Endometriosis

Endometriosis is a disease that occurs when womb cells/tissue, termed endometrium, starts growing in other body parts.

1. Mostly, they grow in the pelvic area but they can also move to other body parts.
2. The womb lining, called endometrium, sheds during menstruation which may grow in other parts of the body and lead to endometriosis.
3. These tissues are usually on other reproductive inside the pelvis or in the abdominal cavity] According to the World Health Organisation, endometriosis affects 10% of females worldwide.

Causes

The exact cause of endometriosis is still unknown. It can be caused by environmental, biological, and genetic factors. However, some theories are believed to be the cause of endometriosis, such as:

1. Retrograde menstruation: This may happen during menstruation. Instead of flowing through the vagina, some menstrual tissue flows backwards through the fallopian tube (tubes that carry eggs to the womb). Then this menstrual tissue may attach and grow in areas other than the womb and form endometriosis implants.
2. Weakened immune system: It is believed that women who have impaired immune systems may develop endometriosis. In this, the immune system fails to recognise and destroy the endometrial tissue that grows outside the uterus.
3. Estrogen exposure: Prolonged estrogen exposure may develop endometriosis. Long exposure to the body’s estrogen can be caused by obesity, a short menstrual cycle, and early-age menstruation. In addition, external estrogen exposure can be a synthetic or natural chemical that disturbs the body's endocrine system (releases hormones).
4. Inflammatory response: An overactive immune system response may cause endometriosis which may further produce pain and cause damage and infertility. The body attacks its own endometrial tissue, which causes damage to the cells and tissue and produces inflammation.
5. Metaplasia: In this theory, it is believed that the endometrial tissue transforms into another type of cell; this is known as metaplasia. For example, surgical scar implantation may occur after surgery of c-section or hysterectomy in which the endometrial cells may attach to the surgical area.

Signs and Symptoms

In many cases, there are no symptoms of endometriosis, but in some cases, you may notice the following symptoms:

1. Back pain or abdominal cramps during menstruation
2. Very painful menstrual cramps
3. Irregular or heavy menstrual bleeding
4. Pain while passing stools (faeces)
5. Dyspareunia (pain during intercourse)
6. Sleep issues
7. Intermittent constipation and diarrhoea
8. Difficulty or pain while passing urine
9. Blood in the urine
10. Frequent urination
11. Bloated feeling with or without pain
12. Depression or anxiety associated with pain
13. Infertility (not being able to get pregnant)

Diagnosis

Most women get to know that they had endometriosis when they visited their doctor for a fertility issue or surgery for some other issue. Sadly, endometriosis mostly gets missed and takes many years to diagnose (an average of seven years)

To diagnose endometriosis, your doctor will:

1. Ask you questions related to your symptoms and menstruation.
2. Check your medical history.
3. Do a pelvic exam in which your doctor will assess the position and size of the ovaries and search for nodules or tender masses behind the cervix.
4. Do imaging tests like transvaginal or abdominal ultrasound. This can find the endometriomas, cysts located in the ovaries and ovaries filled with thick-dark blood. This test detects larger cysts but cannot detect smaller cysts. Other imaging tests such as MRI (magnetic resonance imaging) and CT (computed tomography) might also be done.
5. Do laparoscopy. This surgery helps your doctor to find the endometriosis tissue in the abdomen. This surgery may also be done to treat endometriosis. Through laparoscopy, the doctors can get to know the location, number, and size of the endometrial adhesions or implants. This will also help us understand the grade of endometriosis and which treatment might be suitable to treat endometriosis.
6. Do a biopsy. In a biopsy, a slight tissue sample is taken to the laboratory for testing.
7. Ask for other tests such as urine and blood tests to be done along with imaging tests.
8. However, laparoscopy is found to be more helpful in diagnosing endometriosis compared to other tests.

Treatment

Your gynaecologist will suggest you treatment based on your:

Symptoms

The severity of the disease

Will to conceive/become pregnant

Based on these points, your gynaecologist will suggest the following treatment:

1)Medicinal treatment: This involves hormone-based treatments such as pills or IUD (intrauterine device) or implants and pain-killer medicine. These hormone-based treatments lower the pain and reduce endometrial cell growth. However, this treatment only works as long as you take them; therefore, there are chances that endometriosis will return.

2)Laparoscopy excision therapy

In this surgery, your doctor will make a small cut in the abdomen. Through this cut, your doctor will insert a laparoscope (thin fibre-optic tube) with a lens that helps your doctor see the ovaries, uterus, peritoneum, and tubes. The doctor removes the endometriosis tissue through this cut without removing the reproductive organ or any normal tissue.

3)Hysterectomy: This surgery is performed in severe cases. In this surgery, the endometrial tissue and the uterus, with or without ovaries are removed.

Risk Factors

The risk factors for endometriosis include:

1. Family history: The chance of developing endometriosis increases if your mother or sister has endometriosis.
2. Age: Endometriosis can occur in adult women and teenagers of all ages but is primarily diagnosed in women aged between 25-50 years.
3. Dietary factors: Some studies have suggested that the intake of trans fats and red meat raises the chances of developing endometriosis, and intake of green leafy vegetables, fruits, and omega-3 fatty acids may protect you from getting endometriosis. More studies are required to confirm their usefulness.
4. Menstrual history: Women with longer, heavier menstruation and who have a shorter menstrual cycle than usual are believed to have an increased risk for endometriosis.
5. No pregnancy: Pregnancy is considered to protect you from endometriosis, and never having had children is linked to increased chances of endometriosis. However, endometriosis can still occur after having children.