Endometriosis: Causes, Symptoms, Diagnosis & Treatment

Endometriosis is a complex condition where tissue resembling the uterus lining grows outside the uterus, causing various symptoms. Commonly, this can lead to pelvic pain, heavy menstrual bleeding, and even fertility challenges. Managing endometriosis often requires a multifaceted approach, including medications, surgical interventions, or a combination of both treatments. Want to know more? Read on further to understand everything you need to know about endometriosis.

What Is Endometriosis?

Endometriosis is a disease that occurs when the uterine lining-like tissue grows in other areas of the body. This growth leads to painful periods and may lead to complications such as pregnancy complications due to scarring and blocked fallopian tubes.

Generally, endometriosis impacts the ovaries, fallopian tubes, or outer lining of the uterus. In severe cases, it can affect the bladder and intestines or go beyond the pelvic region, possibly affecting the lungs.

This condition affects approximately 10% of women and those assigned female at birth (AFAB) in the world. However, it is most frequently diagnosed in individuals between 20 and 39. Luckily, the symptoms of endometriosis can be controlled with the right treatment.

Types of Endometriosis

Endometriosis can be categorized into four main types based on the areas it affects within the pelvis or abdomen:

• Endometriomas: These are black cysts filled with fluid. They are usually found in the ovaries, though they can be located in any part of the pelvis or abdomen. They are also known as chocolate cysts.
• Superficial Peritoneal Endometriosis: This is the least severe form, in which endometrial tissue forms lumps and grows on the peritoneum, a thin tissue that covers the walls of the abdomen and pelvis and most of the organs in these regions.
• Abdominal Wall Endometriosis: At times, endometriosis can also occur on the abdominal wall, with the tissue sticking to the surgical site, for example, a C-section.
• Deeply Infiltrating Endometriosis (DIE): In this type, endometrial tissue invades the organs inside or outside the pelvic cavity, such as the ovaries, rectum, bladder, and bowels. However, in rare circumstances, the disease can cause massive scarring of tissue that joins the organs together, resulting in a frozen pelvis, which occurs in 1%- 5% of endometriosis patients.

What Are the Causes of Endometriosis?

The actual cause of endometriosis is not yet known, but some theories may explain the occurrence of this disease. One of the most famous theories is retrograde menstruation, which states that the blood enters the fallopian tubes and the pelvic cavity in backward motion. This backward flow can contain endometrial cells that can implant on other organs such as the ovaries or intestines. As retrograde menstruation is common in women and does not necessarily indicate endometriosis, other factors, such as immune system dysfunction, could be involved in not expelling these displaced cells.

Genetics also plays an important role in the development of endometriosis. It is believed that people with a family history of the disease, for example, a mother or sister diagnosed with the disease, are more likely to develop the condition.

Another theory relates to immune system disorder, in which a low immune response may lead to the growth of endometrial cells outside the uterus. Hormonal factors again play a role in this case, especially estrogen, which leads to the formation of endometrial-like tissue in abnormal locations.

Other possible causes include:

• Coelomic metaplasia, where cells lining the abdominal cavity transform into endometrial-like cells.
• Embryonic cell transformation, where remnants of embryonic cells develop into endometrial tissue later in life.

What Are the Symptoms of Endometriosis?

Pelvic pain is a common symptom of endometriosis, often intensifying around menstruation. Unlike regular menstrual cramps, this pain can be severe and long-lasting. Other symptoms include painful periods (dysmenorrhea), discomfort during sexual activity, and pain while urinating or during bowel movements, particularly around the time of menstruation. Some people may also experience heavy menstrual bleeding or spotting between periods.

Endometriosis is also associated with infertility, and many individuals only learn they have the condition during fertility evaluations. Additional symptoms may include fatigue, bloating, diarrhoea, or constipation, particularly during menstruation. Interestingly, the severity of pain doesn’t always match the amount of tissue growth; some with minimal tissue may experience intense pain, while others with extensive growth might have few symptoms.

How Is Endometriosis Diagnosed?

Endometriosis diagnosis is challenging due to the fact that there is no test that can be used to make a diagnosis without surgery. The diagnostic process often starts with the assessment of symptoms and the patient’s history. A pelvic exam can show endometrial lesions, but it is not very effective in diagnosing small lesions of endometriosis.

Even though ultrasounds and MRIs can reveal some larger cysts, including endometriomas – ‘chocolate cysts’, they cannot diagnose endometriosis or visualize small lesions.

The only definitive method of diagnosing endometriosis is through a procedure known as laparoscopy, which is a form of surgery. During laparoscopy, the doctor will place a small camera through a small cut near the belly button to look at the abdominal cavity. If there is any indication of an abnormal growth, then a tissue sample may be taken for further examination. Biopsy is deemed to be the most accurate technique due to visualization of the tissue and puncture of tissue samples.

Sometimes, endometriosis is discovered accidentally during surgeries for other conditions or in individuals without symptoms. However, diagnosing endometriosis can be delayed due to the complexity of the condition and the wide range of symptoms, making it challenging to identify early in some cases.

Treatment Options for Endometriosis

Unfortunately, there is no known cure for endometriosis, but there are different ways of treating the symptoms. The type of treatment depends on age, the severity of symptoms, and whether the person wishes to conceive in the future.

First, pain management is achieved using the available NSAIDs, which help decrease inflammation and pain. For severe pain, stronger medicines may be administered to the patient.

Hormonal therapies are most frequently prescribed to manage symptoms. Such treatments include oral contraceptives, progestins, and gonadotropin-releasing hormone agonists that help reduce estrogen levels in the body, slowing the growth of the endometrial-like tissue. Nevertheless, these treatments cannot reconstruct tissues or eliminate fibrosis, scarring, or adhesions.

In case of failure of medication, surgery may be recommended. Laparoscopic surgery is effective in the removal or destruction of endometrial tissue. In more severe cases, a total abdominal hysterectomy (removal of the uterus) and possibly the ovaries may be recommended although this is the last option.

To conceive, some people might have to undergo an infertility treatment like IVF because endometriosis can damage the reproductive system by forming scar tissue and inflammation.

Another aspect concerns the complementary approaches patients use to deal with the symptoms, including acupuncture, diet changes, exercises, biofeedback, counselling, etc. Although such methods may help alleviate the symptoms, little research proves their efficiency, and they do not treat the disease.

Conclusion

Endometriosis is a chronic disease in which endometrial tissue grows outside the uterus, causing symptoms and various complications. While there is no known cure for the condition, patients can benefit from medications for pain relief, hormone replacement therapy, and surgery. For the condition to be well managed, the patient should undergo laparoscopy to get an early diagnosis and then be treated according to the findings. More research and a holistic approach to patients’ treatment and management are critical in enhancing the results for the affected individuals.