Conditions
Endometriosis
Over 190 million women globally suffer from endometriosis. This condition not only painfully affects a woman’s monthly cycle but can also heavily affect her fertility. As common as endometriosis is, there are still many misconceptions surrounding this condition. Read to learn more about the causes, diagnosis, and potential treatments to alleviate symptoms.
What is Endometriosis?
Endometriosis is a condition that involves tissue growth outside of the uterus. Endometriosis is derived from the word endometrium, a small layer of the body that prepares an egg to be fertilized. The small endometrium layer is shed when an egg is not fertilized. Every woman sheds the endometrium layer during her menstrual cycle.
The condition occurs when tissue resembling the endometrium layer develops outside the uterus. The abnormal tissue growth builds in areas like the ovaries, the back or front of the uterus, and the fallopian tubes.
Common Symptoms
The signs and symptoms of endometriosis can vary from individual to individual and are typically worsened during menstruation.
Common symptoms include:
One of the main signs of endometriosis is pelvic pain during the menstrual cycle. Pain is described as sharp, stabbing, aching, twisting, or burning.
Pain during periods can be worse than moderate cramping and soreness. Days before and during the menstrual cycle, those with endometriosis can feel intense pain.
Dyspareunia, or pain during intercourse, is a common sign of endometriosis. Intercourse can irritate the tender or sore parts where there are growths. Those who suffer from the condition state that the pain can last up to two days after sex.
Endometriosis tissue does not only grow on the reproductive organs but can also form in the pelvic region by the intestines, bladder, and rectum.
Endometriosis can cause heavy amounts of bleeding during the menstrual cycle. Heavy bleeding can last longer than seven days.
Depending on the stage of the condition and where the endometrial implants are located, endometriosis can cause infertility by blocking fallopian tubes or causing ovulation issues.
Other symptoms of endometriosis may include fatigue, nausea, diarrhea, or constipation.
Note
Endometriosis can share many characteristics with conditions such as irritable bowel syndrome (IBS) or pelvic inflammatory disease. Consult with your doctor to determine your diagnosis.
Causes of Endometriosis
The exact cause of endometriosis remains unknown, however, possible causes include:
Retrograde Menstruation
Menstrual blood flows backward through the fallopian tubes into the pelvic cavity, causing endometrial cells to implant outside the uterus. While this menstrual “backflow” is very common, only a small percentage of patients will actually get endometriosis.
Hormonal Factors
Excess or imbalanced levels of estrogen can lead to the growth of endometrial tissue outside of the uterus. The endometrial implants can respond to hormonal fluctuations during the menstrual cycle, causing inflammation and pain.
Genetics
According to the American Society of Reproductive Medicine (ASRM), research indicates that endometriosis has a genetic component. Having a family history of the condition increases the risk, pointing to a possible genetic predisposition.
Embryonic Cell Transformation
Embryonic cells, which are cells from the very early stages of an embryo, may transform into endometrial-like tissue in the abdomen. It is suggested that this cell transformation occurs due to genetic or environmental factors.
Immune System Dysfunction
An abnormal immune system response may fail to eliminate endometrial tissue, allowing the tissue to grow outside the uterus and promote inflammation.
Surgical Scars
Endometrial cells may attach to surgical incisions and begin to grow, forming endometrial implants in areas such as cesarean section (C-section) scars, hysterectomy sites, or other abdominal surgeries.
How is Endometriosis Diagnosed?
There are a variety of ways endometriosis is diagnosed. At times, the severity of pain or bleeding determines how a person is examined for the condition. Your doctor may ask you a series of questions that can include where and when you are experiencing pain and ask you to describe other symptoms.
Procedures that may be performed to diagnose endometriosis include:
Pelvic Exam
During a pelvic exam, a specialist such as a gynecologist will place their hand and feel for any abnormalities like cysts or scar tissue. When abnormality is touched, it may feel tender or sore.
Ultrasound
An ultrasound is a medical sonography that uses sound waves to produce an image of the reproductive organs such as the uterus and ovaries. While smaller implants cannot be seen on ultrasound, larger cysts of endometriosis in the ovaries (endometriomas) can be identified.
Magnetic Resonance Imaging (MRI)
An MRI is an imaging technique that uses a strong magnetic field and radio waves to produce detailed images of the organs and tissues, helping to locate and identify endometrial implants and endometriomas.
Laparoscopy
A minimally invasive surgery where a telescope with a camera is inserted into the abdomen through the belly button to visually confirm the presence of endometriosis and, if necessary, to remove or biopsy tissue for further analysis.
Stages of Endometriosis
There are four different stages of endometriosis established by the American Society of Reproductive Medicine (ASRM). The stages are separated based on a point system. Points are based on the number of implants (pieces of the lining that appear like spots), cysts, or scar tissue. The severity of the condition and its effect on fertility varies from person to person.
Stage 1: Minimal
(1-5 points)
This is classified to be a minimal stage of endometriosis. At this stage, there is a minimal amount of implants. Implants are also superficial and not deeply implanted in the surrounding area.
Stage 2: Mild
(6-15 points)
At this stage, the condition is considered mild. There are more endometrial implants, and they are also deeper in the body.
Stage 3: Moderate
(16-40 points)
When there is a presence of scar tissue, and small cysts on the ovaries, and many implants are deeply rooted in the surrounding area, this is classified as a moderate form of endometriosis.
Stage 4: Severe
(40+ points)
Stage four is the most severe of the endometriosis categories. In this stage, there are multiple implants, large cysts, and deep scarring in the surrounding area that can affect the pelvic organs.
Treatment and Medications for Endometriosis
Although endometriosis cannot be cured, many options are provided to relieve pain, alleviate symptoms, and support fertility. Multiple factors would determine what treatment is best, such as the severity of the condition, the severity of symptoms, and if the individual would want to have children.
Hormone Therapy
Hormone therapy such as oral contraceptives, or birth control pills, can help treat symptoms of endometriosis. Estrogen is the hormone that causes the endometrial tissue to grow and birth control pills limit the amount of estrogen in the body, alleviating endometriosis symptoms.
Pain Medication
Pain medication can be prescribed or purchased at a local pharmacy. Anti-inflammatory drugs (NSAIDs) assist with pain levels stemming from endometriosis symptoms. If patients have been taking pain medication for an extended time and still feel excruciating pain, they are encouraged to consult with their doctor.
Surgical Treatments
Laparoscopic surgery is performed to remove scar tissue, cysts, and other growths that result from endometriosis. A laparoscopy can be used to view the area to understand what is causing the issues, but it is also utilized to remove endometrial growths.
Endometriosis and Infertility
According to the American Society of Reproductive Medicine, “Up to 30% to 50% of women with endometriosis may experience infertility.” Endometriosis can cause fertility challenges by causing blockages in the fallopian tubes or ovulation issues, preventing the sperm and egg from fertilizing.
Although it can be challenging to conceive for women with endometriosis, it is not impossible, especially with assisted reproductive techniques like in vitro fertilization (IVF). IVF encourages ovarian stimulation and the release of numerous mature eggs. After the eggs have matured, they are retrieved from the uterus and then fertilized in a laboratory.
Reproductive Fertility Center has been helping women with infertility challenges grow their families through procedures like in vitro fertilization (IVF), intrauterine insemination (IUI), and more. Serving patients across the globe for decades, we continue to serve our patients with safe and quality fertility care.
Contact us today to schedule a consultation with a fertility doctor!
Common Endometriosis Questions
Is endometriosis painful?
Does endometriosis go away after menopause?
How serious is endometriosis?
Does endometriosis go away on its own?
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