What is Endometriosis?

 

Endometriosis is a chronic condition that occurs when a woman's uterine tissue grows outside her uterus. The tissues grow in clumps called implants and may spread to the ovaries, fallopian tubes, intestines, and other abdominal organs. Endometriosis affects about ten percent of women of reproductive age. Early diagnosis improves the prognosis, so it is important that women seek medical evaluation if they experience any of the condition's symptoms

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Symptoms of Endometriosis include:

 

1. Pelvic Pain

Depending on the severity of the condition, women often experience mild to severe pelvic pain when they develop endometriosis. The pain can occur just before or during menstruation, when ovulating, or in rare cases, at any time throughout the month. Endometrial tissue that grows outside the uterus will act as it normally would — it will thicken and bleed during menses, but in this unnatural location, this leads to inflammation, which further contributes to pelvic pain. Many women assume the pain is caused by their menstrual cycle, which can lead to a delay in diagnosis and treatment.

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2. Pain Throughout the Body

Endometriosis can also cause pain in the lower back, rectum, legs, and thighs. Usually, the pain can be attributed to organ (endometrial tissue) dislocation, a common side effect of endometriosis. Many medical conditions less dangerous than endometriosis can result in aches and pains throughout the body, but if this symptom develops along with other symptoms of endometriosis, it is best to seek a medical diagnosis. Doctors may employ pelvic exams, ultrasounds, and MRIs for diagnosis.

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3. Painful Intercourse

Some studies show more than 50% of women with endometriosis feel pain during intercourse. This is usually the result of abnormal growth of the endometrial tissue in the ovaries, fallopian tubes and the lining of the pelvis. The thrusting motion of intercourse presses on these growths, causing pain and discomfort that can last beyond sex. This can impact libido if women come to dread sex due to the pain it causes. Some women report that other thrusting motions, such as inserting tampons, cause the same pain.

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4. Infertility

Endometriosis poses a threat to fertility, as it can cause adhesions, scar the fallopian tubes, inflame the reproductive organs, cause hormonal imbalances, and negatively impact the egg quality. This symptom affects 35 to 50 percent of women with endometriosis. Doctors assess the severity of the condition by stages, with stage 1 being the mildest and stage 4 the most severe. Depending on the severity of the condition, fertility treatments may be able to help women with endometriosis conceive. Most cases of endometriosis are mild and therefore associated with minimal scarring. Infertility is usually associated with stage 4 endometriosis.

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5. Excessive Bleeding

Women with endometriosis may also experience excessive bleeding during menstruation and abnormal bleeding at other times of the month. In extreme cases, rectal bleeding and bloody stools present, as well as vaginal bleeding during intercourse. Any abnormal bleeding should be investigated by a doctor.

 

6. Urinary Problems

Many people with endometriosis experience urinary problems, including pain when passing urine, most notably during menstruation. Some women also notice bloody urine, though this is less common. Endometriosis also makes women more vulnerable to urinary tract infections (UTIs). Those with a tendency to develop the infections should be tested for endometriosis.

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7. Disturbed Bowel Function

Endometriosis can also produce symptoms similar to irritable bowel syndrome or IBS. Diarrhea and constipation are common, and their prevalence in other conditions makes a correct initial diagnosis more difficult until other symptoms develop. Women with endometriosis may experience bloating, diarrhea, and constipation during their periods, and may feel pain with bowel movements.

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8. Fatigue

Although doctors do not yet have a clear understanding of why endometriosis causes fatigue, it is common in nearly all women with the condition. One explanation is that chronic pain in the pelvis and other areas of the body disrupts sleep, causing malaise throughout the day. In addition, constant pain can lead to stress, which causes fatigue for various reasons. Inflammation also activates the immune system, which makes the body work harder to prevent illness and subsequently reduces energy levels.

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9. Depression

Depression is a common symptom of endometriosis. Reaching a diagnosis can take years, and the constant barrage of symptoms without answers or treatment can adversely affect mental health. Additionally, endometriosis' ability to decrease fertility can impact emotional well being in women who are trying to conceive, thus increasing the risk of depression and anxiety.

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10. Other Symptoms

Endometriosis may also produce symptoms that are not typically associated with uterine conditions. It can cause nausea, vomiting, hypoglycemia (low blood sugar levels), headaches, low-grade fevers, and more. These symptoms are less common, and none of them alone will alert a medical practitioner to endometriosis. This is why it is important to inform a doctor of all symptoms, no matter how disconnected they may seem, when seeking a diagnosis.

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The severity of your pain may not be a reliable indicator of the extent of your condition. You could have mild endometriosis with severe pain, or you could have advanced endometriosis with little or no pain.

 

Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.

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When to see a doctor?

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    See your doctor if you have signs and symptoms that may indicate endometriosis.

Endometriosis can be a challenging condition to manage. An early diagnosis, a multidisciplinary medical team and an understanding of your diagnosis may result in better management of your symptoms.

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Causes:

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Although the exact cause of endometriosis is not certain, possible explanations include:

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• Retrograde menstruation. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These 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.

• Transformation of peritoneal cells. In what's known as the "induction theory," experts propose that hormones or immune factors promote transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial-like cells.

• Embryonic cell transformation. Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial-like cell implants during puberty.

• Surgical scar implantation. After a 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.

• Immune system disorder. A problem with the immune system may make the body unable to recognize and destroy endometrial-like tissue that's growing outside the uterus.

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Risk factors

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Several factors place you at greater risk of developing endometriosis, such as:

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• 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 menstrual periods that last longer than seven days

• Having higher levels of estrogen in your body or a 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 passage of blood from the body during menstrual periods

• Disorders of the reproductive tract

 

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.

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Complications:

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Infertility

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   The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant.

For pregnancy to occur, an egg must be released from an ovary, travel through the neighboring fallopian tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development. Endometriosis may obstruct the tube and keep the egg and sperm from uniting. But the condition also seems to affect fertility in less-direct ways, such as by damaging the sperm or egg.

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    Even so, many with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise those with endometriosis not to delay having children because the condition may worsen with time.

 

Cancer

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Ovarian cancer does occur at higher than expected rates in those with endometriosis. But the overall lifetime risk of ovarian cancer is low to begin with. Some studies suggest that endometriosis increases that risk, but it's still relatively low. Although rare, another type of cancer — endometriosis-associated adenocarcinoma — can develop later in life in those who have had endometriosis.

 

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