Endometriosis is a painful disorder in which tissue similar to the tissue that lines the inside of your uterus “the endometrium” grows outside your uterus in places such as ovaries, fallopian tubes and the pelvis. This tissue acts as endometrial tissue where it thickens, breaks down and bleeds with each menstrual cycle, it becomes trapped and causes pain and complications such as cancer and infertility.
The exact cause of endometriosis is now entirely known. However, some proposed causes include:
Retrograde menstruation, which means that the menstrual blood flows back through the fallopian tube and enters the pelvis instead of going outside the body.
Embryonic cells transformation which happens by hormones such as estrogen that can transform embryonic cells into endometrial cells causing endometriosis
Peritoneal cells transformation, which is known as the induction theory, in which the peritoneal cells lining the inside of the pelvis transform into endometrial cells
Surgical scar implantation: which happens usually after a hysterectomy surgical scar or C-section scar in which some of the endometrial cells attach to the scar.
Endometrial cell transport through the blood or lymphatic vessels which can go to any part of the body
The main symptom of endometriosis is pain in the pelvis, which happens with menstrual periods. Other signs and symptoms include:Painful menstrual period, the pain can be in the form of cramping that lasts few days after the period is overPain during sexual intercourseExcessive menstrual bleedingPain with urination or bowel movementInfertilityDiagnosis:
To diagnose endometriosis, your doctor will ask you about the symptoms and do careful physical exam. Then to check for the presence of endometriosis, your doctor will perform some tests such as:Pelvic exam: where your doctor will check for any abnormalities such as cysts or scarsUltrasound: which is a test that uses high frequency sound waves to creates images of the inside of the pelvis and can detect endometriosisMagnetic resonance imaging: MRI may help detecting the sites of endometriosis and also help your doctor to plan a surgery if neededLaparoscopy is done in cases, which is a test that is done by the surgeon to look inside the abdomen with a camera and also take biopsy samples if needed, usually it is done under general anesthesia
The treatment options of endometriosis can be medical or surgical. Your doctor will help in guiding the decision of treatment.
Pain medications are usually recommended to help ease the pain especially during menstrual cycles
Hormonal therapy is used and is usually effective in reducing the pain, it helps in slowing the growth of the endometrial tissue and also prevents new implantation of endometrial tissue in other places. It is not a permanent cure, and the symptoms may come back later after treatment is stopped. Hormonal therapy medications include:Hormonal contraceptives such as birth control pills, patches or vaginal rings.Gonadotropin-releasing hormone agonists and antagonists; which lower the estrogen level and prevent menstruation.Progestin therapy: which can halt the growth of the endometrial tissue Aromatase inhibitors: which are a class of medications that reduce the amount of estrogen in the body Surgery can sometimes be recommended to remove the endometrial implanted tissue, especially if you are trying to get pregnant, however sometimes endometriosis can recur.Hysterectomy and removal of the ovaries is considered the most effective treatment, however it is not considered if you are trying to preserve fertility and planning pregnancy
Unfortunately there is no effective means to prevent endometriosis, however period check ups and early diagnosis can help in early interventions and treatment to minimize the complications.