Endometriosis

Endometriosis is a condition in which the inner lining of the uterus (endometrium) grows outside the uterine cavity. Commonly endometrium is found on the ovaries, fallopian tubes, tissues lining the pelvis. In some cases it spreads beyond the pelvic organs.  Endometrial tissue growing outside the uterus is called an endometrial implant. This tissue acts like the normal endometrium tissue. It thickens and breaks apart and bleeds at the end of the cycle; since the blood has nowhere to exit it gets trapped inside the pelvis. This trapped tissue can cause irritation, scar formation, adhesion (the tissue binds other pelvic organs to each other) excessive menstrual cramps and infertility. Usually endometrium implants are benign or non-cancerous.

Endometriosis is more common in women in their 30s and 40s. It can be classified on the basis of its intensity of the scars, location, depth, and size. When superficial implants and mild scarring occurs it can be categorised as minimal or mild. Cysts are formed along with severe scarring in moderate endometriosis. Severe endometriosis is categorised by infertility as a result of the endometrial implant.

Symptoms of endometriosis may vary from woman to woman. Some experience excruciating pain and can have mild endometriosis while some women may not experience pain at all and could have severe endometriosis. Common symptoms of endometriosis are:

Other symptoms include diarrhoea, constipation, bloating, etc.

Accurate cause of endometriosis is unknown. However research suggests possible causes are:

Problems with menstrual flow: tissues shed during period flow in the reverse direction through the fallopian tube to other pelvic areas; this is known as retrograde menstrual flow. 

Genetic factors: endometriosis can be inherited 

Immune system disorder: due to problem in immune system the body may not be able to locate and eliminate endometrial tissue growing outside the uterus. Women with endometriosis are also more prone to cancer.

Hormones: estrogen is responsible to develop the uterine lining called as endometrium. High level of estrogen production may promote endometriosis.

Surgery: during any abdominal surgery or C-section, there are chances that the endometrial tissue gets attached and implanted in surgical scars.

A woman is more prone to endometriosis due to the following risk factors:

Get in touch with your doctor if you experience:

Women suffering from endometriosis find it difficult to get pregnant.  Sometimes these implants may block or change the shape of the reproductive organs. These implants may also block the fallopian tube due to which the sperm is not able to fertilize the egg. Once fertilized the embryo attaches to the endometrium or the uterine lining. Due to endometriosis this lining does not develop and the fertilized egg is not able to attach to the lining. Certain hormonal factors may also be responsible for diminished fertility. In certain cases women with mild or moderate endometriosis can conceive without any difficulty. Infertility can be treated with appropriate treatment for women with severe symptoms.

Diagnosis of endometriosis is done on the basis of the symptoms.  Physical pelvic tests to detect the cysts, ultrasound, CT scan can be done to get accurate image of the organs, laparoscopy is done in which a thin needle is inserted inside the body through a small cut to ascertain the size and location of the implants. Biopsy is done in which sample of the tissues is taken to confirm the diagnosis. 

Endometriosis cannot be cured but the symptoms can be managed. Medical and surgical options are available to manage endometriosis. Hormonal birth control can be used to treat this condition if there are no plans of pregnancy. Pain medications may also be recommended to ease the pain. 

For women who want to conceive, surgery like laparoscopy is a treatment option in which the surgeon makes a small incision on the naval area to remove the implants. 

Ovary stimulation and IVF are measures used to cure infertility. Hysterectomy (removal of uterus) and oophorectomy (removal of ovaries) are surgeries done as last resort to treat endometriosis. However nowadays doctors prefer careful removal of the endometrial tissue instead of removing infected organs.

Even though there is no cure for endometriosis but treatments are available to manage the symptoms, pain and fertility issues effectively.