Endometriosis - Symptom, Treatment And Causes

Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond pelvic organs.

With endometriosis, displaced endometrial tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other.

Endometriosis can cause pain — sometimes severe — especially during your period. Fertility problems also may develop. Fortunately, effective treatments are available.

Symptoms

The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Although many women experience cramping during their menstrual period, women with endometriosis typically describe menstrual cramp that's far worse than usual. They also tend to report that the pain increases over time.

Common Signs and Symptoms of Endometriosis may include:

• Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before your period and extend several days into your period. You may also have lower back and abdominal pain.

• Pain with intercourse. Pain during or after sex is common with endometriosis.

• Pain with bowel movements or urination. You're most likely to experience these symptoms during your period.

• Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).

• Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.

• Other symptoms. You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

The severity of your pain isn't necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have intense pain, while others with advanced endometriosis may have little pain or even no pain at all.

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.

When to see a doctor

See the 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.

Causes

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

• 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 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.

• 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 cells.

• Embryonic cell transformation. Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial 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 cells transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.

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

Risk factors

Several factors place you at 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

• Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces

• Low body mass index

• Alcohol consumption

• 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

• Uterine abnormalities

Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis end temporarily with pregnancy and end permanently with menopause, unless you're taking estrogen.

Complications

Infertility

The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant. 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 damage to the sperm or egg. Inspite of this, many women with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise women with endometriosis not to delay having children because the condition may worsen with time.

Ovarian cancer

Ovarian cancer does occur at higher than expected rates in women with endometriosis. Although rare, another type of cancer — endometriosis-associated adenocarcinoma — can develop later in life in women who have had endometriosis.

Diagnosis: To diagnose endometriosis and other conditions that can cause pelvic pain, the doctor will ask you to describe your symptoms, including the location of your pain and when it occurs.

Tests to check for physical clues of endometriosis include:

• Pelvic exam. During a pelvic exam, the doctor manually feels (palpates) areas in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus. Often it's not possible to feel small areas of endometriosis, unless they've caused a cyst to form.

• Ultrasound. A transducer, a device that uses high-frequency sound waves to create images of the inside of your body, is either pressed against your abdomen or inserted into your vagina (transvaginal ultrasound). Both types of ultrasound may be done to get the best view of your reproductive organs. Ultrasound imaging won't definitively tell the doctor whether you have endometriosis, but it can identify cysts associated with endometriosis (endometriomas).

• Laparoscopy. Medical management is usually tried first. But to be certain you have endometriosis, the doctor may advise a surgical procedure called laparoscopy to look inside your abdomen for signs of endometriosis.

While you're under general anesthesia, the doctor makes a tiny incision near your navel and inserts a slender viewing instrument (laparoscope), looking for endometrial tissue outside the uterus. He or she may take samples of tissue (biopsy). Laparoscopy can provide information about the location, extent and size of the endometrial implants to help determine the best treatment options.

Treatment for endometriosis is usually with medications or surgery. The approach you and the doctor choose will depend on the severity of your signs and symptoms and whether you hope to become pregnant.

Generally, doctors recommend trying conservative treatment approaches first, opting for surgery as a last resort.

Pain medications

The doctor may recommend that you take an over-the-counter pain reliever, such as the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others), to help ease painful menstrual cramps.

If you find that taking the maximum dose of these medications doesn't provide full relief, you may need to try another approach to manage your signs and symptoms.

Hormone therapy

Supplemental hormones are sometimes effective in reducing or eliminating the pain of endometriosis. The rise and fall of hormones during the menstrual cycle causes endometrial implants to thicken, break down and bleed. Hormone medication may slow endometrial tissue growth and prevent new implants of endometrial tissue.

Hormone therapy isn't a permanent fix for endometriosis. You could experience a return of your symptoms after stopping treatment.

Therapies used to treat endometriosis include:

• Hormonal contraceptives. Birth control pills, patches and vaginal rings help control the hormones responsible for the buildup of endometrial tissue each month. Most women have lighter and shorter menstrual flow when they're using a hormonal contraceptive. Using hormonal contraceptives — especially continuous cycle regimens — may reduce or eliminate the pain of mild to moderate endometriosis.

• Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists. These drugs block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation. This causes endometrial tissue to shrink. Because these drugs create an artificial menopause, taking a low dose of estrogen or progestin along with Gn-RH agonists and antagonists may decrease menopausal side effects, such as hot flashes, vaginal dryness and bone loss. Your periods and the ability to get pregnant return when you stop taking the medication.

• Progestin therapy. A progestin-only contraceptive, such as an intrauterine device (Mirena), contraceptive implant or contraceptive injection (Depo-Provera), can halt menstrual periods and the growth of endometrial implants, which may relieve endometriosis signs and symptoms.

• Danazol. This drug suppresses the growth of the endometrium by blocking the production of ovarian-stimulating hormones, preventing menstruation and the symptoms of endometriosis. However, danazol may not be the first choice because it can cause serious side effects and can be harmful to the baby if you become pregnant while taking this medication.

Conservative surgery

If you have endometriosis and are trying to become pregnant, surgery to remove as much endometriosis as possible while preserving your uterus and ovaries (conservative surgery) may increase your chances of success. If you have severe pain from endometriosis, you may also benefit from surgery — however, endometriosis and pain may return.

The doctor may do this procedure laparoscopically or through traditional abdominal surgery in more extensive cases.

Assisted reproductive technologies

Assisted reproductive technologies, such as in vitro fertilization (IVF) to help you become pregnant are sometimes preferable to conservative surgery. Doctors often suggest one of these approaches if conservative surgery doesn't work.

What is endometriosis?

Endometriosis is a common condition where cells of the lining of the womb (the endometrium) are found elsewhere, usually in the pelvis and around the womb, ovaries and fallopian tubes. It mainly affects women during their reproductive years. Endometriosis is not an infection and it is not contagious.

What are the symptoms?

The main symptoms of endometriosis are pelvic pain, pain during or after sex and painful, sometimes heavy periods. It may cause problems with getting pregnant. It can affect many areas of a woman’s life including her general physical health, emotional wellbeing and daily routine. Many women may have no symptoms. It is a long-term condition. Some women with endometriosis become pregnant easily while others have difficulty getting pregnant.

What causes endometriosis?

Endometriosis occurs when the cells of the lining of the womb are found in other parts of the body, usually the pelvis. Each month this tissue outside the womb thickens and breaks down and bleeds in the same way as the lining of the womb. This internal bleeding into the pelvis, unlike a period, has no way of leaving the body. This causes inflammation, pain and damage to the reproductive organs. Less commonly, endometriosis may occur on the bowel and bladder, or deep within the muscle wall of the uterus (adenomyosis). It can also rarely be found in other parts of the body.

The symptoms of endometriosis are common and could be caused by a number of other conditions such as irritable bowel syndrome (IBS) and pelvic inflammatory disease (PID).

• There is no simple test for endometriosis.
• Your gynaecologist may examine your pelvic area, this will include an internal examination.
• You may be offered a scan. This can identify whether there is an endometriosis cyst in the ovaries. A normal scan does not rule out endometriosis.
• For most women, having a laparoscopy is the only way to confirm endometriosis; because of this, it is often referred to as the ‘gold standard’ test. This allows the gynaecologist to see the pelvic organs clearly and look for any endometriosis.

Several factors may influence your decision about treatment. These include:

• How you feel about your situation
• Your age
• Whether your main symptom is pain or problems getting pregnant

What treatment can I get?

The options for treatment may be:

Pain relief

Hormone treatments: There is a range of hormone treatments to stop or reduce ovulation (the release of an egg) to allow the endometriosis to shrink or disappear. The hormonal methods below are contraceptives and will prevent you from becoming pregnant:

• The combined oral contraceptive (COC) pill or patch. These contain the hormones estrogen and progestogen and work by preventing ovulation and can make your periods lighter, shorter and less painful.
• The intrauterine system (IUS): this is a small T-shaped device which releases the hormone progestogen. This helps to reduce the pain and makes periods lighter. Some women get no periods at all.
• The hormonal methods below are non-contraceptive, so contraception will be needed if you do not want to become pregnant:
• Use of hormonal progestogens or testosterone derivatives
• GnRH agonists are drugs that prevent estrogen being produced by the ovaries and cause a temporary and reversible menopause.

Some women find that recreational exercise improves their wellbeing, which may help to improve some symptoms of endometriosis.

Surgery: Surgery can be used to remove areas of endometriosis. There are different types of surgery, depending on where the endometriosis is and how extensive it is. How successful the surgery is can vary and you may need further surgery.

• Laparoscopic surgery: The gynaecologist removes patches of endometriosis by destroying them or cutting them out.
• Laparotomy: If the endometriosis is severe and extensive, you may be offered a laparotomy. This is major surgery which involves a cut in the abdomen, usually in the bikini line.
• Hysterectomy: Some women have surgery to remove their womb (a hysterectomy) with or without the ovaries. Depending upon your own situation, your doctor should discuss hormone replacement therapy (HRT) with you if you have your ovaries removed.

What if I am having difficulty getting pregnant?

Getting pregnant can be a problem for some women with endometriosis. Your doctor should provide you with full information about your options such as assisted conception. If you become pregnant, endometriosis is unlikely to put your pregnancy at risk. In case you have a concern or query you can always consult an expert & get answers to your questions!

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Mens sexual health

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Women’s Sexual heath

Lady finger is also great for female sexual health. Women who suffer from excessive bleedings during their menstrual cycles or endometriosis can use it for their benefit. Poke holes in two to three okras and put them in a glass of water. Keep them overnight at room temperature and drink the liquid first thing in the morning. Drinking this for a few weeks will help reduce the bleeding during the cycle and also help in other matters of sexual health.

Okra is a great vegetable for sexual health and should be included in the diet on a regular basis.

The tissue that lines the uterus is known as the endometrium. In some cases, it can grow outside the uterus. This is known as endometriosis. Endometriosis usually involves organs in the pelvic cavity such as the ovaries, fallopian tubes, bowel and lining of the pelvic cavity. In rare cases, it may involve the vagina, cervix and bladder as well.

Depending on the location and extent of endometrial tissue, it can be classified into four stages ranging from minimal to severe. Most cases of endometriosis fall into the minimal or mild category which involves mild scarring and superficial tissue implants. Moderate or severe endometriosis can cause cysts and severe scarring. Infertility is also commonly associated with severe endometriosis.

Pain in the pelvic area just before and during menstruation is one of the most characteristic symptoms of this disorder. This is because the overgrown endometrial tissue acts like normal endometrial tissue and is shed during menstruation. The only difference is that since there is no exit for this overgrown tissue, it is trapped in the pelvic cavity. The location of the implantation of endometrial tissue also plays a role in the amount of pain experienced. The deeper the implant, more the pain. Implants near areas with high nerve density are also more likely to be painful than implants in areas with low nerve density.  These implants may also release substances into the blood stream that can cause pain.

Other symptoms associated with this disorder are:

• Painful intercourse
• Painful urination
• Pain during bowel movements
• Infertility

These symptoms especially the pelvic pain can vary from month to month in terms of duration and intensity.

A few simple changes in your diet can help manage the symptoms associated with this disorder and in some cases, prevent it as well. Avoid processed food and foods that are high in sodium content. You should also avoid high-fat dairy and food that is rich in arachidonic acid. Instead, increase your consumption of carbs and green leafy vegetables. You could also add two tablespoons of walnut oil a day to your diet to help combat inflammation and the other effects of arachidonic acid.

Early stages of this disease can be treated with hormone therapy, but if it has progressed to the later stages, surgery may be needed. This surgery is performed laparoscopically and aims at removing all the implanted tissue from outside the uterus. However, in cases where the anatomy of the pelvic organs has been distorted by the implants, a hysterectomy may be required. This option, however, it usually considered only in cases where a woman does not have any plans of conceiving more children.

Are you aware of the connection between ovarian cysts and pregnancy? A woman’s ovaries produce eggs and sex hormones, namely estrogen and progesterone. Sometimes, a sac filled with fluid may develop on one of your ovaries. Ovarian cysts are common and are experienced by all women in their lifetime. Commonly, these cysts are painless, accompanied by no specific symptoms. As the cysts grow, symptoms such as swelling or bloating, painful bowel movements, painful sexual intercourse, and pelvic pain during menstrual periods are indicated. Other symptoms like breast tenderness, lower back and thigh pain, nausea and vomiting are also likely.

Link between ovarian cysts and pregnancy
Ovarian cysts are connected to pregnancy as they are associated with a woman’s fertility. Some ovarian cysts which can affect your fertility and hence pregnancy include the following:

Endometriomas
• These are ovarian cysts, which are associated with complications in fertility and occur on account of endometriosis. This is a health condition in which the normal tissue lining around your uterus or the endometrium starts growing outside your uterus.

Ovarian cysts occurring because of polycystic ovary syndrome
• Polycystic ovary syndrome (PCOS) is featured by the development of several small cysts on the surface of your ovaries.
• Irregular menstrual periods and the increase in levels of certain hormones are indicated.
• This condition is associated with fertility. It results in irregular ovulation that causes complications in fertility in many women.

Ovarian cysts which only affect fertility after becoming large
There are some types of ovarian cysts, which do not affect fertility unless they become very large. They are as follows:

Functional cysts

• These cysts include corpus luteum cysts and follicular cysts. These are the most common forms of ovarian cysts.
• Functional cysts from a usual menstrual cycle do not contribute to infertility in any way. Instead, they indicate the functions, which lead to fertility.

Cystadenomas

• These are developments or growths in your ovaries. They usually occur from the surface of your ovaries.
• These cysts require treatment, but do not affect fertility in any negative way.

Dermoid cysts

• These are solid cysts containing tissues similar to skin, teeth and hair instead of fluid content.
• These cysts too are not related to infertility problems during pregnancy.

If you are diagnosed with ovarian cysts and are concerned whether they will affect your pregnancy, it is important for you to consult your doctor. You will be able to discuss the various treatment measures, which revive your pregnancy chances. 

In case you have a concern or query you can always consult an expert & get answers to your questions!