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Endometriosis is a condition in which the tissue that lines the inside of the uterus or womb called the endometrium starts growing outside the uterine cavity. This endometrial tissue can grow in the ovaries, fallopian tubes and even the pelvic area.
The typical symptoms of endometriosis include heavy menstrual flow, pelvic pain, and pain during urinary or bowel movements. Having an immediate family member suffering from the disease, early onset of menstruation and not having a child increase the risk of endometriosis. It usually affects women between the ages of 25 and 40. Women with endometriosis are more likely to have infertility or difficulty getting pregnant.
Endometriosis can be diagnosed with abdominal ultrasound or laparoscopy, which is the gold standard of diagnosis and treatment. Treatment often begins with medications such as oral contraceptives, GnRH analogues and injections to suppress the ovarian function. Surgery is often the last resort to treat the later stages of this condition.
You can take care of yourself at home by trying some simple remedies such as using a heating pad for pain relief and including remedies such as curcumin and green tea. Remember, ignoring the symptoms of endometriosis and not seeking treatment on time can result in severe complications.
- Adults between 25 - 40 years of age
- Pelvic cavity
- Fallopian tubes
- India: 25 million (2020)
- Pelvic adhesions
- Functional or neoplastic ovarian cyst
- Uterine malformation
- Colon cancer
- Ovarian cancer
- USG whole abdomen
- CT/MRI of Pelvis
- Histological examination
- NSAIDs: Ibuprofen
- Oral contraceptives: Desogestrel, Etonogestrel
- Progestin: Medroxyprogesterone
- GnRH analogues: Leuprolide
- Intrauterine devices
- Gynecologist & obstetrician
Symptoms Of Endometriosis
Many women with endometriosis may not have any symptoms. Such women come to know of endometriosis if they face difficulty in conceiving or during a routine ultrasound. The following are the most common symptoms for endometriosis, but each woman may experience symptoms differently:
Chronic pain in lower back and pelvis
Abnormal or heavy menstrual flow or bleeding between periods
Painful menstrual cramps
Pain during sexual intercourse
Painful bowel movements during menstrual periods
Painful urination during menstrual periods
Other gastrointestinal symptoms like bloating, diarrhea, constipation or nausea especially during menstrual periods
Infertility or difficulty in conceiving
Pelvic pain is the pain experienced internally in the reproductive region in both men and women. Read more about the common causes of pelvic pain in women.
Causes Of Endometriosis
Endometriosis is an idiopathic disease, which means the cause of the disease is largely unknown. However, there are a few theories that explain the mechanism of endometriosis:
1. Retrograde or Reverse menstruation: This popular theory suggests that during menstruation, some of the blood and tissue containing endometrial cells from the uterus travels through the fallopian tubes into the pelvic cavity. These endometrial cells stick to the walls of the pelvic cavity and continue to proliferate and bleed over the course of each menstrual cycle. Mostly all women have some degree of reverse menstruation, but only a few develop endometriosis. This is thought to be because of differences in a woman’s immune system.
2. Coelomic metaplasia or Cellular metaplasia: According to this theory, cells in the body outside of the uterus transform into endometrial cells that line the uterus.
3. Endometrial cell transport: This theory suggests that endometrial tissue may travel through the blood or lymphatic system to other distant areas or organs.
4. Direct implantation: Endometriosis can also occur because of direct transplantation in the abdominal wall. Eg. During a cesarean section or some pelvic surgery like hysterectomy, some endometriosis tissue might accidently get implanted in the abdominal incision.
5. Genetic factors also play a role as the disease is much more common if your close relative like your mother, sister also has the disease.
The most common sites of endometriosis include:
The fallopian tubes
Tissues that hold the uterus in place
Outer surface of the uterus
The lining of the pelvic cavity
Other sites of growth could be the vagina, cervix, vulva, intestines, bladder, or rectum. Very rarely, endometriosis can appear in distant parts like the skin, lungs and brain.
Stages of endometriosis
Endometriosis occurs in 4 stages, depending on the depth and area it affects. These are described as follows:
Stage 1: This is the minimal type of endometriosis, where small lesions are present. These are present on the tissue lining the pelvis or abdomen. There is no scar tissue.
Stage 2: This is the mild type of endometriosis. More lesions are present in deeper tissue, along with some scar tissue.
Stage 3: This is the moderate stage of endometriosis. There are several deep lesions at this stage. Small cysts may also be present in ovaries, along with scar tissue or thick bands known as adhesions.
Stage 4: This is the most severe stage of endometriosis. This type of endometriosis is widespread and is associated with several deep lesions and thick adhesions. Large cysts may also be present in one or both ovaries.
Risk Factors For Endometriosis
Women are at higher risk for endometriosis if they:
Have an immediate family member such as a mother, sister or aunt suffering from endometriosis
Started their period at an early age (before the age of 11), also known as early menarche
Have short monthly cycles, which are less than 27 days
Have heavy menstruation or periods that last more than 7 days
Never had a child
Are giving birth for the first time after the age of 30 years
Have an abnormal uterus
Have a medical problem that prevents the normal flow of blood from the body during menstrual periods
Disorders of the reproductive tract
Consume alcohol in excess
Have intercourse during menstruation
Have low body mass index
Diagnosis Of Endometriosis
Various ways by which endometriosis can be diagnosed are:
A pelvic examination: Your gynecologist will carry out a routine pelvic examination after recording your medical history.
USG whole abdomen: A diagnostic imaging technique that uses high-frequency sound waves to produce pictures of the internal structures of the abdomen.
CT scan: A noninvasive diagnostic imaging tool that uses a combination of X-rays and computer technology to create images of the pelvis to detect any abnormalities.
MRI scan: To gain visuals of the organs of the pelvis and lower abdomen.
Laparoscopy: Laparoscopy is considered to be the gold standard of diagnosing endometriosis. In this procedure, laparoscope, which is a thin instrument with a light and a camera, is used to view the pelvic region and its organs.
Histological examination: In certain cases of endometriosis, your doctor can take a biopsy or sample of tissue during laparoscopy and send it to a lab for evaluation.
Specialist To Visit
If you experience any symptoms of endometriosis it is important to visit a gynecologist and obstetrician at the earliest.
Most Indian women don’t have a regular gynaecologist like they do for a family doctor or General Physician(GP). Here is a list of the types of gynecologists you can consult for gynecological related problems.
Treatment Of Endometriosis
Endometriosis can be treated by medicines and surgery. Here’s some of the common treatment options for endometriosis:
Nonsteroidal anti-inflammatory drugs, such as Ibuprofen or other over-the-counter analgesics can give temporary relief from pain. If these do not help, a doctor may prescribe stronger drugs.
Hormonal therapy can lower the amount of estrogen which is directly linked to endometriosis. This helps in reducing bleeding, inflammation, scarring, and cyst formation. Common hormones used are:
Oral contraceptives: Function by suppression of ovarian function. Eg, Desogestrel, Etonogestrel.
Danazol: A synthetic derivative of testosterone (a male hormone).
Progestin: These medicines suppress the activity of ovaries by modulating female hormones in the body. Eg, Medroxyprogesterone.
GnRH analogues- GnRH analogues are given in injection form to suppress the ovarian activity, so the level of the hormones in the body is decreased. One of the most common GnRH analogue is Leuprolide.
Intrauterine devices such as the levonorgestrel system are placed in the uterine cavity, where it suppresses endometrial activity and also helps in regulating menstrual blood flow.
Surgical procedures are often the last resort for the treatment of endometriosis. Surgery is often performed laparoscopically or even with an open procedure. This process involves removal (excision) or burning (fulguration) or both, of the endometriotic tissue. Removal of scar tissue can provide great relief in pain. Along with the relocation of the ovaries and fallopian tubes to their normal position in the pelvis during surgery, it can greatly increase the chances of a woman to get pregnant.
Home Care For Endometriosis
If you are suffering from endometriosis, you can follow these simple tips to ease the symptoms of this condition:
Take adequate rest. You can also use a hot pack, heating pad or hot bottle of water to ease the pain.
You can also take long warm baths to ease the pain and associated symptoms of endometriosis.
Prevent constipation. Constipation is common in women suffering from endometriosis, therefore it is advised to hydrate yourself and include fibre-rich food to relieve the symptoms.
Get regular exercise. Exercise improves blood circulation and helps nutrients and oxygen flow to all the systems of the body. Regular exercise can help in reducing pelvic pain associated with endometriosis.
If the pain gets severe, you can take painkillers after your doctor’s consultation.
Complications Of Endometriosis
Endometriosis may have certain complications if it is severe in nature or is diagnosed or treated at a later stage. Some of the common complications of endometriosis are:
Endometriosis can lead to fertility problems. The following ways are thought to cause infertility:
Endometriosis can change the shape of the pelvis and reproductive organs which makes it difficult for the sperm to find the egg or it can deform the fallopian tubes in such a way that they are not able to pick up the egg after ovulation.
It can cause inflammation that affects the normal function of the ovary, egg, fallopian tubes or uterus.
The immune system, which normally protects the body against any infection, begins to attack the embryo.
The endometrium or the uterine lining where implantation occurs, does not develop normally.
Some women suffering from endometriosis do not have any fertility issues and eventually get pregnant without any treatment. But, for many it can be harder to get pregnant. Sometimes, medication alone fails to improve fertility. Surgery can help you in improving your fertility by removing the patches of endometriosis tissue.
Ovarian cysts and adhesions
Endometriosis leads to adhesions, which are the areas of endometriosis tissue that are sticky and glue the organs together. Endometriosis can also result in ovarian cysts, which are the fluid-filled cysts that can become large and painful. These can be treated with surgery.
Bladder and bowel problems
Endometriosis can also affect your bladder or bowel movements. This condition may require major surgery, which may involve removing a small part of the bladder or intestine.
Women suffering with endometriosis might be at a risk of developing ovarian cancer, but the risk is still relatively low. Another rare type of cancer, endometriosis-associated adenocarcinoma can develop later in life in those who have had endometriosis for a long time.
Most of the couples do not have any significant symptoms of infertility. In fact, it is not until the time they try to conceive that they know about infertility. The signs of infertility in women could be related to the underlying cause of the condition.
Alternative Therapies Of Endometriosis
Here are few of the most common herbal and home remedies for the treatment of endometriosis:
Curcumin: Curcumin or turmeric has anti-inflammatory, antioxidant, and antiproliferative properties that are useful in treating the symptoms of endometriosis. You can take turmeric in the form of tablets or with your tea or milk by mixing a teaspoon of turmeric to your drink.
Puerarin: Puerarin is a compound that is found in kudzu plants. It contains isoflavonoid compounds that possess estrogenic effects. This component binds to the estrogen receptors (ERs) and relieves some of the symptoms of endometriosis.
Resveratrol: Resveratrol is a polyphenol compound that is mainly found in grapes, peanuts, mulberry, and some other plants. These foods have strong antioxidant properties and therefore could be of great help in endometriosis.
Green tea: Green tea is a great antioxidant, which helps in prevention of new blood vessel formation (antiangiogenesis) and inhibits the function of microvessels that are present in the endometrial lesions. This helps in reducing the size and the weight of these lesions thereby hindering the growth of endometriosis.
Living With Endometriosis
If you are suffering from endometriosis, you can follow these easy tips to reduce the pain and othe symptoms of endometriosis:
1. Use a hot pack: For the excruciating pain that comes with endometriosis, you can apply a hot water bottle or heating pad to your lower abdomen. This can help in proper blood circulation and muscle relaxation. Warm baths can also be of great help in treating endometriosis.
2. Take proper rest: If the pain of endometriosis becomes intense, you must take proper rest. You can place a pillow under your knees while you are on your back. While lying on your side, keep your knees close to your chest. These positions can reduce the pressure on your lower back.
3. Get regular exercise: Exercise is helpful in releasing natural painkillers in your body, known as endorphins. Exercise also helps in improving blood circulation and flow of nutrients and oxygen to all the systems of the body.
4. Include a healthy & balanced diet: When it comes to endometriosis, maintaining a healthy weight can be of great help. You must also include plenty of fiber in your diet, which will help in preventing the painful straining during bowel movements.
5. Make use of alternative treatment: You can go for other techniques that also offer ways to relax and may help relieve pain Muscle relaxation, deep breathing, biofeedback and Yoga. you can also go for acupuncture that helps in painful periods.
Frequently Asked Questions
- Endometriosis. The American college of obstetricians and gynecologists; Last accessed on 24th March, 2021
- Farquhar Cynthia. Endometriosis.BMJ. 2007 Feb 3; 334(7587): 249–253
- What are the risk factors of endometriosis. National Institute of Child Health & Human Development.
- C. Matthew Peterson, Johnstone Erica B,Hammoud Ahmad O, Stanford Joseph B, Varner Michael W. Risk factors associated with endometriosis: importance of study population for characterizing disease in the ENDO Study.Am J Obstet Gynecol. 2013 Jun; 208(6): 451.e1–451.11.
- Bilodeau Kelly.Treating the pain of endometriosis. Harvard Health Publishing; Nov 20, 2020.
- Infertility. NHS; Last accessed on 24th march, 2021
- Sai Kong, Yue-Hui Zhang, Chen-Fang Liu,Ilene Tsui, Ying Guo,Bei-Bei Ai, and Feng-Juan Han. The Complementary and Alternative Medicine for Endometriosis: A Review of Utilization and Mechanism. Evid Based Complement Alternat Med. 2014; 2014: 146383.
- Haas Dietmar,Chvatal Radek , Reichert Björn, Renner Stefan, Shebl Omar , Binder Helge, Wurm Peter, Oppelt Peter. Endometriosis: a premenopausal disease? Age pattern in 42,079 patients with endometriosis. Arch Gynecol Obstet. 2012 Sep;286(3):667-70
- Spoorthy Venkatesh, M. Anjali, Akhila Vasudeva, and Pratap Kumar. Sliding Sign and Gel Sonovaginography: A Sneak Peek Prior to Laparoscopy in Patients with Endometriosis.J Hum Reprod Sci. 2020 Jan-Mar; 13(1): 26–30.