Overview
Endometriosis is a painful disorder in which tissue similar to the tissue lining the inside of the uterus grows outside the uterus, usually affecting the ovaries, fallopian tubes, and the tissue lining the pelvis. During menstrual cycles, this tissue thickens, breaks down, and bleeds, but it has no way to exit the body, becoming trapped. Endometriosis can cause cysts called endometriomas, irritation, and the development of scar tissue and adhesions.
Understanding the disease
Symptoms
The primary symptom of endometriosis is pelvic pain, often associated with menstrual periods. The pain may be severe and can increase over time. Other common symptoms include:
- Painful periods (dysmenorrhea) with cramping and back or abdominal pain.
- Pain during or after intercourse.
- Pain with bowel movements or urination, usually during menstrual periods. Additional symptoms may include fatigue, diarrhea, constipation, bloating, or nausea, particularly during menstrual periods. The severity of pain may not always indicate the extent of the condition, as some individuals with mild endometriosis can experience severe pain, while others with advanced endometriosis may have little or no pain.
Risk Factors
Risk factors for developing endometriosis include starting your period at an early age, going through menopause at an older age, having short menstrual cycles (less than 27 days), experiencing heavy menstrual periods that last longer than seven days, and having higher levels of estrogen in your body or greater lifetime exposure to estrogen. Other risk factors include never giving birth, low body mass index, having one or more relatives (mother, aunt, or sister) with endometriosis, and any medical condition that prevents the passage of blood from the body during menstrual periods.
Development
Endometriosis develops when cells similar to those that line the inside of the uterus grow outside the uterus, usually on the ovaries, fallopian tubes, and tissue lining the pelvis. This abnormal growth occurs due to various factors, including:
- Retrograde menstruation: Menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of being expelled out of the body. These cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed during each menstrual cycle.
- Transformation of peritoneal cells: Hormones or immune factors may promote the transformation of peritoneal cells (cells that line the inner side of the abdomen) into endometrial-like cells.
- Embryonic cell transformation: Hormones such as estrogen may transform embryonic cells during puberty into endometrial-like cell implants. These processes contribute to the development of endometriosis, which can lead to the formation of endometrial-like tissue outside the uterus, causing pain, cysts, and adhesions.
Assessment and Diagnosis
Diagnosis
To diagnose endometriosis, your doctor will typically start by asking you to describe your symptoms, including the location and timing of your pain. Some tests that can help check for physical clues of endometriosis include a pelvic exam and various imaging tests, such as ultrasound or MRI. In some cases, your doctor may also perform a laparoscopy, which involves inserting a thin, lighted instrument through a small incision in your abdomen to view your pelvic organs, or an endometrial biopsy, which involves removing a small sample of endometrial tissue for testing.
Management and Treatment
Complications
One of the potential complications of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis may have difficulty getting pregnant. Endometriosis can obstruct fallopian tubes, damage eggs or sperm, or affect fertility in other ways. However, many with mild to moderate endometriosis can still conceive and carry a pregnancy to term. It is advised not to delay having children if you have endometriosis, as the condition may worsen with time. Other complications of endometriosis may include pain with intercourse, pain with bowel movements or urination, excessive bleeding, and other symptoms such as fatigue, diarrhea, constipation, bloating, or nausea.
Treatment
Treatments for endometriosis include medications and surgery. Medications can help alleviate pain and reduce inflammation, while surgery is used to remove endometrial growths or scar tissue. Hormone therapies such as birth control pills, progestin therapy, and gonadotropin-releasing hormone (GnRH) agonists can also be effective in managing endometriosis symptoms. In some cases, laparoscopic surgery may be recommended to remove endometrial growths or scar tissue. It is important to consult with a healthcare professional to determine the best course of treatment based on the individual's specific symptoms and condition.
Preparing for medical consultation
To prepare for an appointment for endometriosis, you can:
- Make a list of any symptoms you're experiencing, including any that might not seem related to endometriosis.
- List all medications, herbs, and vitamin supplements you take, including doses and how often you take them.
- Bring a family member or close friend to accompany you, as appointments can provide a lot of information.
- Take a notepad or electronic device to jot down important information during the appointment.
- Prepare a list of questions to ask your doctor, prioritizing the most important ones. Some basic questions to ask your doctor about endometriosis include:
- How is endometriosis diagnosed?
- What medications are available to treat endometriosis? Is there a medication that can improve my symptoms?
- What side effects can I expect from medication use?
- Under what circumstances do you recommend surgery? By being well prepared, you can ensure that you cover all the essential points during your appointment and gain a better understanding of your condition and available treatment options.