Endometriosis: Symptoms, Causes, Diagnosis, Treatments
According to World Health Organization (WHO), endometriosis affects roughly 10% of reproductive-age women and girls globally.
What is Endometriosis?
Endometriosis is a disease where tissue similar to the lining of the uterus grows outside the uterus, causing pain and/or infertility.
There are four stages of endometriosis:
- Stage 1: Minimal. On your ovaries, there are little lesions or sores, as well as shallow endometrial implants, in mild endometriosis. Inflammation in or around your pelvic cavity is also possible.
- Stage 2: Mild. Light lesions and superficial implants on the ovaries and pelvic lining characterize mild endometriosis.
- Stage 3: Moderate. Many deep implants on your ovaries and pelvic walls characterize moderate endometriosis. There may be more lesions.
- Stage 4: Severe. Many deep implants on your vaginal lining and ovaries characterize the most severe stage of endometriosis. Your fallopian tubes and bowels may also have lesions. Cysts on one or both of your ovaries are also possible.
Some women are severely impacted, while others show no signs or symptoms.
The most common signs and symptoms of endometriosis include:
- Pain in your lower abdomen or back (pelvic pain) is generally worse during your period and prevents you from conducting your daily activities.
- Feeling sick, constipation, diarrhea, or blood in your pee during your period feeling nauseous, constipation, diarrhea, or blood in your pee during your period
- Having trouble getting pregnant
Menstrual blood including endometrial cells travels back through the fallopian tubes and into the pelvic cavity instead of out of the body during retrograde menstruation. These endometrial cells adhere to the pelvic walls and the surfaces of pelvic organs, where they proliferate, thicken and bleed during each menstrual cycle.
Transformation of peritoneal cells
Experts argue that hormones or immunological factors stimulate the transition of peritoneal cells — cells that line the inner wall of your belly — into endometrial-like cells.
Transformation of embryonic cells
During puberty, hormones like estrogen can change embryonic cells (cells in the early stages of development) into endometrial-like cell implants.
Surgical scar implantation
Endometrial cells may cling to a surgical incision after a procedure such as a hysterectomy or C-section.
Transport of endometrial cells
Endometrial cells may be transported to different areas of the body via blood vessels or the tissue fluid (lymphatic) system.
Immune system disorder
The body may be unable to identify and destroy endometrial-like tissue developing outside the uterus due to an immune system dysfunction.
For the diagnosis of endometriosis, laparoscopy is the most widely utilized surgical method. This is a small surgical operation that is done under general anesthesia or local anesthesia in some situations. A tiny incision in the navel is used to inflate the abdominal cavity with carbon dioxide before performing laparoscopy. The abdomen and pelvis are next inspected using narrow, tubular viewing equipment (laparoscope) placed into the expanded abdominal cavity. The endometrial implants may then be seen clearly.
Biopsies, the removal of small tissue samples for inspection under a microscope, can also be conducted during laparoscopy to get a tissue diagnosis. Even if no implants are visible, random biopsies taken during laparoscopy may reveal microscopic endometriosis.
A transvaginal ultrasound or an abdominal ultrasound may be used by your doctor. A probe is put into your vaginal canal during a transvaginal ultrasound.
Ultrasounds of both sorts produce pictures of your reproductive organs. They can assist your doctor in detecting endometriosis cysts, but they are ineffective in ruling out the illness.
To reduce uncomfortable menstrual cramps, your doctor may prescribe an over-the-counter pain medicine such as nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin IB, others), or naproxen sodium (Aleve).
Supplemental hormones can help reduce discomfort and slow the growth of endometriosis in certain cases. Hormone treatment assists your body in regulating the monthly hormonal fluctuations that encourage endometriosis tissue development.
Birth control pills, patches, and vaginal rings help regulate the hormones that cause endometrial tissue to develop each month. When using a hormonal contraceptive, many women have lighter and shorter menstrual flow. In certain circumstances, hormonal contraceptives, particularly continuous-cycle regimens, can help to minimize or eliminate discomfort.
Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists
These medications stop ovarian-stimulating hormones from being produced, reducing estrogen levels and preventing menstruation. Endometrial tissue shrinks as a result of this. Taking a modest dosage of estrogen or progestin together with Gn-RH agonists and antagonists may reduce menopausal adverse symptoms such as hot flashes, vaginal dryness, and bone loss. When you stop using the medicine, your menstrual cycles and ability to become pregnant return.
A variety of progestin therapies, such as an intrauterine device with levonorgestrel (Mirena, Skyla), the contraceptive implant (Nexplanon), and contraceptive injection (Depo-Provera), or a progestin pill (Camila), can stop menstrual periods and endometrial implant growth, potentially alleviating endometriosis signs and symptoms.
Aromatase inhibitors are a type of drug that lowers estrogen levels in the body. To treat endometriosis, your doctor may prescribe an aromatase inhibitor in conjunction with a progestin or a combined hormonal contraceptive.
Conservative surgery is typically used for women who want to become pregnant or who are in severe pain and have failed to respond to hormonal treatments. It aims to remove or eradicate endometrial growths while avoiding damage to the reproductive organs.
Endometriosis is diagnosed and seen through laparoscopy, a minimally invasive operation. It’s also employed to get rid of any misplaced or aberrant endometrial-like tissue. To surgically remove the growths or to burn or vaporize them, a surgeon makes small incisions in the abdomen.