Unveiling Endometriosis: Understanding Symptoms, Diagnosis, and Treatment

What is Endometriosis?

Endometriosis in women is a condition where the lining of the womb or uterus is found outside of it. Especially in the areas near the pelvis or lower abdomen. Although doctors find it in other rare places like heart, lungs, eye, and cesarean section scars too.

How common is endometriosis in women?

Overall endometriosis seems to occur in about 10% of all women. However, when doctors consider the subset of Infertile women, it seems to be present in 25 to 50% of them. Of the women who have long-standing lower abdomen pain, endometriosis is present in 75 to 80% of them.

Symptoms of endometriosis in women:

One of the first things you need to know about the symptoms is that their severity does not correlate with the extent of the disease.

Some women with extensive endometriosis have no symptoms. Others, with even minimal disease, may have incapacitating pain. In many women, endometriosis does not cause pain until it has been present for several years.

The main symptom of endometriosis in women is a pain in the lower abdomen and pelvic area. The pain usually varies during the menstrual cycle, worsening before and during menstrual periods. Sometimes the pain may persist even after the periods are over and this differentiates it from the other common causes of pain during periods that some women have. There is pain during intercourse as well.

Misplaced endometrial tissue responds to the same hormones estrogen and progesterone as normal endometrial tissue in the uterus. Consequently, the misplaced tissue may bleed during menstruation and cause inflammation. 

Symptoms vary depending on the location of endometrial tissue:

Intestines: Abdominal bloating, pain during bowel movements, diarrhea or constipation, or rectal bleeding during menstruation.

Bladder: pain during urination, urine that contains blood, and a frequent and urgent need to urinate.

Ovaries: Formation of a blood-filled mass called endometriotic cysts or chocolate cysts because they contain chocolate-colored fluid inside. 

Other symptoms may be:

Menorrhagia or heavy periods: If endometriosis affects the wall of the uterus, the diagnosis is known as Adenomyosis. In such cases, women can have menstrual irregularities, such as heavy menstrual bleeding and spotting before menstrual periods or spotting continuing long after the periods are over. Other uncommon but possible symptoms can be:

  • Migraines
  • Nausea, and
  • Lower back pain

The misplaced endometrial tissue and its bleeding may irritate nearby tissues. As a result, scar tissue may form, sometimes as bands of fibrous tissue (adhesions) between structures in the abdomen. The missing endometrial tissue and adhesions can interfere with the functioning of organs. 

Endometriosis in women may also cause infertility by interfering with sperm and egg interaction. Thus, releasing some chemicals destroys the eggs and sperm. It also reduces the uterus’s ability to accept the embryo and make it grow.

During pregnancy, endometriosis may become inactive temporarily or sometimes permanently. Endometriosis tends to become inactive after menopause because estrogen and progesterone levels decrease.

Pain during periods is very common. How does one differentiate which one is serious and which one is not? 

Pain is not a very uncommon symptom for women. More than 90% or more women would suffer from it at some point in their lives. When periods happen, certain chemicals like Prostaglandins are released which causes the pain of periods. This pain typically starts when periods start and pain is relieved within a day or so and may require mild painkillers.

However certain symptoms may tell us that the pain is not normal, for eg:

  • Firstly, when the pain starts even before periods, increases during periods, or even persist after the periods are over
  • Also, when the pain is so severe that normal day-to-day functioning is hampered
  • When over the months and years, pain during periods has only been increasing
  • If during periods, passing urine or stool also caused pain
  • Lastly, if the pain is also felt during deep penetration intercourse

Most adolescents when they present with these symptoms are told that marriage would solve all their problems or maybe having a baby will. If you experience the above symptoms, don’t ignore them, see a Gynaecologist. Diagnosis can be sometimes very easy and sometimes extremely tricky and based more on the doctor’s gut instinct and experience. 

Diagnosis of Endometriosis in women:

In sexually active women, doctors prefer performing a vaginal examination as it provides some vital clues which further help in the diagnosis. During the examination, the woman will experience pain at specific points that point in the direction of endometriosis. 

Vaginal ultrasound and an MRI may help in the diagnosis if the following are present:

Characteristic-looking cysts in the ovaries are called endometriotic cysts or chocolate cysts. They are called so because they are called chocolate-colored fluid inside the cysts which is nothing but altered blood. It’s prudent to remember that even if the cysts are not present, endometriosis may still be present in other forms in the deeper tissues.

Endometriotic nodules in various parts of the pelvis: Blood markers like CA125 when raised may point towards the possibility of endometriosis being present. However, the values may be normal even if the disease is severe.

When none of the above tests are helping, then the diagnosis is clinched by performing  Laparoscopy or putting a telescope into the tummy through the belly button. The endometriosis can be directly visualized, and tissues can be collected and sent for biopsy testing.

When doctors check adolescent girls they don’t like to perform a laparoscopy and if no other method helps the diagnosis, they directly set out to treat based on symptoms. The relief in symptoms helps to make a retrospective diagnosis that what they are or were dealing with is endometriosis.

Why does Endometriosis Take Place?

Doctors don’t know why it happens but there are several hypotheses. Some say the lining travels through the fallopian tube and falls into the tummy. Some say it travels through the blood vessels while some think that cells located outside the uterus may change into uterine lining cells. 

Characteristics that Lead to Endometriosis in Women

Endometriosis sometimes runs in families and is more common among first-degree relatives like mothers, sisters, and children of women with endometriosis. It is more likely to occur in women with the following characteristics:

  • Have their first baby after the age of 30
  • Have never had a baby
  • Started to menstruate earlier than usual or stopped menstruating later than usual
  • Have short menstrual cycles (less than 27 days long) with heavy periods that last more than 8 days
  • Have certain structural abnormalities of the uterus

Certain situations seem to be protective or preventive like for example those who:

  • Have had several pregnancies
  • Started to menstruate later than usual
  • Breastfeed a long time
  • Have used low-dose oral contraceptives for a long time
  • Exercise regularly (especially if they started before age 15, exercise more than 4 hours a week, or both)

Is there a “cure” for endometriosis?

There is no cure for endometriosis. However, there are many treatment and management options to greatly improve patients’ quality of life. 

To summarize here are some important facts about endometriosis:

  • Endometriosis is a progressive disease
  • Sometimes it may take up to 8 years before a diagnosis can be made
  • The symptoms do not correlate with the severity of the disease
  • Endometriosis causes infertility
  • Fallopian tubes are usually open in endometriosis giving a false sense of complacency that pregnancy can occur naturally
  • Endometriosis is bound to recure after both medical and surgical management
  • Treatment will depend on the age, the symptoms, and the need for fertility
  • Speak to your doctor about future plans and the pitfalls of surgery before getting a laparoscopy done.

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