The uterus of a woman is lined with a tissue called the endometrium. Sometimes, this tissue may develop outside of the uterus. This condition is called endometriosis.
Endometriosis can occur in any woman of childbearing age, including teenagers. It can also recur in women previously treated for endometriosis.
Normally, endometrial tissue lines the inside of the uterus. The presence of endometrial tissue outside the uterus is known as endometriosis. All endometrial tissue, whether inside or outside the uterus, can respond to the female sex hormones controlling the reproductive cycle. Just as the endometrial tissue lining the inside of the uterus grows, thickens, and then breaks down and bleeds, so does the endometrial tissue outside the uterus.
However, endometrial tissues and blood inside the uterus are discharged in the normal way, by menstruation, if fertilisation of the egg has not occurred. Endometrial tissue outside the uterus has no normal exit. Thus, when breakdown and bleeding occur, the endometrial tissue remains in the body.
The growing and bleeding of endometrial tissue remaining in the body may cause pain, abnormal menstruation, and scar tissue formation. Endometriosis may also result in infertility.
The following are risk factors that increase the chances of women developing this condition:
- Age - Endometriosis can start at puberty but usually affects women in the 30s and 40s age group
- Family history of endometriosis
- Pregnancy history - Women who have not given birth are at a higher risk of developing endometriosis
- Menstrual history - Women who have shorter cycles, heavier/longer periods and started menstruating at a young age have a higher risk of this condition
Symptoms of endometriosis can be mild or severe. Some people have agonising pain while others just a little discomfort or even no symptoms at all.
Nonetheless, the following are common signs of endometriosis:
- Pelvic pain
- Pain during menstruation
- Pain in the lower abdomen before or after menstrual bleeding
- Irregular or heavy menstrual bleeding
- Pain during sexual intercourse
- Discomfort during bowel movements
- Lower back pain
Symptom-free endometriosis may be discovered during a routine pelvic examination or surgery for some other condition. Alternatively, your doctor may suspect endometriosis if you have any of the above symptoms, upon which he or she may do a physical examination.
Endometriosis is usually diagnosed via:
- Pelvic examination
Laparoscopy may be conducted to confirm a diagnosis. This procedure is usually done on an outpatient basis and is performed under general or local anaesthesia.
A thin viewing instrument called a laparoscope is inserted through a small incision just below the navel. The laparoscope allows the physician to see the abdominal and pelvic cavity and identify abnormally located endometrial tissue.
A second small incision may be made for the insertion of another instrument used as probe or used to remove a small sample of tissue. This sample can then be examined to confirm the diagnosis of endometriosis.
- Minimal - With minimal endometriosis, small lesions and shallow endometrial implants are present on the ovaries. The pelvic cavity and some of the surrounding areas might also be inflamed.
- Mild - People with mild endometriosis usually have light lesions and shallow endometrial implants located on the ovaries and pelvic linings.
- Moderate - Moderate endometriosis usually presents with numerous deep implants on the ovaries and pelvic linings. The patient may also have more lesions.
- Severe - With severe endometriosis, there are many deep implants on the ovaries and pelvic lining. Lesions may be present on the fallopian tubes and bowels. The patient might also develop cysts in one or both ovaries.
There are two natural occurrences that often improve the signs and symptoms of endometriosis - pregnancy and menopause.
During pregnancy, ovulation and menstruation cease and the symptoms of endometriosis may be temporarily relieved.
Following menopause, the ovaries permanently stop secreting female sex hormones and all endometrial tissue withers naturally. Menopause usually occurs when a woman is in her 40s or 50s.
Endometriosis is usually treated with:
- Hormonal drugs - the administration of hormonal drugs can shrink the endometrial tissue and even cause it to disappear eventually
- Hormonal contraceptives - birth control pills and patches prevent the growth of endometrium tissue so that implantation of a woman’s fertilised egg is near impossible. Thus, they can help with endometriosis symptoms
- Conservative surgery - scar tissue and endometrial tissue are removed, while preserving the reproductive organs
- Radical surgery (hysterectomy) - removal of the uterus and ovaries eliminates the source of the hormones that cause endometrial tissue to grow and bleed
- Combination treatment - a treatment plan consisting of a combination of hormonal drugs and conservative surgery is often recommended
While medical intervention is your best bet against managing this condition, the following lifestyle tips may help with the pain:
- Eat healthily - Have a diet that contains fresh fruits and vegetables, and omega-3 fatty acid-rich foods (salmon, walnuts). Reduce your intake of trans fat, alcohol, and caffeine.
- Exercise regularly - Exercise increases blood flow, reduces stress, and can help with symptoms of endometriosis. Try going for a walk a few times a week in the beginning if you’re not used to being active.
- Destress - Stress may worsen your condition. As such, find ways to manage it. You can try meditation or consider speaking to a therapist.
Endometriosis is a chronic illness that does not have a cure just yet. However, there are treatments available that can help you manage the pain and the complications of this condition. Book an appointment with a Gynaecologist at Gleneagles Hospitals today if you are struggling with any of the symptoms mentioned above.