By Dr. Annanyaa Reddy
Endometriosis is a chronic inflammatory condition that brings challenges such as severe pelvic pain and difficulties getting pregnant. It is relatively common, affecting around 10% of adolescents and women of the reproductive age group (15-49 years) globally. Some women face this condition post-menopause as well. Nearly 26 million women in India have endometriosis. Around 25-50% of women with infertility and 50-80% of women with pelvic pain are diagnosed with endometriosis.
Despite its high prevalence, many women are unaware of endometriosis and suffer for a long time without receiving the appropriate help. Today, let’s break this cycle and explore everything about endometriosis: symptoms, causes, risk factors, diagnosis, and treatment.
Let’s Start with the Basics! What Is Endometriosis?
Endometriosis is a uterine condition. During the first phase of the menstrual cycle, estrogen causes the endometrium (uterine lining) to grow and thicken inside the uterus in preparation for potential pregnancy. When conception does not happen, this lining sheds and exits the body through the vagina during a menstrual period.
In endometriosis, tissue like the uterine lining grows outside the uterus, such as over the ovaries, fallopian tubes and other pelvic organs. Rarely, it can also develop in different body parts like the lungs, nose, brain, or over surgical scars.
Endometrial tissue also responds to estrogen, undergoing growth, thickening, and shedding during menstruation. The only difference is that they cannot leave the body entirely since they are in abnormal places. As a result, the body experiences inflammation, scar tissue formation, ovarian cysts, and adhesions binding pelvic tissues and organs together.
Signs and Symptoms of Endometriosis You Should Know
The most common symptom of Endometriosis is chronic pelvic pain that lasts for over six months.
However, women with endometriosis may also have the following symptoms:
- Painful periods (pain may start before a period, continue during menstruation and remain for a few days afterwards)
- Heavy menstrual flow
- Spotting or bleeding in between periods
- Pain during or after sex
- Pain with bowel movements or urination
- Rectal bleeding
- Bleeding with urination
- Difficulty getting pregnant
- Fatigue
More useful highlights around the signs and symptoms of endometriosis:
- Some women with endometriosis may also have less common symptoms such as chronic cough, chest pain, and shoulder tip pain.
- Women with endometriosis-related ovarian cysts may experience abdominal pain along with pelvic discomfort.
- Women having endometrial tissues growing in or around their surgical scar may experience recurring pain and swelling in that area, particularly during menstruation or intercourse.
- In high-risk women, endometriosis can occur with a few other conditions, such as pelvic inflammatory disease and irritable bowel syndrome.
- Many women will not have any symptoms of endometriosis and only find out about the condition when they face difficulties getting pregnant.
Common Known Causes of Endometriosis
Researchers and doctors are yet to understand the causes of endometriosis. At present, there are various theories about why this condition develops. Let’s explore the popular ones:
- Genetics: Evidence suggests that women having a family history of first-degree relatives (mother or sister) with endometriosis are 7-10 times more likely to have the condition.
- Direct transplantation: During surgeries such as c-sections, hysterectomies, or laparoscopic procedures, pieces of endometrial tissue can transfer and grow on various pelvic organs or structures outside the uterus.
- Stem cell theory: Stem cells play a role in regenerating the endometrium (uterine lining) after it sheds during menstruation. Endometriosis occurs when these stem cells develop into endometrial cells and implant in areas beyond the uterus.
- Retrograde menstruation theory: For a long time, experts believed endometriosis happened when the menstrual blood flowed backwards (retrograde) through the fallopian tubes, attached to the organs in the pelvis, and continued to grow there. However, this theory is unreliable, as endometrial implants sometimes occur in areas beyond the pelvis. Moreover, retrograde menstruation is relatively common and does not usually cause problems.
Risk Factors of Endometriosis
Various factors that can increase the risk of endometriosis include:
- Low weight at birth
- Never given birth
- Being underweight
- Early onset of menstruation (before 11 years of age)
- Shorter menstrual cycles (27 days or less)
- Heavy menstrual periods
- Late menopause
Why Is It Challenging to Diagnose Endometriosis?
Most women with endometriosis are not diagnosed until nearly 7-10 years after developing the condition. Despite medical advances, what is the reason behind delayed diagnosis?
Multiple factors are at play in this situation. Firstly, our society normalises pain, which largely influences a woman’s decision to seek help when necessary. Secondly, the signs and symptoms of endometriosis often overlap with other health conditions, such as irritable bowel syndrome, interstitial cystitis, adenomyosis, and pelvic inflammatory disease.
Moreover, the severity of symptoms often doesn’t correlate with the extent of the disease. It means if you have unbearable pain, it does not necessarily mean your endometriosis has spread aggressively. Neither does little to no pain indicate lesser endometriosis growth. All of this combined leads to diagnostic challenges.
That being said, if you think you may have endometriosis based on the symptoms discussed earlier, consult your gynecologist without further delay! If left untreated, endometriosis can mean more sick days, constant tiredness, and mental health challenges. In short, it will significantly affect your quality of life.
What to Expect During Your First Endometriosis Evaluation? How Should You Prepare for the Consultation
Coming to the question: how will your gynecologist diagnose endometriosis? Here’s a step-by-step guide to help you understand what to expect during your consultation and how to prepare for it:
- Medical history review: The gynecologist will begin the appointment by briefly discussing your symptoms. Tell them when you first noticed your pain, where you feel it, how severe it is, when it occurs, and whether it worsens during your periods. You can expect them to discuss more about your menstrual cycle and infertility issues. They will also likely discuss your family history and other related details to rule out risk factors.
- Pelvic exam: During the pelvic exam, the gynecologist will carefully insert one or two gloved fingers in your vagina to examine the areas of your pelvis. They will check for any abnormal signs such as pain, tenderness, ovarian cysts, and growths behind the uterus.
- Diagnostic tests: Lastly, the gynecologist will order imaging tests like ultrasound and magnetic resonance imaging (MRI) to understand the spread, location, and size of endometriosis growths.
After the diagnosis, the provider will discuss the findings with you and suggest a relevant treatment plan. More on this ahead!
How to Treat Endometriosis? Explore Non-Surgical and Surgical Strategies
Is there a permanent cure for endometriosis? The answer is no. But is it possible to manage endometriosis? Yes, absolutely! Using the right treatment plan, people with endometriosis can reduce pain, improve fertility, and enjoy a good quality of life.
There’s no one-size-fits-all approach when it comes to endometriosis treatment. Gynecologists prepare individualised treatment plans depending on the severity of the symptoms and whether the woman hopes to become pregnant in the future.
Pain Management
The first-line of treatment is usually pain management This can be done through a combination of painkillers and exercise, specifically pelvic floor physiotherapy.
Painkillers: NSAIDs (non-steroidal anti-inflammatory drugs) are often recommended to relieve pain
Pelvic Floor Physiotherapy: Studies have shown that pelvic floor physiotherapy can relieve much of the pain caused by endometriosis. This is because when a person experiences pain at or around the uterus, the muscles surrounding create a guarding response (contracting or tensing up). This creates more tension in the pelvic floor and abdomen. Pelvic floor physiotherapy can stretch and strengthen the pelvic floor decreasing pain and improve overall mobility here.
Medical Management
The gynecologist may recommend further medication if symptoms persists.
- Oral contraceptive pills and gonadotropin-releasing hormone (GnRH) to slow down the progression of endometriosis
- Levonorgestrel-releasing intrauterine system to reduce menstrual flow, hormonal fluctuations, and endometriosis symptoms
Non-medical treatment options:
- Start a pelvic floor physiotherapy exercise routine
- Consume a balanced diet
- Avoid alcohol and smoking
- Join therapy and support groups
- Take Pelvic floor physiotherapy
Surgeries:
- Laparoscopic surgery to remove endometriosis tissue
- Hysterectomy to remove the uterus
How Does Endometriosis Affect Fertility? What Are the Treatment Options?
Endometriosis affects fertility in many ways. If the endometrial tissue is present in the ovaries, they can cause fluid-filled cysts and decrease the number of eggs, reducing the chances of pregnancy every month. In 30% of endometriosis cases, the condition affects the fallopian tubes. It prevents the egg released from the ovary from travelling through the fallopian tube into the uterus for fertilisation. In other cases, even if an egg gets fertilised, it may be hard to attach and grow in the uterus.
Once the gynecologist understands your unique reason behind infertility, they can decide on the effective treatment options for you, such as:
- Medication management to reduce endometrial growth
- Surgical removal or destruction of the endometrial implants
- Egg freezing before surgery to preserve healthy eggs
- Intrauterine insemination (IUI) or In vitro fertilisation (IVF)
Conclusion
There are options for treating endometriosis! Many women with endometriosis mistake the condition for bad period cramps and heavy flow, suffering silently all their lives. They end up at a gynecologist's office only when they are not able to get pregnant.
The takeaway here? If you or a loved one has any degree of pelvic or period pain, do not normalise it. It could mean many things, and endometriosis is one of them. Additionally, as the condition can occur without symptoms, routine gynecologist consultations should be a part of your healthcare plan. This way, your provider can keep a check on your sexual and reproductive health and detect any abnormalities early.
At Proactive For Her, we are committed to helping women with tailored solutions for endometriosis. Book a consultation with any of our trustworthy and non-judgmental gynecologists today and receive the help you deserve.