Understanding Endometriosis: Symptoms, Causes and Treatment

Endometrium is an organ that lines the inner walls of the Uterus. It prepares the uterus for pregnanacy and houses the fetus. On the other hand, if there is no implantation and pregnancy, the lining of the uterus sheds as menstrual blood. 

Endometriosis is an extremely painful condition where the endometrial tissue that is supposed to be present inside the uterus grows outside the womb. Some common areas are other pelvic organs or abdominal region. 

Women in reproductive age experience this condition and is common in about five to ten percent of the population. However, this condition often does not get diagnosed or treated. 

Endometriosis Symptoms:

Understanding endometriosis symptoms ensures to establish proper line of communication with your gynecologist.

• Pelvic pain: The main symptom of endometriosis is pain in the pelvic region during periods. The pain is often severe and the aching radiates to the back and lower thighs. Another common non menstrual  pain related symptom is aching on opening the bowels.
• Dysmenorrhea: Painful cramps during menstruation that lasts at least five to six days continuously. The period pain is more severe than regular cramps experienced in some form by women on the first couple of days.
• Dyspareunia: Pain during intercourse is also a classic symptom of endometriosis. This pain is often described as deep set pain lasting for several hours post intercourse.
• Menorrhagia: Menorrhagia is a term that is used to describe heavy bleeding during period with blood clots that last for a week. 
• Bowel issues: Endometriosis can often lead to bowel and bladder problems like irritable bowel syndrome, painful urination and increased frequency.
• Infertility: There are higher chances of infertility in women with endometriosis as the presence of tissue over growths or scar tissues hinders implantation of the embryo necessary for attaining successful pregnancy. 
• Mental Health: There has been a strong association of endometriosis with mental health conditions leading to decreased quality of life with depression and anxiety.

What exactly causes Endometriosis?

There is no specific reason for why some women suffer with endometriosis. It is however, theorized that the period blood instead of travelling downward to cervix, flows towards the fallopian tubes. This is called Retrograde menstruation where a few cells get implanted outside the uterus where they can grow.

Cellular metaplasia has also been studied as a possible cause. This essentially means that the cells that are outside the uterus change to endometrial cells via DNA changes and grow further. 

Another factor that can contribute towards the presence of endometrial tissue outside the uterus is excessive estrogen in the body. Excessive estrogen can lead to high inflammation and pain. 

All of these causes are not well established and are current theories. This makes treating endometriosis harder as the exact cause is unknown. 

Why is diagnosing Endometriosis difficult?

• Overlapping symptoms: The main symptoms of endometriosis often overlap with other gastrointestinal issues and are usually non specific. Hence this condition is misdiagnosed as either Irritable bowel syndrome or Pelvic inflammatory disease.
• Less awareness: The symptoms of period pain may be dismissed and be associated with normal  period pain as the symptoms are similar. 
• Lack of specific diagnostic methods: The gold standard for actually making the proper diagnosis for endometriosis is via laproscopy. Darker lesions on ovaries, peritoneum and other pelvic organs as seen in the laproscope can be biopsied for further laboratory analysis. 
• Lack of research: This particular disease is not as robustly studied as other re0productive diseases. This presents challenges to the health care provides to provide accurate diagnosis.
• Chronic disease: Although endometriosis usually starts during the younger years, many women don’t seek help until later in life when there are infertility issues. 

Treatment for Endometriosis

Unfortunately, the treatment options for Endometriosis are limited today. 

In women who wish to conceive, treatment options are conservation and managed with medical intervention that mainly suppresses the pain or hormones to decrease the ovarian function. These include using contraceptive methods or birth control in the form of pills, Intrauterine devices (IUDs) and patches.

There are also some options for removal of endometrial tissue with electrocautery but is however reserved to patients with extreme cases where the MRI.

Another important thing is to note that there is some correlation to the increased risk of Ovarian Cancer. 

For a women who does not want to bear children, a complete hysterectomy along with removal of ovaries offers chance for cure.

Conclusion

Endometriosis is undoubtedly a debilitating condition that is often not recognized as a disease that leads to extreme pain and discomfort in women. Consulting a Gynecologist with a lot of experiences drastically increases the chances of accurate diagnosis and proper management of the disease. It is important to recognize that for Endometriosis, an individualized approach is necessary as the symptoms are non specific in most cases.