Definition and Overview

Endometriosis is a condition that occurs when endometrial cells travel from the uterus to other parts of the body. Since endometrial cells are what make up the lining of the uterus, their misplacement causes a problem in a woman’s reproductive system. In most cases, the tissue forms on the ovaries, the outer part of the uterus or the fallopian tubes. They may also develop on the intestines, in various parts of the belly, and sometimes even beyond.

Despite their misplacement, these cells nevertheless respond to the stimulation of the reproductive hormones. This causes menstrual bleeding every month, causing them to shed blood outside of the uterus. This means that the blood is unable to flow outside the body each month. These abnormal blood deposits, in the long run, may accumulate and cause scar tissue. Although it is not dangerous, it can be painful and may prevent a woman from getting pregnant.

Endometriosis, which currently affects 5% of American women, is considered one of the top causes of female infertility worldwide.

Causes

What specifically causes the endometrium to grow outside of the uterus is still unknown. However, several factors are recognized as contributors to the problem. These include:

  • Reflux menstruation – This occurs when some menstrual blood flows back toward the fallopian tubes instead of making their way out.

  • Abnormal functioning of the female hormone estrogen – Findings show that endometriosis most commonly strikes women at their childbearing age, which is between their teenage years and their forties. Since women have higher estrogen levels during these years, and because symptoms of endometriosis have been found to go away after a woman experiences menopause, it is believed that estrogen plays a role in the occurrence of endometriosis.

  • Heredity – Some studies show that having a first-degree relative who suffer from endometriosis increases the risk of developing the condition by up to 10 times. Some studies raise this likelihood to almost 50%, stating that women who have a family history of endometriosis have a 59% risk of developing the condition.

  • Abnormal weight – A number of studies have established a link between being overweight, particularly in the latter stages of childhood or during the early teenage years, to a higher risk of developing endometriosis.

  • Irregular menstrual cycles. Women, whose menstrual cycles are less than 28 days or whose monthly period is longer than a week, have increased risk of getting endometriosis.

  • Abnormality in the reproductive organs. In some cases, the shape of a woman’s uterus, vagina, or cervix may hinder or slow down menstrual flow. In the long run, this can cause endometriosis.

Key Symptoms


Endometriosis does not always produce symptoms, causing many women to discover their condition only when they find it difficult to conceive a child.

If symptoms do occur, they usually include:

  • Pelvic pain
  • Dysmenorrhea or cramps during menstrual periods
  • Irregularly heavy menstruation
  • Spotting or bleeding in between menstrual periods
  • Infertility
  • Tendency to miscarry
  • Painful sexual intercourse or bleeding after intercourse
  • Painful urination
  • Painful bowel movement
  • Diarrhea
  • Constipation
  • Nausea
  • Bloating

You may also experience pain in the part of your body where the endometrial cells grow. Thus, chronic pain in the belly or intestinal region, as well as pain in the lower back, may also indicate endometriosis.

The pain levels suffered by patients tend to differ; some experience only mild pain, mistaking pain symptoms as normal menstrual cramping. On the other hand, some women experience intense pain that hinders them from carrying out their normal activities.

Most of these symptoms become more pronounced during menstruation.

Who to See

If you experience any of these symptoms, especially if you never experienced them before, see your general physician or obstetrician-gynecologist right away. For fertility issues, such as when you have been trying to get pregnant for more than 12 months with no success, you should see a reproductive endocrinologist.

Immediately seek medical help if:

  • Your usually painless periods suddenly become painful
  • The pain is too severe and interferes with normal life
  • You have blood in your urine or stool
  • You experience any unexplained changes in your menstruation or your bowel movements

Your doctor will conduct a physical examination of your abdomen and pelvic and may also request for an ultrasound and an MRI. These imaging tests will determine for certain whether you have endometriosis or not. If these tests prove unsuccessful in detecting the problem, a laparoscopy may also be used. This surgical procedure involves inserting a fiber optic rod attached to a camera into a tiny incision made in your belly button.

Types of Treatments Available

There is currently no cure for endometriosis, but women can seek different treatment options most suitable for their specific cases. Treatment usually depends on the severity of the symptoms felt. Treatment options include:

  • Hormone therapy – This is recommended for women who only complain about pain but feel no other symptoms. This therapy can help control estrogen levels, shrink the misplaced cells, and relieve pain. Different types of hormone therapies currently used include Gonadotropin-releasing hormone agonist (GnRH-a) that triggers a menopause-like state, progestin pills that stop ovulation, and Danazol, which raises androgen levels. Take note, however, that these therapies usually come with side effects, which must be seriously considered prior to the therapy.

  • Contraception – Birth control pills can help relieve symptoms such as heavy or irregular bleeding. Since they also control menstrual bleeding, they can help keep the condition from worsening. Naturally, however, this option is only feasible for those who have no plans of getting pregnant in the near future. The continuous use of birth control pills to help with endometriosis reduces your risk of getting ovarian cancer, which is very common among women suffering from this condition.

  • Pain medications – NSAIDs or anti-inflammatory drugs such as ibuprofen can be used to relieve the pain associated with endometriosis.

  • Surgery – Although rarely recommended, surgery becomes necessary in cases where the abnormal growths appear and start affecting other organs. In severe cases, surgical procedures known as oophorectomy and hysterectomy, which are the removal of the ovaries or the uterus, may also be considered. These, however, will rule out all chances of pregnancy.

There are some home treatment tips that may help patients deal with the symptoms of endometriosis. These include:

  • Applying warm compress to painful area, usually on the belly
  • Regular exercise to increase the flow of endorphins to reduce pain
  • Lying down with a pillow under the knees
  • Relaxation techniques for pain management

Women who want to get pregnant but are hindered by endometriosis, require special treatment such as:

  • Surgical removal of the abnormal growth/scar tissue
  • Infertility treatment
  • Fertility drugs

Other fertility solutions such as insemination and in vitro fertilization may also be considered in cases where the patient still fails to get pregnant even after the surgical treatment of endometriosis.

References:

  • University of Maryland Medical Center: “Endometriosis.”
  • The New England Journal of Medicine: “Endometriosis.”
  • Bulleti C, Coccia ME, Battiston S, Borini A. (2010). “Endometriosis and infertility.” J Assist Reprod Genet
  • Journal of Endometriosis and Pelvic Pain Disorders. “Power over pain: a brief review of current and novel interventions for endometriosis-associated pain.”
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