Endometriosis: Causes, Complications, and Treatment

Endometriosis – Meaning A disorder in which tissue similar to the tissue that forms the lining of the uterus grows outside of the uterine cavity is known as endometriosis. The lining of the uterus is known as the endometrium. When endometrial tissue grows on the ovaries, bowel, and tissues lining the pelvis, endometriosis occurs. It’s […]

Endometriosis – Meaning

A disorder in which tissue similar to the tissue that forms the lining of the uterus grows outside of the uterine cavity is known as endometriosis. The lining of the uterus is known as the endometrium.

When endometrial tissue grows on the ovaries, bowel, and tissues lining the pelvis, endometriosis occurs. It’s not usual for endometrial tissue to spread beyond the pelvic region, but it’s not impossible. An endometrial implant is the endometrial tissue growing outside of uterus

The menstrual cycle hormonal changes affect the misplaced endometrial tissue, causing the area to become inflamed and painful which means the tissue will grow, thicken, and break down. Over the period of time, the tissue that has broken down has nowhere to go and becomes trapped in the pelvis.

This tissue that is trapped in the pelvis can cause:

  • irritation
  • scar formation
  • adhesions, in which tissue binds the pelvic organs together
  • severe pain during periods
  • fertility problems

Endometriosis is a gynecological condition which is common, affecting up to 10 percent of women. If having this disorder then you are not alone.

Endometriosis symptoms

The symptoms of endometriosis may differ. Mild symptoms are experienced by some women, but others can have moderate to severe symptoms. The severity of the pain doesn’t signal the degree or stage of the condition. When having a mild form of the disease yet agonizing pain might be experienced. It’s also possible that severe form might be possible and have very little discomfort.

The most common symptom of endometriosis is pelvic pain. You may also have the following symptoms:

  • painful periods
  • pain in the lower abdomen before and during menstruation
  • cramps one or two weeks around menstruation
  • heavy menstrual bleeding or bleeding between periods
  • infertility
  • pain following sexual intercourse
  • discomfort with bowel movements
  • lower back pain that may occur at any time during your menstrual cycle

Having no symptoms might also be a possibility. Getting regular gynecological exams is important, which will allow the gynecologist to monitor any changes. This is particularly essential if having two or more symptoms.

 

Endometriosis treatment

Understandably, quick relief from pain and other symptoms of endometriosis is needed. This condition can disrupt the life if it’s not treated. No cure is available for endometriosis, but its symptoms can be managed.

To help reduce the symptoms and manage any potential complications options of medical and surgical are available. Conservative treatments may first be tried by the doctor. If the condition doesn’t improve then surgery may be recommended.

These treatment options reactions are different for everyone. The doctor will assist in finding the one that works best

It may be irritating to get diagnosis and treatment options in the early stages in the disease. Due to the fertility issues, pain, and fear that there is no relief, this disease can be hard to handle mentally. A support group should be considered to find or educating yourself more on the condition. Treatment options may include:

Pain medications

Over-the-counter pain medications can be tried such as ibuprofen, but these aren’t effective in all cases.

Hormone therapy

Supplemental hormones intake can sometimes relieve pain and stop the progression of endometriosis. Hormone therapy helps regulating the body in the monthly hormonal changes that promote the tissue growth that occurs when having endometriosis.

Hormonal contraceptives

Fertility is reduced by hormonal contraceptives by preventing the monthly growth and buildup of endometrial tissue. The pain can be reduced or even eliminated in less severe endometriosis with birth control pills, patches and vaginal rings.

For stopping menstruation, the medroxyprogesterone (Depo-Provera) injection is also effective as it stops the growth of endometrial implants and relieves pain and other symptoms. This might not be the first choice, however, due to the risk of decreased bone production, weight gain, and an increased incidence of depression in some cases.

Gonadotropin-releasing hormone (GnRH) agonists and antagonists

Women take what are known as gonadotropin-releasing hormone (GnRH) agonists and antagonists to block the development of estrogen which stimulates the ovaries. The hormone that’s mainly responsible for the development of female sexual characteristics is known as estrogen. The production of estrogen when blocked prevents menstruation and creates an artificial menopause.

Side effects like vaginal dryness and hot flashes are caused by GnRH therapy. Small doses of estrogen and progesterone if taken together can help to limit or prevent these symptoms.

Danazol

Danazol is another medication used to stop menstruation and decreasing symptoms is called. While taking danazol, the disease may continue to progress. Side effects of danazol may include acne and hirsutism. Abnormal hair growth on the face and body is called hirsutism.

Other drugs that may improve symptoms and slow disease progress are being studied.

Conservative surgery

Conservative surgery is conducted for women who wanting to get pregnant or experiencing severe pain and for whom hormonal treatments aren’t helpful. The aim of conservative surgery is the removal or destroying endometrial growths without damaging the reproductive organs.

Laparoscopy which is a minimally invasive surgery used to both visualize and diagnose, endometriosis and also for the removal of the endometrial tissue. Small incisions are made by the surgeon in the abdomen to surgically remove the growths or to burn or vaporize them. A way to destroy “out of place” tissue, lasers is commonly used these days.

Last-resort surgery (hysterectomy)

Rarely, a total hysterectomy may be suggested by the doctor as a last resort if the condition doesn’t improve with other treatments.

During a total hysterectomy, the uterus and cervix are removed by the surgeon. The ovaries are also removed by them because these organs make estrogen, and estrogen causes the growth of endometrial tissue. Visible implant lesions are also removed by the surgeon.

A hysterectomy is not generally considered as a treatment or cure for endometriosis. After a hysterectomy, getting pregnant may not be possible. A second opinion should be taken before agreeing to surgery if thinking about starting a family.

 

 

Endometriosis – Causes

During a normal menstrual cycle, the lining of the uterus is shed by the body which allows menstrual blood to flow from the uterus through the small opening in the cervix and out through the vagina.

The exact cause of endometriosis is unknown, and there are various theories regarding the cause, although no theory has been proven scientifically.

Endometriosis occurs due to a process called retrograde menstruation is found in one of the oldest theories. This occurs when instead of leaving the body through the vagina menstrual, blood flows back through the fallopian tubes into the pelvic cavity.

Hormones transform the cells outside the uterus into cells which are similar to those lining the inside of the uterus, called as endometrial cells are found in another theory.

Some other theories believe that the condition may occur if small sites of the abdomen convert into endometrial tissue which may happen due to the cells in the abdomen growing from embryonic cells, which can change its shape and act like endometrial cells. The reason for why this causes is not known.

These displaced endometrial cells may be found on pelvic walls and the surfaces of pelvic organs, such as bladder, ovaries, and rectum. Growth, thickening, and bleeding may continue over the course of menstrual cycle in response to the hormones of cycle.

It’s also possible that leakage of the menstrual blood into the pelvic cavity through a surgical scar, such as after a cesarean delivery (also commonly called a C-section).

The endometrial cells are transported out of the uterus through the lymphatic system as mentioned in another theory. Still in another theory it is said that it may be due to immune system being faulty that isn’t destroying errant endometrial cells.

Endometriosis might begin in the fetal period with misplaced cell tissue that begins to respond to the hormones of puberty as believed in some theories. This is often known as Mullerian theory. The production of endometriosis might also be connected to genetics or even environmental toxins.

 

 

Endometriosis stages

Endometriosis has four stages or kinds. It can be any of the below:

  • minimal
  • mild
  • moderate
  • severe

The stage of the disorder is determined by various factors. The location, number, size, and depth of endometrial implants may be included in these factors.

Stage 1: Minimal

In minimal endometriosis, small lesions or wounds and shallow endometrial implants on ovary may be present. Inflammation in or around the pelvic cavity may also occur.

Stage 2: Mild

Light lesions and shallow implants on an ovary and the pelvic lining are involved in mild endometriosis.

Stage 3: Moderate

Deep implants on ovary and pelvic lining are involved in moderate endometriosis. More lesions can also be present.

Stage 4: Severe

Deep implants on the pelvic lining and ovaries are involved in the fourth and most severe stage of endometriosis and may also include lesions on fallopian tubes and bowels.

 

 

Diagnosis

The symptoms of endometriosis can be same as that to the symptoms of other conditions, such as ovarian cysts and pelvic inflammatory disease. An accurate diagnosis is needed for treating the pain.

One or more of the following tests may be performed by the doctor:

Detailed history

Symptoms and personal or family history of endometriosis will be noted down by the doctor. If there are any other signs of a long-term disorder, a general health evaluation may be performed also.

Physical examination

During a pelvic examination, abdomen may felt manually by the doctor for cysts or scars behind the uterus.

Ultrasound

A transvaginal ultrasound or an abdominal ultrasound may be used by the doctor. A transducer is inserted into the vagina during a transvaginal ultrasound.

Both kinds of ultrasound provide images of the reproductive organs and can help the doctor in identifying cysts connected with endometriosis, but they aren’t effective in ruling out the disease.

Laparoscopy

By viewing it directly is the only certain method for identifying and is done by a minor surgical procedure called as a laparoscopy. Once it is diagnosed, removal of the tissue is in the same procedure.

 

 

 

Endometriosis complications

A serious complication of endometriosis is having fertility problems. Women having milder types may be able to conceive and carry a baby.

Fertility is not improved by medications. After having endometrial tissue surgically removed, some women were able to conceive. If this doesn’t work in your case, fertility treatments or in vitro fertilization may be considered to help improve the chances of having a baby.

Having children sooner rather than later might be considered if diagnosed with endometriosis and wanting children. The symptoms may worsen over the period of time, which can make it difficult to conceive. Doctor may need to examine before and during pregnancy. Doctor should be consulted in order to understand the options.

Managing chronic pain can be difficult, fertility when not being a concern. Common issues may include depression, anxiety, and other mental issues. Doctor should be consulted about ways to deal with these side effects. Joining a support group may also be helpful.

Risk factors

Around 2 to 10 percent of childbearing women in the United States being between the ages of 25-40 are diagnosed with endometriosis. It usually produces years after the beginning of the menstrual cycle. This condition can be painful but understanding the risk factors can help in determining whether the condition is likely and when should the doctor be contacted

Age

Risk for endometriosis is among women of all ages. It generally affects women between the ages of 25 and 40, but at puberty the symptoms may start.

Family history

If having a family member who has endometriosis then the doctor should be consulted. Then the risk of developing the disease is higher.

Pregnancy history

The symptoms may temporarily reduce of endometriosis in pregnancy. Risk of developing the disorder is greater in women who haven’t had children. However, women who’ve had children may still have a chance of getting endometriosis. This assists the understanding that the development and progress of the condition is influenced by hormones.

Menstrual history

Doctor should be consulted if having issues regarding period. Shorter cycles, heavier and longer periods, or menstruation that starts at a young age may be included in the issues. A higher risk may be placed by these factors.

 

The Bottom Line

Endometriosis is a chronic condition with no cure the causes are not understood yet.

But this doesn’t mean in the condition the daily life is impacted. For managing pain and fertility issues, such as medications, hormone therapy, and surgery effective treatments are available. After menopause the symptoms of endometriosis generally improve.

 

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