Endometriosis is a very common condition that can affect anyone with a uterus.  It is when tissue that is similar to the tissue lining the uterus, called endometrium, is found outside of the uterus.  This can cause severe pain for some women.  The tissue acts like normal uterine tissue where it thickens, breaks down, and you bleed. 

The trouble is there is nowhere for this blood to escape the body, causing it to become trapped.  The most common places for endometriosis to occur are the ovaries, fallopian tubes, uterus ligaments, posterior cul-de-sac, anterior cul-de-sac, outer surface of the uterus, or the lining of the pelvic cavity.  Rarer spots for endometriosis to develop are the intestines, rectum, bladder, vagina, cervix, vulva, or abdominal surgical scars. 

There is no cure for endometriosis but symptoms can be treated and managed. 

 

Risk Factors 

Anyone who has a uterus is at risk of endometriosis.  Though there are some risk factors. 

  • If you are between the age of 30-40 you are at a higher risk. 
  • Other risks are having no children, starting your period before age 11, or having menopause at a later than normal age. 
  • Having periods that last longer than 7 days and are considered heavy. 
  • If your cycle is 27 days or less. 
  • Having a family history of a close relative, mom, aunt, or grandmother with endometriosis. 
  • Having a condition that stops menstrual blood from flowing from the body can also put you at higher risk. 
  • Having high levels of estrogen or a low body mass index can also raise your risk of endometriosis. 

 

Causes Of Endometriosis

The cause of endometriosis is unknown.  There are some thoughts as to what could cause it though.  Possible causes:

  • One is genetics.  If you have a family history of endometriosis that may cause yours. 
  • Retrograde menstruations, where endometrial cells flow back into your fallopian tubes or pelvic cavity instead of out of your body, causing the cells to attach to the pelvic walls where they grow, then they thicken, break down and bleed with each of your menstrual cycles. 
  • Another cause could be transformation of peritoneal cells into endometrial-like cells.  Embryonic cell transformation, estrogen may transform embryonic cells into endometrial like cells during puberty. 
  • Surgical scar implantation during a c-section can cause endometrial cells to become attached in the scar where they then grow. 
  • An immune system disorder may also cause endometriosis.  

 

Stages Of Endometriosis

There are 4 stages of endometriosis.  Stage 1 being minimal, stage 2 mild, stage 3 moderate, and stage 4 severe.  Stages are based on location, amount, depth, and size.  The severity of pain does not coincide with the severity of the stage.  Someone with stage 1 could have severe pain while someone with stage 4 had no pain. 

 

Symptoms

Symptoms are different for everyone.  Some people may not exhibit any symptoms.  

  • Infertility is a symptom of endometriosis. For some women they don’t even know they have endometriosis until they are having difficulty getting pregnant.
  • One of the main symptoms is excessive pain during menstruation.  Severe abdominal cramps combined with lower back pain. 
  • Some people with endometriosis have chronic pelvic and lower back pain
  • Another symptom is pain during intercourse. 
  • You may experience abnormal or heavy menstrual flows. 
  • Painful urination usually during menstrual periods or painful bowel movements. 
  • Other symptoms can be diarrhea, constipation, nausea, fatigue, and bloating. 

Sometimes endometriosis is misdiagnosed for pelvic inflammatory disease or irritable bowel syndrome.  Irritable bowel syndrome can accompany endometriosis which can make diagnosing trickier. 

 

Diagnosis

Diagnosing endometriosis starts with a visit to your OBGYN.  There your doctor will do a physical exam along with a pelvic exam.  They will also want to take your family history.  Other types of imaging they may need to do is an ultrasound, whether this is outside or a vaginal ultrasound. 

CT scan or MRI may also be needed to see if you can see any cysts caused by the endometrium or if you can see the endometrium affecting any other pelvic organs. 

A laparoscopy procedure can be done while you are under general anesthesia.  In this procedure your doctor will take a tiny scope through a small incision in your abdomen to look and take a biopsy of any tissues that seem out of place or strange.  

 

Treatment

There is no cure for endometriosis, though you can be treated and symptoms can be managed.  Treatment is different for everyone.  Your treatment will be based on overall health, current symptoms, extent of the disease, tolerance to medication, procedures, and therapies, how the disease looks to progress, your opinion, and your desire for pregnancy. 

In some cases over the counter pain relievers are all the treatment you may need.  Hormone therapy is another option for treatment.  This can be achieved with oral contraceptives, progestins alone, gonadotropin-releasing hormone agonist or medical menopause, or a form of synthetic testosterone. 

Surgery is an option depending on the severity of the condition.  Laparoscopy can be done to see where the tissue is in your pelvic cavity and what organs are affected.  A laparotomy is when your doctor will try to remove or displace as much of the endometrium tissue without damaging healthy tissues. 

A hysterectomy removing the uterus, and ovaries is also a treatment option. 

 

Conclusion

Endometriosis can cause severe pain for some people.  Others may have no pain but when they start to have a family and are having trouble find out they suffer from this condition.  Though there is no cure you still can have children while having endometriosis, if you find a treatment that works for you.  Treatment is key to prevent complications such as permanent infertility or an increased risk of cancer.  This condition can worsen over time.  

 

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