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Endometriosis: Causes, Symptoms, Diagnosis & Treatment

Endometriosis is a painful gynaecological disorder which affects between 6 and 10 per cent of women of reproductive age globally [1] . Around 25 to 30% of infertile women have endometriosis and around 30 to 50% of women with endometriosis are infertile [2] .

What Causes Endometriosis

The endometrial tissues are situated in the inside linings of the uterus. These tissues are made up of glands, blood cells, and connective tissues. Normally, the endometrial tissues grow in the uterus to prepare the lining of the womb for ovulation.

Endometriosis occurs when the endometrial tissues grow outside the uterus. This affects the ovaries, fallopian tubes, the lymph nodes, and the peritoneum. The displaced endometrial tissues thicken, breaks down and bleeds during menstruation, which causes pain.

When the lesions grow larger, it affects other bodily functions.

The exact cause of endometriosis is unknown, however, the possible causes include the following.

1. Retrograde menstruation - The menstrual blood containing endometrial tissues flows back into the fallopian tubes and the pelvis instead of exiting the body.

2. Embryonic cell growth - Embryonic cells lining the pelvis and abdomen develop into endometrial tissue during puberty.

3. Transformation of peritoneal cells - Peritoneal cells are cells that line the inner side of the abdomen which transforms into endometrial tissues.

4. Endometrial cell transport - The lymphatic system transports endometrial cells to other parts of the body.

5. Immune system disorder - Problems with the immune system can make it difficult for the body to detect and destroy endometrial tissue growing outside the uterus.

6. Hormones - Endometriosis is triggered by the oestrogen hormone.

7. Surgery - After surgeries such as C-section and hysterectomy, endometrial tissues can attach to a surgical incision.

Symptoms Of Endometriosis [2]

The primary symptom of endometriosis is pelvic pain, which is mostly caused during menstruation. Other symptoms are as follows:

  • Periods lasting longer than 7 days
  • Painful periods (dysmenorrhoea)
  • Heavy menstrual bleeding
  • Nausea and vomiting
  • Fatigue
  • Bloody stool or urine
  • Bowel and urinary problems like pain, constipation, bloating and diarrhoea.
  • Pain during intercourse
  • Infertility [3]

The symptoms of endometriosis are similar to other medical conditions such as ovarian cysts, pelvic inflammatory disease, and irritable bowel syndrome.

Risk Factors Of Endometriosis [4]

  • Genetics
  • Medical history
  • Having periods at an early age
  • Short menstrual cycles (27 days or fewer)
  • Having higher levels of oestrogen in the body
  • Women aged between 30 to 40 years
  • Low body mass index
  • Reproductive tract abnormalities

Other health conditions like allergies, asthma, autoimmune diseases, chronic fatigue syndrome, ovarian cancer and breast cancer have been linked to endometriosis.

Also, a research study has linked endometriosis to certain chemicals [5] .

Complications Of Endometriosis

  • Infertility
  • Ovarian cysts
  • Ovarian cancer
  • Scar tissues and adhesion
  • Inflammation
  • Intestinal and bladder complications

Diagnosis Of Endometriosis

The doctor will first ask about your symptoms followed by tests like pelvic exam, ultrasound, MRI, and surgical laparoscopy. The diagnosis of endometriosis is categorized as follows:

  • Stage 1 - Lesions are small and isolated
  • Stage 2 - Lesions are mild
  • Stage 3 - Lesions are moderate
  • Stage 4 - Lesions are multiple

Treatment Of Endometriosis [6]

  • Pain medications - Over-the-counter medicines such as nonsteroidal anti-inflammatory drugs (NSAIDs), ibuprofen or naproxen sodium to help bring relief from menstrual cramps.
  • Hormone therapy - Treatment is done through therapies like hormonal birth control, gonadotropin-releasing hormone (Gn-RH) agonists and antagonists, medroxyprogesterone (Depo-Provera) or danazol. These reduce the pain associated with endometriosis.
  • Surgery - If you have endometriosis and are trying to conceive, surgery is done to remove the endometrial tissues while preserving the uterus and ovaries.

Tips To Manage Endometriosis Symptoms

  • Heating pads and warm baths can relax your pelvic muscles, thus reducing cramps and pain.
  • Light excercises like walking may reduce pain and slow the progression of oestrogen levels.
  • Avoid drinking caffeine.
View Article References
  1. [1] Rogers, P. A., D'Hooghe, T. M., Fazleabas, A., Giudice, L. C., Montgomery, G. W., Petraglia, F., & Taylor, R. N. (2013). Defining future directions for endometriosis research: workshop report from the 2011 World Congress of Endometriosis In Montpellier, France.Reproductive sciences (Thousand Oaks, Calif.),20(5), 483-499.
  2. [2] Mishra, V. V., Gaddagi, R. A., Aggarwal, R., Choudhary, S., Sharma, U., & Patel, U. (2015). Prevalence; Characteristics and Management of Endometriosis Amongst Infertile Women: A One Year Retrospective Study.Journal of clinical and diagnostic research : JCDR,9(6), QC01-QC3.
  3. [3] Bulletti, C., Coccia, M. E., Battistoni, S., & Borini, A. (2010). Endometriosis and infertility.Journal of assisted reproduction and genetics,27(8), 441-447.
  4. [4] Moradi, M., Parker, M., Sneddon, A., Lopez, V., & Ellwood, D. (2014). Impact of endometriosis on women's lives: a qualitative study.BMC women's health,14, 123.
  5. [5] Buck Louis, G. M., Peterson, C. M., Chen, Z., Croughan, M., Sundaram, R., Stanford, J., … Kannan, K. (2013). Bisphenol A and phthalates and endometriosis: the Endometriosis: Natural History, Diagnosis and Outcomes Study.Fertility and sterility,100(1), 162-9.e92.
  6. [6] Mettler, L., Ruprai, R., & Alkatout, I. (2014). Impact of medical and surgical treatment of endometriosis on the cure of endometriosis and pain.BioMed research international,2014, 264653.
Story first published: Tuesday, May 7, 2019, 18:30 [IST]