Endometriosis definition

Endometriosis is a disorder in which tissues forming the uterine cavity lining grow outside the uterine cavity. Your uterine cavity lining is called endometrium. This piece mainly focuses on the symptoms and signs of Endometriosis including the causes, risk factors, diagnosis, treatment and prognosis.

Another perspective of endometriosis definition is when Endometrial Tissue grows on your ovaries and tissues lining the pelvis. It is possible but unusual for endometrial tissue to spread beyond the pelvis.

An endometrial implant is defined as an endometrial tissue that grows outside of your uterus.

Hormonal changes that occur during your menstrual cycle may affect the misplaced endometrial tissue. This causes the endometrial tissue to become inflamed and painful. The tissue will grow, thicken and break down, which may over time go nowhere but become trapped in your pelvis.

These conditions may result from endometrial tissue trapped in your pelvis:

• Fertility problems
• Scar formation
• Irritation
• Severe pain during your periods
• Adhesions in which tissue binds together your pelvic organs

Endometriosis affects about 10 percent of women. So, it is a common gynecological disorder.

What causes endometriosis?

Before delving into the symptoms and signs of endometriosis, it is appropriate to first look at what causes endometriosis.

It is important to note that your body sheds the lining of your uterus during a regular menstrual cycle. As a result, menstrual blood flows from your uterus through the small cervical opening and out through your vagina.

Though the exact cause of endometriosis is not known, there are several theories regarding its cause. In addition, there is no scientific proof for any one of these theories.

One old theory has it that endometriosis happens due to a process of what is called retrograde menstruation. This means flow of menstrual blood back through the fallopian tubes into the pelvic cavity, instead of the blood leaving through the vagina.

Also, a theory suggests that hormones transform the cells outside the uterus into similar cells to endometrial cells.

Some people believe that endometriosis may occur if small areas of the abdomen change into the endometrial tissue. This is possible because abdominal cells, which grow from embryonic cells, may change shape and behave like endometrial cells. However, it is not clear why this happens.

The displaced endometrial cells may be found on the ovaries, surfaces of the pelvic organs, the pelvic walls and rectum. These cells grow, thicken and bleed in response to the hormones of your menstrual cycle.

Further, menstrual blood may leak into the pelvic cavity through a surgical scar like the cesarean section.

Another theory has it that endometrial cells may be carried out of the uterus through the lymphatic system. Yet, another theory suggests it may be due to a faulty immune system that fails to destroy errant endometrial cells.

Additionally, some people believe that endometriosis starts in the fetal period with misplaced cell tissue that responds to the hormones of puberty. This theory is known as Mullerian theory.

Finally, it is also believed that endometriosis might be linked to environmental toxins or genetics.

What are the symptoms and signs of endometriosis?

The symptoms and signs of endometriosis vary. For example, some women experience mild symptoms while others may have moderate to severe symptoms.

Keep in mind that the severity of your pain does not indicate the stage or degree of the condition. You may experience an agonizing pain even with a mild form of the disorder. On the other hand, a severe form may come with a very little discomfort.

The most common symptom of endometriosis is pelvic pain, often linked to menstrual periods. Women with endometriosis describe menstrual pain that is far worse than usual.

You may also have the following symptoms and signs of endometriosis:

• Dysmenorrhea (painful periods)
• Infertility
• Lower abdominal pain before and during menstruation
• irregular periods
• Heavy menstrual bleeding
• Bleeding between periods
• Pain with sexual intercourse
• Lower back pain at any time during menstrual cycle
• Discomfort with bowel movements
• Cramps one to two weeks around menstruation
• Pain with urination
• Diarrhea, nausea, fatigue, bloating or constipation especially during menstrual periods

Endometriosis may be mistaken for ovarian cysts or pelvic inflammatory disease. Also, it may be confused with irritable bowel syndrome. An irritable bowel syndrome may cause bouts of constipation, abdominal cramping and diarrhea.

However, you may have endometriosis with no symptoms. But if you have one or more symptoms, get regular gynecological exams to enable your gynecologist monitor any changes.

What are the stages of endometriosis?

There are four types or stages of Endometriosis including minimal, mild, moderate and severe. The stage of the condition can be determined by different factors. These factors include the number, size, location and depth of endometrial implants.

Minimal stage

Minimal endometriosis presents with small lesions or wounds and shallow endometrial implants on the ovary. Additionally, inflammation in or around the pelvic cavity may occur as a major sign of endometriosis.

Mild stage

In the mild stage, the signs of the endometriosis may include light lesions and shallow implants on your ovary and the lining of the pelvis.

Moderate stage

In the moderate stage, more lesions may occur. Also, the signs of endometriosis in this stage may include deep implants on your ovary and pelvic lining.

Severe stage

For the severe stage, the signs of endometriosis include deep implants on the ovaries and pelvic lining. Also, there may be lesions on the fallopian tubes and the bowels.

How can endometriosis be diagnosed?

The symptoms and signs of endometriosis may mimic that of other disorders such as pelvic inflammatory disease and ovarian cysts. For proper treatment, you need an accurate diagnosis of the condition. 

Your doctor will conduct one or more of the following investigations:

Detailed history taking

Your doctor will ask you about your condition with emphasis on your symptoms, and personal or family history of endometriosis.

Also, your doctor may assess your general health condition to rule out any other signs of a long-term disorder.

Physical examination

Your doctor may examine your pelvis by manually feeling your abdomen for cysts or scars behind the uterus.

Ultrasound

Your doctor may ask for an abdominal ultrasound or a transvaginal ultrasound scan. This will provide images of your reproductive organs and help your doctor identify cysts associated with endometriosis. However, both types of ultrasound are not effective in ruling out endometriosis.

Laparoscopy

The most definitive and most accurate diagnosis comes from direct viewing of endometriosis. Your doctor performs a minor surgical procedure known as a laparoscopy to view endometriosis directly.

Once the condition is diagnosed, your doctor can remove the tissue in the same procedure.

What are the risk factors for endometriosis?

In the United States, for example, 2 – 10% of childbearing women between the ages of 25 to 40 have endometriosis. There is need to understand the risk factors of this condition. This will help you determine whether you are susceptible to the disorder and when to speak with your doctor.

Here are factors that can put you at a high risk of developing endometriosis:

• Ages between 25 and 40 years are more likely, but symptoms can start at puberty
• Heavy menstrual periods lasting longer than 7 days
• Low body mass index
• Family history of endometriosis
• Short menstrual cycles of less than 27 days
• Reaching menopause at an older age
• Starting your menstrual period at an early age
• Having not had children
• Reproductive tract abnormalities
• Having higher levels of estrogen in your body
• Having a greater lifetime exposure to estrogen produced by your body
• Any medical condition preventing normal passage of menstrual flow out of the body

Endometriosis occurs several years after the start of your menstruation. It is important to note that symptoms and signs of endometriosis improve with pregnancy. Also, they may disappear with menopause, unless you are taking estrogen.

What are the complications of endometriosis?

Infertility

Infertility or impaired fertility is a serious complication of endometriosis. However, women with milder form of endometriosis may not have issues with fertility. They may be able to conceive and carry a baby to term. About 30 to 40 percent of women with endometriosis may find it difficult to get pregnant.

Pregnancy occurs when your ovary releases an egg which travels through the fallopian tube where a sperm cell fertilizes it. The fertilized egg attaches itself to the uterine wall where it develops.

However, endometriosis may block the tube and prevent the egg and sperm from coming together. In addition, endometriosis may affect fertility in less direct ways such as damaging the egg or sperm.

Women with mild to moderate endometriosis can conceive and carry a pregnancy to term. Doctors advise not to delay having children if you have endometriosis, because the disorder may get worse with time.

So speak with your doctor who will assess you before and during pregnancy.

With severe endometriosis, medications may not improve fertility. However, some women have been able to get pregnant after surgical removal of the endometrial tissue.

If after your doctor surgically removes the endometrial tissue and you are still unable to conceive, fertility treatments may help. Also, you may need in vitro fertilization to improve your chances of having a baby.

Apart from fertility, chronic pain is a difficult symptom to manage. Additionally, anxiety, depression and other mental problems are common.

Cancer

Women with endometriosis have a higher risk of developing ovarian cancer than those without endometriosis. However, the overall lifetime risk of ovarian cancer is low.

Studies show that endometriosis increases the risk of ovarian cancer, but it is a relatively low risk. There is evidence that endometriosis-associated adenocarcinoma may occur later in life in women who have had endometriosis.

How can endometriosis be treated?

Every woman with endometriosis obviously wants a quick relief of the symptoms and signs of endometriosis. If left untreated, this disorder can disrupt your life. It is important to note that endometriosis has no cure, but its symptoms can be managed.

Medical and surgical options are available to help you reduce your symptoms and manage potential complications. Your doctor may start with conservative treatments and will recommend surgery if your condition doesn’t improve.

Your doctor will help you find the best option for you as everyone reacts differently to these options.

Getting diagnosis and treatment early in the disease may be frustrating. This disease may be difficult to handle mentally because of the pain, fear that there is no relief and the fertility issues. You may well find a support group and learn more about the condition.

Treatment options for endometriosis include the following:

Pain relief medications

Some over-the-counter pain medications such as ibuprofen and diclofenac may be of help. However, they are not effective in all cases of endometriosis.

Hormonal contraceptives

Hormonal contraceptives impair fertility by inhibiting the monthly growth of endometrial tissue. In less severe endometriosis, vaginal rings, patches and birth control pills can eliminate pain.

Also, you can take medroxyprogesterone injection, known as Depo-Provera, to stop the growth of endometrial implants. It relieves pain and other symptoms. Also, it is effective in stopping menstrual period. However, it may cause weight gain, depression and decreased bone production as side effects.

Hormone therapy

You may take supplemental hormones which sometimes relieve pain and halt the progression of endometriosis.

Endometriosis is associated with tissue growth. So when you take supplemental hormones, your body becomes well primed to regulate hormonal changes that promote the tissue growth.

Danazol

Danazol is another medication you can take to reduce symptoms. It also stops menstruation. However, the disease may continue to progress while taking danazol.

The side effects of danazol include hirsutism and acne. Hirsutism is an abnormal, facial and body hair growth.

Studies of other drugs that may improve symptoms and signs of endometriosis, and slow disease progression are ongoing.

Gonadotropin-releasing hormone agonists and antagonists

Gonadotropin-releasing hormone (GnRH) agonists and antagonists block the production of estrogen. Estrogen is the hormone responsible for the development of female sexual characteristics.

When women take GnRH, it blocks estrogen production, prevents menstruation and creates artificial menopause.

However, GnRH therapy has side effects such as hot flashes and dryness. Take small doses of estrogen and progesterone at the same time as GnRH therapy to prevent or limit these symptoms.

Conservative surgery

Your doctor may recommend removal or destruction of endometrial growths without tampering with your reproductive organs. This treatment option is good for women who experience severe pain and for whom hormonal treatments are not working.

Also, women who want to get pregnant will benefit from this surgery. Surgeons use minimally invasive surgery (laparoscopy) to visualize and diagnose endometriosis.

Doctors use laparoscopy to remove the endometrial tissue. Your surgeon makes a small incision in your abdomen and surgically burn, vaporize or remove the growths.

These days, scientists use lasers to destroy the endometrial tissue.

Hysterectomy

As a last resort, your doctor may rarely recommend a total  hysterectomy. This may be an option if your condition fails to improve with other treatments.

A total hysterectomy entails the removal of the uterus and cervix. Your surgeon will also remove the ovaries to stop estrogen production by the ovaries. As earlier stated, estrogen causes the growth of endometrial tissue.

In addition, the surgeon will remove visible implant lesions. The major downside of hysterectomy, however, is that you will not be able to conceive after the surgery. Therefore, be well-informed about the implications before agreeing to the surgery, particularly if you are thinking about starting a family.

Conclusion

It is important to note that endometriosis is a chronic condition and has no cure. Also, we do not understand the causes yet.

However, there are effective treatments that help to manage fertility issues and pain associated with endometriosis. Such treatment options include the use of medications, hormone therapy and surgery.

Finally, the symptoms and signs of endometriosis improve after going through menopause.

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