Endometriosis is a chronic and painful medical condition which causes cells that behave like those within the womb, called the endometrium, to appear in other parts of the body such as the ovaries, fallopian tubes, bladder, bowel and sometimes even as far as the diaphragm and lungs.
During every menstrual cycle, the endometrium prepares to house a fertilized egg. It thickens, breaks down and bleeds when there is no fertilized egg to nurture. For patients with this disease, the displaced endometrial cells in other parts of the body also behave like this, breaking down and bleeding. Because there is nowhere for all the blood to go, the surrounding cells and tissues are irritated. This causes inflammation or swelling, and eventually scars and abnormal adhesions, which are abnormal tissues that cause organs to adhere or stick together.
Symptoms of Endometriosis
The main symptom of endometriosis is pelvic pain, which usually happens during your menstrual period. However, there can be pain even outside the period so make sure you see a doctor if you are experiencing any of these symptoms. Other common symptoms include:
- Very painful menstrual cramps – also called dysmenorrhea
- Pain during or after sex
- Pain with bowel movements
- Pain outside of your periods
- Pain when urinating
- Bleeding or spotting outside your periods
- Infertility or reduced fertility
- Chronic Urinary Tract Infections
- Nausea especially during menstrual periods
Cause(s) of Endometriosis
The cause(s) of endometriosis isn’t completely clear but it appears to occur as a result of menstrual blood flowing backwards into the body, known as retrograde menstruation. Endometriosis is not contagious nor transferable, but the likelihood of having this disease is higher if one has a mother, sister or aunt with the disease.
Another theory is that some cells in the peritoneum (i.e. the membrane that lines the abdominal cavity) are transformed through hormone / environmental / immune factors into endometrial cells.
Also, a surgical procedure such as hysterectomy or C-section may cause transportation of these cells to other parts of the body.
A few factors may also contribute to the risk of endometriosis and these include: not giving birth or getting pregnant early, starting your menstrual periods early, alcohol consumption, and uterine abnormalities.
How is Endometriosis diagnosed?
To diagnose endometriosis, 3 main methods are used. An ultrasound scan, a pelvic exam, and an laparoscopy.
An Ultrasound Scan makes use of high frequency sound waves to look at images within the pelvis and is able to make out endometrial cysts.
A pelvic exam can be used to feel inside your pelvis to see if there are large cysts.
The most definitive way to diagnose endometriosis is through a laparoscopy. This is a procedure where a small instrument called a laparoscope is inserted through the abdominal walls in order to examine the organs within the abdomen. A small incision is cut to put this instrument through and discover areas of endometriosis.
Sometimes, some doctors request a CT scan if there are some markers in your blood work but a CT scan is not usually effective in diagnosing endometriosis.
Sadly, diagnosis is very often delayed for endometriosis sufferers, and the diagnosis time is about 7 to 10 years on an average. This is because some of the symptoms of endometriosis can be attributed to other conditions, therefore resulting in delayed diagnosis.
How is Endometriosis treated?
As endometriosis currently has no cure, a few management/treatment options are available.
Pain management – Most doctors prescribe various painkillers to endometriosis sufferers to help with managing the pain during and outside the menstrual periods. These include Ibuprofen, Paracetamol, Mefanamic Acid, Co-Codamol, Aleve or Tramadol. It is usually trial and error to see which works for most patients. Many patients complain about all these being ineffective still.
Hormone Therapy – It is believed that the changes in hormones in the body as a result of the menstrual cycle or hormonal imbalance affects these endometrial cells found outside the womb. Various hormonal therapies are used such as:
- Hormonal contraceptives such as pills which help to balance or control the hormones and hence reduce the bleeding and pain related to endometriosis.
- Progestin contraceptive which is an intra-uterine implant e.g. Mirena coil which stop menstrual periods and the growth of these implants.
- Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists which lower estrogen levels and stop the production of ovarian-stimulating hormones and hence menstruation. This causes an artificial menopause and cause endometrial tissue to shrink.
Lifestyle and Diet – Most doctors say that there is no proof to this, but many endometriosis sufferers have tried a few dietary and lifestyle changes which have been found to improve their symptoms. These include abstaining from many inflammation triggers such as high FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) foods. These are poorly absorbed simple and complex sugars found in various foods and fruits. More information about FODMAP can be found here and here. Also, relief may be gotten from avoiding or reducing diary products, red meat, processed foods, alcohol and coffee. Also, incorporating a lot of vegetables (including green cruciferous like Kale, spinach), fibre and inflammation-reducing fruits into your diet has shown improvement in symptoms, as well as exercise and meditation.
Excision or Ablation Laparoscopic Surgery – A laparoscopy is used to diagnose endometriosis effectively, and at the same time, any endometrial cells or tissue found can be either burned with laser or excised by removing it from the roots. Excision is usually better as it takes out everything as much as possible, while ablation only burns off the cells that can be seen by the surgeon.
For more information on endometriosis, visit the NHS website.