Endometriosis: Causes, Symptoms, Diagnosis, and Treatment Options

What is Endometriosis?

Endometriosis is a condition where tissue similar to the lining of the uterus, called endometrium, grows outside the uterus, causing pain and complications such as infertility. This condition can affect women of any age, especially those in their childbearing years, including teenagers.

Endometriosis Causes

The exact cause of endometriosis is not fully understood, but it is believed to result from a combination of factors.Endometrial tissue, which typically 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 severe pain, abnormal menstruation, and scar tissue formation. Endometriosis may also result in infertility.

Several factors may contribute to the development of endometriosis, including:

• Hormonal influences - Estrogen promotes the growth of endometrial tissue.
• Retrograde menstruation - Menstrual blood flowing backward into the pelvic cavity can cause endometrial cells to implant outside the uterus.
• Genetic factors - A family history of endometriosis increases the risk of developing the condition.
• Immune system dysfunction - The immune system may fail to eliminate misplaced tissue, allowing it to thrive.

These factors combine to cause severe pain, abnormal menstruation, and infertility in some women with endometriosis.

Endometriosis Risk Factors

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- Women with relatives who have endometriosis are more likely to develop it.
• 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.

Endometriosis Symptoms

Symptoms of endometriosis can range from mild to severe. Some people have agonising pain while others have just a little discomfort or even no symptoms at all. The symptoms of endometriosis can be similar to the symptoms of other conditions, such as ovarian cysts and pelvic inflammatory disease.

Nonetheless, the following are common signs of endometriosis:

• Chronic pelvic pain
• Painful menstrual cramps
• Pain in the lower abdomen before or after menstrual bleeding
• Irregular or heavy menstrual bleeding during menstrual period
• Pain during sexual intercourse
• Infertility
• Discomfort during bowel movements
• Lower back pain

Endometriosis Diagnosis

Symptom-free endometriosis may be discovered during a routine pelvic examination, or during surgery for another 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.

To diagnose endometriosis, your doctor may conduct a physical exam and recommend tests, such as:

• Pelvic examination
• Ultrasound
• Laparoscopy

Laparoscopy may be conducted to confirm a diagnosis. This procedure is typically performed on an outpatient basis and is conducted under general or local anesthesia.

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 a probe or used to remove a small sample of tissue. This sample can then be examined to confirm the diagnosis of endometriosis.

Endometriosis Stages

Endometriosis is classified into four stages based on the severity:

• 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.

Endometriosis Treatment Options

Two natural occurrences often improve the signs and symptoms of endometriosis:

• Pregnancy - During pregnancy, ovulation and menstruation cease, and the symptoms of endometriosis may be temporarily relieved.
• Menopause - Following menopause, the ovaries permanently stop secreting female sex hormones, and all endometrial tissue withers naturally. Menopause typically occurs in a woman's 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 endometrial tissue so that implantation of a woman’s fertilised egg is nearly 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 for better symptom management.

The choice of treatment depends on factors such as the patient's age, the stage of endometriosis, whether fertility preservation is a priority, and the severity of the symptoms.

Lifestyle Changes to Help Endometriosis

While medical intervention is your best bet against managing this condition, the following lifestyle tips may help manage endometriosis symptoms:

• 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 are 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.

Make an Appointment at Gleneagles Hospital Penang

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. If you are experiencing any of the symptoms mentioned above, book an appointment with a Gynaecologist at Gleneagles Hospital Penang. Our experts can help you diagnose and manage endometriosis, ensuring you receive the best care.