What Is Endometriosis? Causes, Symptoms, and Treatment Explained

Endometriosis is a frequently painful disorder in which tissue resembling the uterine lining grows outside of the uterus. The tissue lining the pelvis, fallopian tubes, and ovaries is frequently impacted. Endometriosis growths can occasionally be discovered outside of the reproductive organs, like the ovaries. 

Endometriosis tissue thickens, degrades, and bleeds with every menstrual cycle, much like the lining of the uterus would. It doesn't exit the body, though, and it grows in inappropriate locations. Endometriomas are cysts that can develop when endometriosis affects the ovaries. Scar tissue may occur if the surrounding tissue becomes inflamed. Additionally, bands of fibrous tissue known as adhesions may develop. As a result of this, pelvic tissues and organs may adhere to one another. 

Pain is a common side effect of endometriosis, particularly during menstruation. Fertility issues could also arise. However, some medicines might help you manage the illness and its side effects.

Symptoms of endometriosis:

Pelvic pain is the primary sign of endometriosis. It is frequently associated with menstruation. Even though many people have cramps throughout their periods, endometriosis patients frequently report experiencing far worse menstrual pain than usual. Additionally, the pain might worsen with time.

The following are typical signs of endometriosis:

• painful periods: During the days leading up to a monthly cycle, pelvic pain and cramping may begin. You can also experience stomach and lower back aches. Dysmenorrhea is another term for unpleasant periods.
  
  
• Pain during sex: Endometriosis frequently causes pain during or after intercourse.
  
  
• Pain during urination: Discomfort when urinating or having bowel movements.
  
  These symptoms are most likely to appear before or during your menstrual cycle.
  
  
• Excessive bleeding: You may occasionally experience heavy menstruation or inter-period bleeding.
  
  
• Infertility: In some cases, endometriosis is initially discovered during infertility therapy examinations.
  
  
• Other symptoms: You can have nausea, bloating, constipation, diarrhoea, or exhaustion. The prevalence of these symptoms is higher before or during menstruation.

The severity of your discomfort may have nothing to do with the quantity or size of endometriosis growths in your body. You can have a tiny bit of tissue that hurts a lot. Alternatively, you may have a large amount of endometriosis tissue with little to no discomfort.

Some endometriosis patients, however, may not exhibit any symptoms. They frequently discover they have the illness after undergoing surgery for another reason or when they are unable to conceive.

Endometriosis symptoms can occasionally be mistaken for those of other illnesses that can cause pelvic pain. These include ovarian cysts and pelvic inflammatory diseases. Alternatively, it could be mistaken for irritable bowel syndrome (IBS), which is characterized by episodes of cramping in the stomach, constipation, and diarrhoea. Endometriosis can also coexist with IBS. 

Causes of endometriosis:

There is no recognized cause for endometriosis. Although there are numerous theories about the etiology of endometriosis, none of them provides a comprehensive explanation for its occurrence.

Some people who have endometriosis may have their ailment due to a combination of the following factors:

• Retrograde menstruation:

A portion of the endometrium, or lining of the womb, travels backwards during menstruation, exiting through the fallopian tubes and entering the abdomen. After that, this tissue grows and attaches itself to the pelvic organs. According to some studies, all menstruating women undergo some kind of retrograde menstruation; nonetheless, their bodies can eliminate this tissue without it accumulating on their organs. This idea does not explain why endometriosis has occasionally been seen in males who have been exposed to oestrogen through medication therapies or why it has occasionally developed after a hysterectomy.

• Genetic predisposition:

According to certain research, family members' genetic code may be able to pass on endometriosis to future generations. Although the origins are unknown, some families may be more prone to endometriosis.

• Lymphatic spread:

It is believed that endometriosis tissue particles circulate throughout the body via the circulation or the lymphatic system. This may help to explain why it has been discovered in places like the brain and eyes.

• Immune dysfunction:

It is believed that the immune system may not always be able to combat endometriosis. Many endometriosis patients seem to be less immune to other illnesses. It is unknown if this is a cause of endometriosis or if it is a contributing factor.

• Environmental reasons:

According to this hypothesis, endometriosis can be brought on by certain environmental pollutants. Dioxin can have an impact on the body, immune system, and reproductive system. Studies have indicated that animals exposed to elevated dioxin levels developed endometriosis. For humans, this theory has not yet been validated.

• Metaplasia:

The process by which one type of cell transforms into another is known as metaplasia. Inflammation typically triggers metaplasia, which allows cells to adapt to their surroundings and better fit their surroundings.

When it comes to endometriosis, metaplasia would account for the cells' spontaneous appearance inside the body, including in the skin and lungs. It would also explain why endometriosis cells show up in males who have undergone hormone therapy or in women who don’t have a uterus. 

Risk factors of endometriosis:

The following variables increase the risk of endometriosis:

• never getting pregnant.
  
  
• beginning your menstrual cycle early in life.
  
  
• experiencing menopause later in life.
  
  
• Brief menstrual cycles, such as those lasting shorter than 27 days.
  
  
• menstrual cycles that are heavy and last beyond seven days.
  
  
• Either being exposed to more estrogen produced by your body over your lifetime, or having higher levels of estrogen in your body.
  
  
• low index of body mass.
  
  
• a mother, aunt, sister, or other family members who have endometriosis.

An additional risk factor for endometriosis is any medical condition that stops blood from leaving the body during menstruation. Reproductive tract conditions can also do this.

Symptoms of endometriosis can appear years after the onset of menstruation. During pregnancy, the symptoms could temporarily improve. If you do not take estrogen medication, menopausal pain may gradually lessen.

How to diagnose endometriosis?

Your doctor will probably begin by performing a physical examination to determine whether you have endometriosis. You'll be asked to explain your symptoms, such as the location and timing of your pain.

• Pelvic exam: To check for any odd changes, your healthcare provider will use one or two gloved fingers to feel specific parts of your pelvis. These alterations may include painful patches, nodules, scarring behind the uterus, and cysts on the reproductive organs. Until a cyst has developed, tiny patches of endometriosis are frequently undetectable.
  
  
• Ultrasound: This test creates images of the interior of the body using sound waves. A device known as a transducer may be applied to the stomach region to take the pictures. Alternatively, it could be inserted into the vagina during a transvaginal ultrasound examination. To obtain the best image of the reproductive organs, either sort of test may be performed. The presence of endometriosis cannot be determined by a routine ultrasound. However, it can identify cysts associated with endometriomas.
  
  
• Imaging by magnetic resonance (MRI): Radio waves and a magnetic field are used in this examination to create images of the body's organs and tissues. For some, surgical planning is aided by an MRI. It provides your surgeon with comprehensive information regarding the size and location of growths caused by endometriosis.
  
  
• Laparoscopy: A laparoscopy allows the surgeon to look for endometriosis tissue inside your abdomen. You are given medication before the procedure that reduces pain and induces a sedative mood. Next, your surgeon inserts a thin viewing device known as a laparoscope after making a tiny incision close to your navel.

Treatment:

Endometriosis is frequently treated with medication or surgery. The severity of your symptoms and your desire to become pregnant will determine the course of action you and your medical team choose.

Usually, medication is suggested first. If it is insufficiently beneficial, surgery may be necessary.

• Pain medicines: Your medical team may suggest over-the-counter painkillers. These medications include naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, and other nonsteroidal anti-inflammatory drugs, or NSAIDs). They can lessen uncomfortable menstrual cramps.
  
  If you are not attempting to conceive, your healthcare staff may suggest hormone therapy in addition to pain medication.
  
  
• Hormonal therapy: Hormone medications can occasionally reduce or eliminate endometriosis pain. Endometriosis tissue thickens, degrades, and bleeds as a result of the fluctuations in hormone levels that occur during the menstrual cycle. Hormones produced in a lab may inhibit the formation of new tissue and limit the growth of existing tissue.
  
  
• Surgical treatment: Surgical procedures may be recommended for those with severe symptoms, such as infertility, or when other treatments fail. 
  
  
• Fertility treatment: In vitro fertilization (IVF) and other assisted reproductive technologies may be suggested for those experiencing infertility as a result of endometriosis.

Conclusion:

Millions of people worldwide suffer from endometriosis, a complicated, multidimensional illness. Research has improved our understanding of its mechanics and produced more effective management measures, even though its precise cause is still unknown. Improving outcomes for individuals with endometriosis requires early detection, tailored therapy, and a comprehensive approach to care.

It's critical to get medical help if you or someone you know is exhibiting endometriosis-like symptoms. Controlling symptoms, maintaining fertility, and improving general well-being can all be greatly impacted by prompt diagnosis and suitable treatment.

References:

1. https://www.ncbi.nlm.nih.gov/books/NBK567777/ 

2. https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656

3. https://pubmed.ncbi.nlm.nih.gov/39055487/ 

4. https://www.verywellhealth.com/metaplasia-7377448

5. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00389-5/abstract