Endometriosis is a gynecological condition that affects 190 million women globally, according to the World Health Organization. A chronic disease with no known cause or cure, endometriosis demands continuous research and is gaining widespread recognition.
Development of endometriosis begins when tissue that normally grows in the uterine lining starts growing outside of the uterus – typically in the ovaries, fallopian tubes, or pelvis. In extreme cases, endometriosis may even appear in the lungs, brain, or skin.
Despite being located outside the uterus, the abnormal tissue acts similarly to normal endometrial tissue — it thickens, breaks down, and bleeds with each menstrual cycle.
However, in areas where these abnormal tissues cannot easily exit the body, they build up, causing inflammation and severe pain. These problems may compound and lead to ovarian cysts, irritation of surrounding tissues, or other problems in the intestines and bladder.
Symptoms and Causes
The primary symptom of endometriosis is painful periods. Abdominal pain and cramping are normal during menstruation, but women with endometriosis experience pain that is unbearable, rendering them unable to move.
Other signs of endometriosis include excessive or heavy bleeding during periods, bleeding between menstrual cycles, pain during or after sex, pain with bowel movements or urination, and digestive issues during periods.
While the causes of endometriosis are unknown, researchers have suggested many possibilities. One of the most common points to ‘retrograde menstruation,’ occurring when menstrual blood containing endometrial tissue flows back into the fallopian tubes and attaches to the pelvic wall.
Another theory suggests that endometrial tissues travel through blood vessels or the lymphatic system.
Several factors can put you at greater risk of developing endometriosis, such as:
- Having a close relative (mother, aunt, or sister) with endometriosis
- Having never been pregnant or given birth
- Starting your period at an early age (younger than 11)
- Experiencing short menstrual cycles (less than 27 days)
- Experiencing heavy bleeding and long menstrual cycles (longer than 7 days)
- Having high estrogen levels
- Having a low body mass index or insufficient body fat
Diagnosis and Treatment
Diagnosing endometriosis can be difficult, as its symptoms are similar to that of other reproductive conditions, such as uterine fibroids or pelvic inflammatory disease. After sharing your symptoms with a gynecologist, they will perform a pelvic exam to check for cysts or scar tissue. Additionally, they may perform a transvaginal ultrasound or MRI to further identify abnormalities in the pelvis.
Treatment approaches will vary, depending on the severity of the endometriosis and whether or not you want to have children. Doctors commonly recommend hormone therapy first, opting for surgery only if initial treatment fails. Typical hormone therapy options include:
- Hormonal contraceptives, to control the hormones responsible for endometrial tissue buildup
- Gonadotropic-releasing hormone (Gn-RH) therapies, to lower estrogen levels, prevent menstruation, and shrink endometrial tissue
- Progestin therapy, to halt menstruation and the growth of endometrial implants
Hormone therapy is not a permanent fix, and endometriosis symptoms may return if you decide to stop taking this type of treatment.
Should surgical intervention become necessary, surgeons will perform a laparoscopy to manually remove endometrial tissue through a small incision in the abdomen while preserving the reproductive organs. While a hysterectomy – the total removal of the uterus – is still a treatment option in extreme cases, gynecologists generally consider it a last resort.
Unfortunately, endometriosis can lead to other health complications, such as impaired fertility and slightly higher risk of certain gynecologic cancers.
It is estimated that up to one-half of women with endometriosis have difficulty getting pregnant. Despite the difficulty of the journey, it is certainly possible to have a healthy pregnancy and have a child with the help of fertility treatment. While certain types of cancer, including ovarian cancer and endometrial adenocarcinoma, occur at slightly higher rates in women with endometriosis, the overall lifetime risks for these cancers are exceedingly low.
Living with Endometriosis
If you have endometriosis, it is possible to make individual lifestyle changes that may help manage symptoms and relieve discomfort. Pelvic pain and cramping can be alleviated with heating pads, exercise, and over-the-counter pain medication. Limit inflammatory foods in your diet, such as red meat and alcohol, and include more fruits, vegetables, and fatty fish.
Additionally, emotional support may help with mental or emotional distress caused by the condition. Joining a support group of women who acknowledge and share your experience may encourage a sense of optimism and strength.
If you are experiencing symptoms of endometriosis, consider meeting with an expert at the Obstetrics and Gynecology Department at NHPP/Westchester Health. To schedule an appointment, visit https://www.westchesterhealth.com/obstetrics-and-gynecology.