During a woman's menstrual cycle, the endometrium tissue builds up around the uterus wall. If the woman gets pregnant during that time, the wall gets thicker and serves as a protection layer. If the woman does not get pregnant, the layer is shed and comes out along with the blood. However, in the case of endometriosis, as the tissue grows outside the uterus, this response to any hormonal changes in the body and breaks down in the same way endometrium does, resulting in bleeding the pelvis area. This also leads to inflammation and scarring of the actual endometrium. This leads to lesions, cysts, and tissue growth in various parts of the reproductive system. The outer endometrium mimics all the activities done by the actual endometrium confusing the hormones and the body. This disrupts the general body functions, leading to many other issues. This is how endometriosis is developed in the female human body.
Causes
The exact cause of endometriosis is still unknown. There were many studies conducted, but nobody could actually come up with the precise cause. There are multiple theories and conspiracies around it. The following are the possible causes of endometriosis.
- Immune Disorders: Immunity is one of the biggest strengths a body possesses. When that is disrupted, the body cannot differentiate between its friend and foe. This can be one of the reasons why the body cannot detect the pseudo endometrium, which is growing outside the wall of the uterus. So, as the immune system is weak, it is confused between which endometrium is real and which needs to be destroyed.
- Genetics: Genetics play a vital role in developing and maintaining our health. No matter how much of a healthy lifestyle you lead, it is sometimes the genetics you cannot escape from. So, suppose endometriosis is running in your family. In that case, you are most likely to be affected by it because of the inherited genes. Not only that, some experts even say that it only worsens from generation to generation.
- Retrograde Menstrual Flow: This is one of the popular causes of endometriosis. A few experts say that the menstrual blood that contains endometrial cells may pass back through your fallopian tubes and, thereby, into your pelvic cavity. So, the cells revisit your organs, causing endometriosis.
- Peritoneal cell transformation: According to the induction theory, hormones or immune factors promote the transformation of peritoneal cells, the cells that line the inner side of your abdomen, into endometrial-like cells. So, when peritoneal cells transform into endometrial-like cells, this forms a pseudo endometrium outside the uterus, which acts as the true endometrium.
- Embryonic cell transformation: During puberty, many physical changes are observed in the female body. So, during that time, hormones such as estrogen can transform embryonic cells (cells in the early stages of development) into endometrial-like cell implants. These further form into the endometrium layer and cause disruption in the body.
- Endometrial cell transport: In such a case, the endometrial cells may be transported to other parts of the body via blood vessels or the tissue fluid (lymphatic) system. So, the lesions need not necessarily be present in the uterus or fallopian tubes. They may be anywhere in the female human body.
- Surgical Scar Implantation: When there is a surgery related to the female reproductive system, like a hysterectomy or C-section, there may be chances where the endometrium cells may get attached to the incision where the surgery happened and start to grow from there.
Complications and Symptoms
There numerous complications associated with endometriosis. We have also understood how it affects the other parts of the body apart from the female reproductive system. So, let us have a look at a few of them.
- One of the major complications faced by women with endometriosis is infertility. Obviously, suppose the uterus and the reproductive system are involved in the process. In that case, the reproduction quality automatically degrades. 2 in 5 women with endometriosis struggle to get pregnant in their lifetime. Also, when endometrium tissue is wrapped around the ovaries, it blocks the release of the egg, which disrupts the entire ovulation process in a female body.
- People detected with endometriosis are at a higher risk of ovarian cancer and other cancers like breast cancer.
- There is a higher chance of developing cysts in people already suffering from endometriosis. This can further lead to PCOS as well. Although both are different types of disorders, there may be closely related in terms of symptoms.
- Endometriosis can also lead to complications related to the intestines and urinary bladder. This may start with as trivial as UTIs and loose stools and later develop into more enormous complications.
- Inflammation in various parts of the body, including endometrium and skin. As the lesions are not confined to the reproductive system, this may lead to inflammation in several organs, which may lead to further complications.
When ignored, it can even affect the quality of your lifestyle. So, the following are the symptoms that need close attention.
- Extremely painful periods and heavy cramps
- Periods lasting for more than 7 days or very brief periods, less than 2 days
- Heavy menstrual flow or very minimal flow
- Blood spotted in urine or stool
- Nausea and Fatigue
- Changes and complications in bowel movements and urinary tract.
- Pain during sexual intercourse
- Spotting in between periods
- Unable to get pregnant
Apart from all of the symptoms, endometriosis can also be linked with other health-related issues, such as:
- Inflammation and Allergies
- Sensitivity of organs
- Ovarian and a few other types of cancers
- May lead to autoimmune diseases
- Chronic fatigue syndrome
Stages of Endometriosis
Endometriosis is generally classified into four stages. Let us have a closer look at what each stage means.
Stage 1: This is called the minimal stage. This is when only a few small lesions are detected. Still, there is no development or identification of the scar tissue. There are only isolated implants and no other significant adhesions in medical terms. Also, there is a very minimal amount of abdomen space involved here.
Stage 2: This is the mild stage. This is an advanced stage of the minimal stage where more lesions are found, but there is still no detection of scar tissue. At most, 2 inches of the abdomen are involved at this stage.
Stage 3: This is the moderate stage. This is a stage where you have multiple and deep lesions along with a layer of endometriomas and scar tissue around the uterus, ovaries, and fallopian tubes as well.
Stage 4: This is the severe stage. This is the stage where cysts are already developed, and the wall of the endometrium is so thick resembles the wall of a pregnant woman. One may develop scar tissues in multiple places in the body, including the uterus and lower parts of the intestines. However, the stages are just to determine the body's internal condition. It has nothing to do with the external symptoms. For example, a Stage 1 person may experience the most painful periods, and a stage 4 person may experience nothing at all. Although the severity increases, it is not directly proportional to the symptoms.
Diagnosis
From the symptoms mentioned earlier, your doctor can easily understand if you have endometriosis or not. But, to confirm the same, one may have to undergo the following tests.
- Pelvic Examination: Through a regular pelvic regular examination, both internal or external, the doctor can examine any sort of scars, tissues, or lesions present inside your reproductive system. However, this method cannot diagnose the first two stages of endometriosis, and the doctor may suggest going for Imaging Tests or Scans.
- Ultrasound: This is one of the popular diagnostic methods used to diagnose the disease. Here, two methods are used. The regular ultrasound and the transducer. While the regular ultrasound may identify the cysts, it cannot actually confirm the presence of endometriosis. This is exactly why this method is paired with a transducer pressed against your organs or sent inside your body through the vagina to capture the pictures of your reproductive system, which gives more clarity about the condition.
- Magnetic resonance imaging (MRI): Magnetic Resonance Imaging scanning, popularly known as the MRI scan, is a test that uses a magnetic field and radio waves to create detailed images of your body's organs and tissues. This scan gives complete information about the location and the size of the endometrial implants. This helps the doctor and the patient to make an informed decision about the kind of treatment they should go for.
- Laparoscopy: This is a procedure where the doctor may refer you to a surgeon to completely understand the condition. This is usually done when the endometriosis is in the latter stages and needs a piece of expert advice to go further with the procedure. This is a procedure that allows the surgeon to see inside your abdomen (laparoscopy). While you are sedated, your surgeon makes a small incision near your navel and inserts a thin viewing instrument (laparoscope) to look for signs of endometrial tissue outside the uterus. Like MRI, even this is used as an understanding of the treatment.
- Biopsy: This is an extended diagnosis of laparoscopy, where the surgeon takes a small sample of your tissue and is sent to the lab for further diagnosis. This is usually done in the latter stages of the condition and is also used to detect any sort of malicious cells in the body that may be malignant to the body if ignored.
Possible areas which may be affected by endometriosis in the reproductive system:
A few possible areas are highly likely to be affected by endometriosis inside the female reproductive system. They are the lining of the pelvic cavity, the outer surface of the uterus, the ligament that supports the uterus, the ovaries, the fallopian tubes, the cavity between the uterus and bladder(anterior cul-de-sac), and the cavity between the uterus and rectum(posterior cul-de-sac).
As mentioned, apart from the female reproductive system, few other organs in the body are affected by endometriosis. This may not be the case for everyone. Still, a few people may also find endometriosis symptoms in the intestines, vagina, vulva, abdominal surgery scars, the intestines, rectum, cervix, and urinary bladder.
Treatment
Unfortunately, there is no permanent cure for endometriosis. However, there are a few treatments to treat this condition. The treatment of endometriosis often depends on the stage in which it is detected. As mentioned earlier, the type of diagnosis also helps make informed decisions about the treatment methods. The following are the most commonly used treatments for endometriosis.
Pain Killers
This is one of the most popular treatments used. This is one of the most common symptoms of endometriosis. Although period pain varies from person to person, it is important to pay attention to it and consult the gynaecologist immediately when it is unbearable. They may help you with a few medications that may help you soothe and manage the pain. They may include anti-inflammatory drugs such as Ibuprofen. However, if that does not work, the doctor may suggest strong medicines in order to get the condition under control.
Hormonal Treatments
One of the other methods used for the condition is hormonal treatment. This may be as simple as a birth control pill. In some cases, they may even recommend going for gonadotrophin-releasing hormone. Experts are trying to mimic the regularly produced in the body through hormonal therapy, which is disrupted due to endometriosis. This may help lower the estrogen levels, which facilitates stopping the tissue from growing further. However, this treatment cannot repair the already existing condition or improve fertility.
Surgery
This is usually the final treatment options people go for. As already mentioned earlier, there is no proper permanent cure for the condition. One can only regulate endometriosis with a few treatments available. Surgery is usually suggested in Stage 4, where the walls of the uterus become thick, and it shows it on your belly. If the condition is beyond control, doctors may even suggest a hysterectomy, which is the removal of both ovaries. However, this is advisable for women who are at the menopause stage or crossed the menopause stage.
Fertility Treatments
As mentioned, infertility is one of the popular conditions faced by people with endometriosis. There are many young women all around the world who face this issue. So, people who are suffering from endometriosis and want to get pregnant want to go for alternative treatments like IVF and other lab procedures.
Apart from the aforementioned treatments, a few lifestyle changes are recommended for people who are suffering from endometriosis.
Healthy Eating
This goes without saying. It is extremely important to have healthy eating habits in order to have a healthy and sustainable lifestyle. Some experts believe that the high-fat content of meats such as beef encourages your body to produce chemicals known as prostaglandins, which may lead to increased estrogen production. Excess endometrial tissue may be caused by an increase in estrogen levels.
However, increasing the levels of Omega 3 in the body may have an overall positive effect on reproductive health. Cutting trans fats and increasing the intake of healthy fats lead to the body's healthy functioning. Introducing fresh fruits, vegetables, nuts, and seeds to your diet is also one step towards healthier eating.
The following are the foods that need to be avoided:
- Highly processed and junk food
- Caffeinated beverages
- Minimize dairy and gluten consumption, as it may worsen the inflammation
- Red Meat
- Alcohol and other substitutes
- Trans and highly saturated fat
Regular Exercise
Apart from healthy eating, a moderate amount of exercise can also be beneficial in the case of endometriosis. It need not be heavy, as an increase in the stress hormones due to heavy exercise will do worse than good. So, a moderate amount of exercise will be quite helpful. At least 30 minutes of any form of regular exercise is noticed to be beneficial in the case of endometriosis.
Manage Stress
Stress is one of the worst enemies of the human body. Especially in the cases like endometriosis and PCOS, managing stress and relaxing can manage at least 40% of the issue. So, it is extremely important to take care of oneself and relax using various methods like meditation, yoga, massages, and even acupuncture. It is not only beneficial for one's endometriosis but is also good for the holistic health of the person.
Supplements
Along with a healthy diet and regular exercise, there are a few supplements that may actually help in controlling and treating endometriosis. A small study conducted on women suffering from endometriosis showed that regular intake of vitamin E and vitamin C helped in decreasing pelvic pain and inflammation.
Although you can induce them using regular foods, the dosage may not be the same every day. So, one can take the doctor's advice and try inducing supplements into their diet. Another study has proven that intake of curcumin, which is found in turmeric, may help with inflammation due to endometriosis. However, curcumin is usually advisable to be consumed along with black pepper to increase the absorption of curcumin into the body.
Studies have even proven that intake of vitamins A, D, C, and zinc also helped with endometriosis. So, it is evident that having a healthy balanced diet and adding supplements according to the need can actually help in managing endometriosis.
However, one cannot rely on just one way of treatment or diet to treat a problem. Consult experts, take advice with respect to lifestyle, diet, and physical activities, and get a tailor-made, customized solution to your problem. If you go blindly without an expert's consultation, that might not lead to long-term, sustainable results.
Takeaway
So, although endometriosis is one such condition that does not have a permanent cure to it, when you observe your body carefully and understand the signs, it is easy to detect in the early stages. If you see any of the 2 or 3 symptoms, consult a doctor immediately. Since it has no cure, prevention is the only way. However, at times even that may not be
under control. In such cases, just don't panic and lead a healthy lifestyle by preventing it from worsening and keeping things under control. By doing all of this, it becomes less of a load to manage endometriosis, and this further helps in major complications caused by endometriosis.
Frequently Asked Questions
Can I never get pregnant with endometriosis?
Although fertility is primarily affected by endometriosis, that doesn't mean that one can never get pregnant. Medical science is so much more advanced today, and visiting the right expert will give you the right answer and the right advice.
Does having endometriosis means having cancer?
Not at all. Although they are referred to as benign tumours and behave in the same way that cancer cells behave, that doesn't mean that they can be classified as cancer cells. Although there are chances that women with endometriosis are at risk of cancer, the numbers are very less.
Does getting pregnant solve endometriosis?
This is one of the common myths people have that getting pregnant will solve the case of endometriosis. However, that is not the case. Although some women may feel that their symptoms are subsidized during pregnancy, it is because of the hormonal changes and a tad bit of balance between hormones due to pregnancy. But that doesn't mean that it is permanently cured.
Does hysterectomy cure endometriosis?
This is again another myth people have that if the female reproductive system is removed, they will have no problem at all. However, as mentioned, endometriosis cells can grow in any part of the female body. And there is no proven reason for the same. So, no hysterectomy cannot cure endometriosis completely.
References
- https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
- https://www.webmd.com/women/endometriosis/understanding-endometriosis-treatment
- https://www.medicalnewstoday.com/articles/149109#symptoms
- https://www.webmd.com/women/endometriosis/endometriosis-causes-symptoms-treatment
- https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis
