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Your guide to endometriosis

Endometriosis is a disorder in which endometrial cells, like the ones covering the inside of the uterus, start growing abnormally in a location outside of the uterus. In normal conditions, endometrial cells create the lining covering the inside walls of the uterus and this lining is being shed each month during menstrual bleeding.

However, if these cells start growing in an area outside of the uterus, they are called endometrial implants and can cause different types of damage depending on their location. These implants can show up on the ovaries, the Fallopian tubes, on the outside surfaces of the uterus, on the lining covering the pelvic cavity or less commonly, in the vagina, cervix or bladder.

Rarely these endometrial implants can spread to locations distant to the pelvic region – they can appear on the liver, on the old surgery scars, even in the lung or on the brain. Even though these structures are not cancerous, their presence in the locations where they shouldn’t be disrupts the normal functioning of the body causing different problems.

Why does this happen?

The endometrial cells continue acting as if they’re still in the uterus – the layer of the endometrial cells thickens and then shreds. Except, in this case, the shredded layers have nowhere to go. This excess tissue becomes a burden for local structures and organs, causing irritation and eventually development of scar tissues and abnormal tissue growth between the organs.

What are the symptoms of endometriosis?

The primary symptom is strong pain in the pelvic region, often following menstrual period. The pain connected to endometriosis can be far stronger than the common menstrual cramps and it can increase over time. Even though pain is often connected to endometriosis, it is not an exclusive companion of this disorder – sometimes endometriosis can progress with no painful episodes whatsoever.

Other symptoms that may indicate this condition include:

  • Pain during or after sex
    A girl's back
    Photo credit: aerodesign.pl / Foter / CC BY-SA
  • Pain when urinating or with the bowel movement, sometimes blood in the urine
  • Low back pain
  • Excessive bleeding during periods (menorrhagia) or bleeding between menstrual periods (menometrorrhagia)
  • Chronic fatigue
  • Diarrhea, bloating or constipation
  • Nausea
  • If the endometrial tissue reaches the lungs or the brain, symptoms like chest pain, coughing blood, headaches or seizures may occur.

As you can see, the symptoms can be mistaken for other health issues, such as pelvic inflammatory disease, ovarian cysts or the irritable bowel syndrome.

What causes endometriosis?

Unfortunately, the definite cause of endometriosis has not been determined yet. There are several theories that may be offering an explanation for this condition, although there isn’t sufficient amount of evidence to make a final conclusion on this topic.

Still, there are a few risk factors that have been recognised to increase the chances of developing endometriosis:

  1. Previous cases of endometriosis in close family members (mother, sister or aunt)
  2. Medical conditions that prevent the menstrual blood flowing out from the body
  3. Previous pelvic infections
  4. Abnormalities in the uterus
  5. Endometriosis occurs more often in women who haven’t given birth before.

How is endometriosis diagnosed?

After the initial conversation with your doctor about your previous medical history, symptoms you’ve been experiencing and the circumstances when the pain occurs, you may be required to take some physical exams.

Pelvic exam – your doctor will manually examine your pelvic area for any abnormalities, cysts or scarring tissue.

Ultrasound – this is not a definite method for discovering endometriosis, but it can show cysts that may be associated with this condition.

Laparoscopy – since this method is invasive, it is the final stop in the diagnosis process. The surgeon will look inside your abdomen searching for signs of endometriosis under general anesthesia. If required, the surgeon can take small tissue samples and send them to laboratory testing – this procedure is called biopsy.

Surprised girl
Photo credit: pedrosimoes7 / Foter / CC BY

What are the risks?

Aside from symptoms that can go from uncomfortable to severe and debilitating, endometriosis has also been linked to ovarian cancer and infertility.

How does endometriosis cause infertility?

The percentage of women experiencing problems conceiving due to endometriosis is very high – approximately 30-50%. Keeping in mind the complexity of the condition and the difficulty of correct diagnosis, it is believed that many cases of unexplained infertility are connected with this condition.

The mechanism involved in the damage endometriosis causes to a woman’s fertility is not completely clear and is probably complex. The scarring that can occur in the pelvis, on the ovaries or on the Fallopian tubes can present an anatomic obstacle for fertilisation. Endometriosis can also affect the fertility by causing the production of hormones that can get in the way of ovulation, fertilisation or implantation of the embryo.

Treatment options depend on your personal choice and your doctor’s preference. They include pain medications to manage the symptoms; hormonal therapy that is mostly used to eliminate the pain and prevent further development of the endometrial tissue; and a surgical procedure that is believed to be superior to other options, but is usually recommended to be saved as a last resort.

If the conservative surgery is ineffective, your doctor may recommend one of the assisted reproductive treatments such as IVF.

While battling the condition, it is important that you find an efficient method to manage your symptoms and relieve the discomfort. Some techniques that may give results are:

  • Warmth can relax the muscles in your pelvic region and reduce the pain – you can try soaking in a warm bath or using a heating pad.
  • OTC medications such as ibuprofen, paracetamol or naproxen can also help with pain. With non-steroidal anti-inflammatory drugs, it is important to find a medication that works best for you, so it may take a few attempts until you find a particular medication that helps relieve the pain quickly and efficiently.
  • Physical activity may help reduce the pain as well – find an activity you enjoy and try to practice it on regular basis. Gentle yoga exercises combined with breathing relaxation techniques can help you relax and redirect your thoughts.
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