What Causes Endometriosis?

By Dr. Duru Shah

The most severe painful periods in women occur due to a condition called "Endometriosis". Though it is a benign condition, it can behave like a cancer!

It spreads its tentacles from the ovaries to the pelvis and can go further to invade the bowel, the bladder, the uterus, scars in the abdomen wall and sometimes travel even beyond the pelvis and the abdomen into the chest!

what causes endometriosis

What Is Endometriosis?

It is simply the invasion of the endometrium (inner lining of the uterus) into spaces where endometrium is normally not found. It responds to the hormones in the body in a similar way as the endometrium responds.

Every month, the endometrium within the uterus grows thicker in response to the rising hormones in the blood of a menstruating woman, and prepares itself to receive an embryo.

If a woman has been sexually active and has conceived, then this thick lining helps in nourishing the growing embryo. But if a woman is not pregnant, the endometrium is shed off through the vagina during a menstrual period and the cycle starts all over again in the next month.

Just as the endometrium within the uterus responds, so also does the endometrium outside the uterus - to the circulating reproductive hormones.

It grows thicker and sheds every month, and when it sheds, the blood which accompanies it, has no outlet. This collection of blood into spaces, which have no outlet, causes the extreme pain which accompanies this condition.

The pain in the early stages maybe mild, but as the disease progresses, the pain gets excruciating and unbearable, leaving a woman in agony which is difficult to be controlled with some routine painkillers.

what causes endometriosis

Unfortunately, endometriosis is the disease of young women in their reproductive age, when oestrogen, the youth hormone is in circulation.

Hence, it can occur in any girl after she starts menstruating but is not seen after menopause. It is important to keep this in mind, as there are many girls who have such severe pain during periods that they actually miss school or college during their periods.

Some of them vomit and even faint, and they are told that this is normal, they are asked to bear the pain and the fact that it will diminish after marriage. If only the woman opts to get an ultrasound done, we would be able to treat these young girls and make their lives more comfortable, besides preventing the disease from getting more severe.

The only self-limiting event is menopause. Once a woman attains menopause either naturally or due to surgical removal of the ovaries which produce the reproductive hormones causing the endometrium to grow and shed, the disease comes to a halt and regresses gradually.

But even after menopause, it can get stimulated once again if the affected woman goes in for therapies containing oestrogenic compounds such as isoflavones (herbal) or oestrogen itself.

Endometriosis is more commonly seen in working women or those who have "Type A" personalities and in women who delay childbirth. Approximately, 40% of infertile women have endometriosis, which may be mild, moderate or severe.

what causes endometriosis

In infertile women, the disease may be so mild that it may not show on sonography. But if we suspect that it may be present, then to prove the diagnosis, we have to proceed with a laparoscopy i.e., check the interior of the abdomen with a telescope.
Besides, the pain which it causes in the lower abdomen and back, endometriosis can also be the cause of extreme pain during sexual intercourse which is termed as dyspareunia.

There is unfortunately no cure for this disease as of today, only because we still do not know the cause of this disease. Fortunately, we do have potent drugs that can help to keep it under control, but these drugs do have side effects, thus limiting their use.

Surgery is the preferred choice of treatment for relief of pain, especially if excessive. The surgery can be performed laparoscopically or as an open surgery, depending on the severity of the condition.
The ideal option for infertility management in a woman having moderate or severe endometriosis is assisted reproduction (IVF) after removing as much of the disease as possible surgically.

Endometriosis is truly a condition which may make a woman dread the approach of her period and also her sexual partner.

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    Dr. Duru Shah is a Consultant Gynaecologist in private practice, with a special interest in Gynecological Endocrinology Infertility and Assisted Reproduction.

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