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Endometriosis

Overview

Endometriosis is a condition in which the endometrial tissue, i.e., the tissue that normally lines the inside of your uterus (the endometrium), starts growing outside the uterus. These misplaced bits of tissue behave just like they would inside the uterus: they thicken, break down, and bleed with your menstrual cycle. However, this blood cannot exit the body and thus, becomes trapped, leading to pain, inflammation, and scar tissue formation. Sometimes, endometriosis is associated with the formation of adhesive bands of fibrous tissues, due to which pelvic tissues and organs may stick to each other. While endometriosis affects the ovaries, fallopian tubes, and the tissues lining your pelvis, in more severe cases, it may even spread to other organs beyond the pelvic region. Endometriosis is associated with a great deal of discomfort and pain, especially during the menstrual cycle; in many cases, it has also been reported to cause fertility problems.

The exact cause of endometriosis is still somewhat of a mystery, but several theories exist:

  • Retrograde menstruation: This theory postulates the backward flow of endometrial cell-rich menstrual blood into the fallopian tubes and eventually, into the pelvic cavity. These cells then adhere to the pelvic organs, where they start to grow.
  • Embryonic cell transformation: Hormones such as oestrogen may cause embryonic cells (which can develop into any type of body tissue) to transform into endometrial-like cell implants during puberty.
  • Immune system disorders: Sometimes, the immune system may fail to recognise endometrial tissue growing outside the uterus, allowing it to continue developing.
  • Surgical scars: After surgeries like caesarean section delivery, endometrial cells might attach to surgical incisions; this can cause endometriosis.
  • Genetics: If a patient’s mother or sister has endometriosis, the patient has a higher risk of developing this condition.

  • Pelvic pain: This is the hallmark of endometriosis. Pain may start before your period and continue through it. It is often much more intense than typical menstrual cramps.
  • Dyspareunia (painful sexual intercourse): Many women with this condition report pain during or after sex.
  • Pain during bowel movements or urination: These symptoms are most common during the menstrual cycle.
  • Excessive bleeding: Some women experience heavy periods or bleeding between periods.
  • Infertility: Endometriosis can make it harder to conceive. In fact, this condition is often diagnosed in women undergoing fertility treatments.
  • Other symptoms: Patients may experience fatigue, nausea, bloating, constipation, or diarrhoea, particularly during your menstrual cycle.

  • Pelvic exam: During a pelvic exam, cysts or scar tissue near your reproductive organs may be felt
  • Ultrasound: A transvaginal or abdominal ultrasound can help identify cysts caused by endometriosis, called endometriomas.
  • Magnetic resonance imaging (MRI): An MRI can provide a detailed image of the internal organs and help plan surgeries or other procedures.
  • Laparoscopy: This is the gold standard for diagnosing endometriosis.

One or more of the following methods may be recommended for endometriosis treatment:

  • Pain medication: Over-the-counter pain relievers (such as ibuprofen) can help alleviate mild symptoms.
  • Hormonal therapy: Hormones play a key role in endometriosis. Options include:
    • Birth control pills: These can regulate your menstrual cycle and reduce pain.
    • GnRH agonists: These drugs temporarily stop your body from producing certain hormones, putting you into a temporary menopause.
    • Progestin therapy: This can reduce or stop menstrual flow and the growth of endometrial implants.
  • Surgery: If conservative treatments are not effective or if the patient is trying to conceive, surgery to remove as much endometrial tissue as possible may be recommended. Laparoscopic surgery is often used to remove or destroy growths, scar tissue, and adhesions.
  • Fertility treatment: If endometriosis is causing infertility, assisted reproductive techniques like in-vitro fertilisation (IVF) may be necessary.
  • Hysterectomy: In severe cases, removing the uterus—hysterectomy—may be considered, which includes laparoscopic hysterectomy. This is generally recommended only if you are not planning to have children in the future and is usually the last resort.

  • You have severe pelvic pain that does not go away even after the consumption of over-the-counter pain medications.
  • You are unable to conceive for over a year despite repeated attempts.
  • Your periods have become unusually heavy or irregular.
  • You experience pain during or after intercourse.
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