Endometriosis is an incredibly painful disorder where the tissue that usually lines the insides of your uterus, the endometrium, grows outside of the uterus instead. This condition most commonly affects the fallopian tubes, ovaries, and tissue lining your entire pelvic region. In severe cases, the endometrial tissues can spread farther into the body and to other organ systems.
Due to the spread of the endometrial tissues into the body, these cells act just as uterine cells would: they thicken, break down and bleed with each menstrual cycle. This means the cells are causing abnormal bleeding throughout the body and in places where it cannot freely escape, such as the menstrual cycle and vagina provide. Tissues surrounding these misplaced endometrial cells can become very irritated, eventually developing in to scar tissue and adhesions. Adhesions are abnormal fibrous tissue that can cause pelvic tissues and organs to stick to each other, becoming permanently attached. Endometriosis causes mild to severe pain, especially during your period. Fertility problems are also reported with this condition, although treatments are available.
What are the symptoms of Endometriosis?
The most defining and often first symptom experienced is severe pelvic pain around the time of your menstrual cycle. While many women experience period pain and cramping, women who suffer from endometriosis typically describe menstrual pain that is far beyond bearable. Over the years with endometriosis, the pain usually gets worse.
Typical signs and symptoms of endometriosis can include:
Excessive bleeding. You may experience occasional heavy periods or bleeding between periods, which is called menometrorrhagia.
Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility and linked as a possible reason why conception does not happen.
Other symptoms. You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during and around your menstrual periods.
Painful periods or 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 at any time during, after or before sex is common with endometriosis.
Pain with bowel movements or urination. You are most likely to experience these symptoms during your period.
The level of the pain you experience with endometriosis does not signify the level or extent of the condition. Some women who have a mild form of this condition experience extreme pain, and those with severe endometriosis experience no pain. Endometriosis can be mistaken for many other conditions that have pelvic pain, like pelvic inflammatory disease, or PID. Even ovarian cysts can mimic the same symptoms, as can irritable bowel syndrome.
What are the causes or triggers of endometriosis?
While the main reason this condition develops has no main cause, doctors and specialists alike have agreed that these things could be a cause of endometriosis.
Surgical scar implantation. After surgery, like a hysterectomy or C-section, endometrial cells may attach to a surgical incision causing severe scarring and adhesions.
Endometrial cells transport. The blood vessels or tissue fluid from the lymphatic system may transport endometrial cells to other parts of the body.
Immune system disorder. It is possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that are growing outside of the uterus.
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 is known as the “induction theory,” experts propose that hormones or immune factors promote transformation of peritoneal cells, which are cells that line the inner side of your abdomen, into endometrial cells.
Embryonic cell transformation. Hormones such as estrogen may transform embryonic cells, which are cells in the earliest stages of development, into endometrial cell implants during puberty.
What are the risk factors for increasing my chances of getting endometriosis?
There are several factors that could play a role in your development of endometriosis. They are:
- 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
- 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
The condition of endometriosis usually develops several years after the beginning of menstruation. The signs and symptoms of endometriosis can suddenly and temporarily disappear during pregnancy and end permanently with menopause unless you are taking estrogen.
How is endometriosis diagnosed?
Noting your pelvic pain, your doctor will ask you for all of your other symptoms and ailments, including the specific locations of the pain you are having. Next, they may order any of these tests to look for physical signs of endometriosis:
-Ultrasound. This test uses high-frequency sound waves to create images of the inside of your body. To capture the images, a device called a transducer 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 your doctor whether you have endometriosis, but it can identify cysts associated with endometriosis (endometriomas).
–Magnetic resonance imaging or MRI. An MRI is an exam that uses a magnetic field and radio waves to create detailed images of the organs and tissues within your body. For some women, an MRI helps with surgical planning, giving your surgeon detailed information about the location and size of endometrial implants.
–Pelvic exam. During a pelvic exam, your doctor manually feels or palpates areas in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus. Usually, it is not possible to feel small areas of endometriosis, unless they have caused a cyst to form.
–Laparoscopy. In some cases, your doctor may refer you to a surgeon for a procedure (laparoscopy) that allows the surgeon to view inside your abdomen. While you’re under general anesthesia, your surgeon makes a tiny incision near your navel and inserts a slender viewing instrument (laparoscope), looking for signs of endometrial tissue outside the uterus.
A laparoscopy can provide information about the location, extent, and size of the endometrial implants to help determine the best treatment options. Your surgeon may take a tissue sample or biopsy for further testing. Often, with proper surgical planning, your surgeon can fully treat endometriosis during the laparoscopy so that you only need one surgery.
Are there any complications that can happen from having endometriosis?
The main complication that most experience with endometriosis is issues with conceiving and fertility. One-third to one-half of women who live with endometriosis will have difficulty getting pregnant, and some may need medical intervention. Because this condition can block and obstruct the fallopian tubes, this inhibits the sperm from being able to proceed through the tubes to fertilize the ovum. Even with this condition, women with mild to moderate endometriosis can still conceive and carry a pregnancy to term. In severe cases, women are encouraged not to wait to start a family if that is their desire with endometriosis because, with time, this condition only worsens.
Another complication from this condition is the heightened risk of ovarian cancer for those with endometriosis. Certain cases of cervical cancer and adenocarcinoma have been linked to the developing and worsening condition. Whenever cells are stressed, and damage has been caused, this can signal the cells to reproduce and form into precancerous cells, thusly leading to cancer.
If you think that you may have endometriosis, contact your doctor and make an appointment to begin testing. Once you have your diagnosis, a proper treatment plan can be put in to place. Endometriosis is usually treated with medications and surgical intervention.