All About Endometriosis
Dr. Nimmi Mahajan (she/her)

Dr. Nimmi Mahajan (she/her)

Nov 25Menstrual health

All About Endometriosis

This blog has been compiled by Komal Adhlaka, a content writer for Proactive For Her.

Endometriosis happens when the endometrium grows outside of the uterus. It may affect more than 11% of women between 15 and 44. It is common among women in their 30s and 40s. The symptoms of endometriosis can be improved by several different treatment options which may increase your chances of getting pregnant.

Endometriosis is a common gynaecological condition that affects 25 million women in India, nearly 25 to 50% of infertile women have it, while 30-50% of women with endometriosis are infertile. The name of this condition comes from the word "endometrium," which is the tissue that lines the uterus.

Endometriosis occurs when the endometrium grows outside the uterus. Endometriosis occurs mostly in ovaries, fallopian tubes, and the lining of the pelvis but can involve other organs such as the urinary bladder, bowel, and rectum. Endometrium breaks apart and bleeds at the end of your menstrual cycle. But this blood has no place to flow. Hence, the areas surrounding the uterus may become inflamed or you may have scar tissue and lesions.

Types of Endometriosis

Based on the region of growth, there are three main types of endometriosis:

  • The superficial peritoneal lesion is the most common type of endometriosis where you have lesions on your peritoneum that lines your pelvic cavity.
  • Endometrioma or Chocolate cysts (ovarian lesions) are dark-colored, fluid-filled cysts that form in your ovaries.
  • Deeply infiltrating endometriosis is where the endometrium grows under your peritoneum and can affect organs around your uterus, such as your bowels or bladder.

Symptoms 

The primary symptom of endometriosis is pelvic pain during menstrual periods, typically more severe than the cramps that usually happen with periods. Other common signs and symptoms of endometriosis include:

  • Painful periods (dysmenorrhea). Pelvic pain, lower back pain, abdominal pain, and menstrual cramps.
  • Pain in the Abdomen or back
  • Pain with bowel movements or urination. 
  • Painful Sex. 
  • Excessive bleeding. You may experience occasional heavy menstrual periods or intermenstrual bleeding.
  • Difficulty in getting pregnant
  • Other symptoms. You may experience fatigue, diarrhea, constipation, bloating, or nausea during menstrual periods.

Not everyone with endometriosis may experience the same intensity of pain. While some could have severe pain while others could experience mild or no pain at all. Endometriosis is sometimes confused with conditions like pelvic inflammatory disease (PID) or ovarian cysts or irritable bowel syndrome (IBS).

Diagnosis 

Your doctor will conduct a physical exam and a pelvic exam to thoroughly examine your abdomen, uterus, and cervix for any signs of tenderness, or discharge, to rule out any other cause of pain.

Diagnosis is basically clinical suspicion followed by investigations. Ultrasound, MRI, Laparoscopy, and endometriosis biopsy are some of the investigation procedures that might be conducted.

endometriosis

Stages of Endometriosis

According to the American Society of Reproductive Medicine, four stages of endometriosis ( based on Laparoscopic findings) include:

  • Stage I (minimal). There could be a few small lesions but no scar tissue.
  • Stage II (mild). More lesions but no scar tissue. This stage involves less than 2 inches of your abdomen.
  • Stage II (moderate). The lesions may be deep, with endometriomas and scar tissue around your ovaries or fallopian tubes.
  • Stage IV (severe). There are many lesions and scar tissue around your ovaries and fallopian tubes or between your uterus and the lower part of your intestines. There may also be large cysts in your ovaries.

Causes

Although the exact cause of endometriosis is not certain, possible explanations include:

  • Retrograde menstruation. The menstrual blood with endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These cells stick to the pelvic walls and pelvic organs. Throughout your next menstrual cycle, they thicken and bleed.
  • Genetics. Endometriosis may run in Families. If your mom or sister has endometriosis, you’re more likely to get it.
  • Transformation of peritoneal cells. In the "induction theory," experts say that hormones encourage the transformation of peritoneal cells that line the inner side of your abdomen into endometrial-like cells.
  • Immune system disorder. A problem with the immune system may not allow the body to recognize and destroy endometrial-like tissue, growing outside the uterus.

Risk factors

Several risk factors place you at greater risk of developing endometriosis, include:

  • Infertility
  • Early start of the period
  • Short menstrual cycles, lasting less than 27 days
  • Heavy menstrual periods lasting longer than seven days
  • Having higher levels of estrogen in your body, or greater lifetime exposure to it.
  • Late menopause
  • Low body mass index
  • May run in families, first degree relatives (like mother, sister, etc.)
  • Any medical condition that prevents the passage of blood from the body during menstrual periods
  • Reproductive tract disorders

Complications during Endometriosis

Infertility

Infertility is one of the major complications of endometriosis. Though, with mild and moderate endometriosis, women can still conceive.

For the unversed, pregnancy occurs when an egg is released from an ovary to make its journey to the fallopian tube and be fertilized by a sperm cell. After fertilization, the egg attaches itself to the uterine wall. While endometriosis may block the fallopian tube and keep the egg and sperm from uniting. Endometriosis may also affect fertility indirectly by damaging the sperm or egg.

Cancer

Another major complication of endometriosis may be ovarian cancer. Initially, the overall lifetime risk of ovarian cancer is low. Another type of cancer — endometriosis-associated adenocarcinoma — can develop later in life in those who have had endometriosis in their health history. This type of cancer is rare, though.

Treatment

Treatment for endometriosis usually involves medication or surgery, depending on the severity of signs and symptoms

  • Pain Medication

Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) Ibuprofen (Advil, Motrin IB, others) or Naproxen sodium (Aleve) help ease severe menstrual cramps. These medications must only be taken on the doctor’s prescription.

  • Hormonal contraceptives

Birth control pills, patches and vaginal rings help control the hormones responsible for the buildup of endometrial tissue each month.

  • Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists

Gn-RH is a drug that blocks the production of ovarian-stimulating hormones, lowers estrogen levels, and prevents menstruation. They create pseudo-menopause. This leads to the shrinking of endometrial tissue.

  • Progestin therapy

A variety of progestin therapies, including an intrauterine device with levonorgestrel (Mirena, Skyla), the contraceptive implant (Nexplanon), and contraceptive injection (Depo-Provera) or progestin pill (Camila), can halt menstrual periods and the growth of endometrial implants, which may relieve endometriosis signs and symptoms.

  • Aromatase inhibitors

Aromatase inhibitors are a class of medicines that reduce the amount of estrogen in your body.

  • Conservative surgery

If you have endometriosis and are trying to conceive, surgery to remove the endometriosis implants while preserving your uterus and ovaries (conservative surgery) may be helpful. Your doctor may do this procedure laparoscopically or, traditional abdominal surgery in more extensive cases. Even severe endometriosis can be treated with laparoscopic surgery. After surgery, your doctor may recommend taking hormone medication to help ease the pain.

  • Hysterectomy

Removal of the uterus (hysterectomy) is done in those women where medical management has failed, those with advanced disease, or where recurrence has occurred and those whose family is complete and symptoms are severe. Even when the ovaries are not removed, a hysterectomy may still have a long-term effect on your health, especially before the age of 35.

  • Fertility treatment

Endometriosis can lead to trouble conceiving. If you're having difficulty getting pregnant, your doctor may recommend fertility treatment supervised by a fertility specialist.

Lifestyle Changes

Warm baths, hot water bottles, and heating pads can give quick relief from endometriosis pain. Certain lifestyle changes might also help.

Eat right

Going on a special diet won't completely help your symptoms. But the right diet might get some form of relief from altering what you eat.

  1. Limit your trans fat intake as a high intake of trans fats is associated with a higher risk of endometriosis.
  2. Avoid too much gluten consumption as a Research indicates high amounts of gluten intake may lead to bodily inflammation—and that may exacerbate endometriosis
  3. Eat a low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) diet. These are fermentable carbohydrate molecules in certain foods including dairy, wheat, rye, apples, pears, peaches, onion, garlic, mushrooms, etc. When these molecules are removed or reduced in the diet, women tend to witness improvements in their concurrent Irritable Bowel Syndrome (IBS) with endometriosis,
  4. Eat foods high in omega-3 fatty acids. Research has found that people who consume omega-3 fatty acids have less endometriosis pain and inflammation. Experts claim that omega-3 fatty acids raise the levels of the production of prostaglandins, compounds in the body that produce hormone-like effects, and reduce pelvic pain.

Conflicting evidence around diet and endometriosis indicate that many clinicians will adopt a practical approach that can be called RA-RA, (Remove, Assess, Reintroduce, Assess). Take out things from your diet, see if you feel better, then bring them back in and see how you feel then. This is a trial and error program that is completely under your direction and your control and we know different foods upset different people with endometriosis, so there is no universal recommendation

Exercise regularly

Exercising regularly reduces inflammation and stress, and releases endorphins, which can make you less sensitive to pain.

Lower-intensity workouts like yoga can be beneficial, too, by stretching the pelvic tissues and muscles, your pain may be relieved and stress may be reduced.

Try alternative therapies

Besides scientific therapies, alternative therapies which are all-natural may also relieve some women. These therapies may include:

  1. Herbal medicine
  2. Acupuncture
  3. Ayurveda
  4. Massage

Before going for alternative therapy, talk to your doctor first, especially if you’re taking over-the-counter supplements since they could have side effects that you may not know about.

Disclaimer: This information is educational and should not be construed as medical advice. Please consult your doctor before making any dietary changes or adding supplements.

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