Endometriosis

Endometriosis: Everything You Need to Know (and how to deal with it!)

Are you experiencing menstrual cramps during your period?

This slight discomfort is usually common in most women.

But when you feel that the menstrual pain hurts more than the usual and becomes intolerable, it may be a signal to take your situation seriously.

Extreme menstrual and pelvic pain are indicative symptoms of endometriosis which affects a lot of women worldwide.

What is Endometriosis?

Endometriosis is a gynecological condition where the tissues lining the uterus, the endometrium (hence the name), begin to grow outside and reach the other reproductive organs and even up to the parts of your abdomen and most of the time cause severe pain during menstrual period.

Why is Endometriosis considered as a gynecological condition?

Since the outgrowths are endometrial in nature, they also respond to hormonal changes during menstrual cycle and continue to thicken and shed every time you have your period.

Doesn’t sound too alarming right?

But remember, these endometrial tissues grow outside your uterus, thus, the bleeding cannot exit your body!

Over time this result to irritations, swelling and scarring on the normal tissues of affected neighboring organs. In some cases, it may even result to some organs and pelvic tissue to attach to each other.

The common parts where endometriosis can develop are

  • ovaries
  • fallopian tubes
  • exterior part of the uterus
  • the linings of the pelvic

Rarely, endometrial tissues can reach and form in the areas outside the pelvic cavity such as:

  • the intestines
  • bladder, rectum
  • cervix
  • vulva
  • vagina
  • abdominal scars caused by surgery

I heard that endometriosis can also cause chocolate cysts. What are these?

Typically, when the condition reaches the ovaries, fluid-filled cysts called ovarian endometriomas are formed within the ovarian tissues.

These are also commonly chocolate cysts.  This name is derived from the characteristic brown and tar-like appearance of the cysts that is very similar to chocolate.

This chocolate-like appearance is caused by old menstrual blood and tissues that are trapped inside the cavity of the cysts in the ovary.

These cysts can grow from 2-20 cm in size and can develop in one or both ovaries. This condition can be found in 20-40% of women with endometriosis although mostly linked with more severe stages.

What are the symptoms of Endometriosis?

In addition to extreme menstrual and pelvic pain, some of the most common symptoms also include:

  • Extreme menstrual pain spreading to your lower back and abdomen
  • Prolonged menstrual pain throughout your period
  • Pain during (and after) intercourse
  • Pain during urination and bowel movements (during period)
  • Abnormal heavy flow
  • Gastrointestinal issues including diarrhea, constipation and bloating
  • Nausea and fatigue
  • Difficulty getting pregnant

Chocolate cysts also exhibit similar symptoms with endometriosis since it is a subgroup of this condition—usually in the more severe stages.

When a cyst ruptures, severe pain is usually experienced on the location of the cyst in the body.

Will the symptoms ever stop?

If you are still in menstruating age, there is always a chance of developing this condition.

Without treatment, patients have reported that symptoms temporarily end with pregnancy and permanently cease after menopause.

However, since endometrial tissues respond to hormones like estrogen, increased level of these hormones will trigger endometriosis symptoms even after menopause.

I want to have children. Is it still possible with this condition?

If you have been trying to conceive for a long time now and have been failing, you may consider seeing to your gynecologist because based on reports on infertility on women, 20-50% have endometriosis.

The out-of-place endometrial tissue growths can impose a threat to the other healthy reproductive organs and affect the ability to conceive a child.

In fact, based on studies, women with ovarian endometriomas (chocolate cysts) has been found to have fewer and weaker egg cells and have increased levels of follicle stimulating hormones (FSH)—an indication of an unhealthy ovary.

With treatment (as discussed below), the removal of cysts and endometrial tissue outgrowths can improve the chance of getting pregnant but absolute fertility is not guaranteed.

In some cases, after treatment, other women still have difficulty getting pregnant or cannot conceive at all while some women report normal conception despite having ovarian endometriomas.

For fertility problems, your doctor may recommend you to a fertility specialist to help you.

What causes this condition?

Although there are not yet proven causes, researches have speculated these following reasons on how and why endometriosis develops;

  • Retrograde menstruation where menstrual blood with endometrial cells flows in a backward manner into the fallopian tubes and into the pelvic cavity instead of exiting the body
  • Abnormal transformation and transport different cells such as:

(1) peritoneal cells in the lining of your abdomen,

(2) embryonic cells into endometrial cells as influenced by hormones or immune factors

  • Transport of endometrial cells into other parts of the by the blood vessels or by the lymphatic system
  • Issues with immune system where the body cannot recognize and fight the endometrial outgrowths
  • Surgical incisions where endometrial tissues can attach to after surgery
  • Genetics and family history

Am I at risk of developing endometriosis?

Any woman in their reproductive age can be affected by this condition but it has been reportedly most common in women aged 30-40.

If you are a woman in your 30s and have not yet given birth before, the risk may be is higher for you.

In addition, the following also increases your chances of having endometriosis:

  • Abnormal uterus and menstrual pattern (period cycle not same as normal)
  • Period at an early age and menopause at older age
  • Higher levels of hormones i.e. estrogen
  • Family member (mother, sister, aunt) have endometriosis
  • Unhealthy lifestyle habits like excessive consumption of alcohol

How will I know if I have endometriosis?

If you recognize these symptoms in your body, the best thing you must do is to write them down and see your doctor as soon as you can.

Based on your list, your doctor may already have a suspicion and able to recommend any of the following diagnostic test that may include examining your abdomen and pelvic area:

  • Pelvic Exam
  • Ultrasound
  • Advanced imaging technology such as CT-Scan and Magnetic resonance imaging (MRI)
  • Blood tests
  • Laparoscopy (gold standard for diagnosis)

Depending on the severity of the condition, your gynecologist may refer you for laparoscopy —a procedure where a surgeon looks at inside your abdomen.

Before the procedure, you will be given general anesthetic and a small incision near your navel will be made. Then, a small viewing device called laparoscope will be inserted to search for existing endometrial tissues outside the womb. Through this test, the location, size and severity of the endometrial tissues can be determined.

In addition, your surgeon may take sample tissues for biopsy to know the extent of the condition.

Are there stages of Endometriosis?

Based on the results of your diagnostic tests, your doctor will be able to asses the severity and the stage of your endometriosis.

These stages are determined depending on the number, thickness, location and the extent of complexity and threat to other nearby organs caused by the endometrial tissues.

The commonly accepted endometriosis stages are the following:

  • Stage 1: Minimal
  • Stage 2: Mild
  • Stage 3: Moderate
  • Stage 4: Severe

Does the extent of pain indicate the severity of my endometriosis?

No, the extent of pain that you feel is not a measure of the severity of the condition and obviously cannot be used to determine what stage of endometriosis you have.

Based on the reports, some patients that have Stage 4 endometriosis exhibit lesser pain and symptoms while patients with Stage 1 or 2 endometriosis experience intolerable pain and evident symptoms and vice versa.

Therefore, the level of pain is not a reliable indication of the stages.

Proper diagnosis from your doctor is still the surest way to determine the severity of your endometriosis.

What are my treatment options?

For endometriosis, the following treatments are available depending on the severity of the condition:

  1. Practical remedies for pain
  • Home remedies such as warm baths and heating pads to relive discomfort  and pain from menstrual cramps
  • Regular exercise and healthy lifestyle
  • Painkillers and anti-inflammatory medicines you can avail over the counter
  • Alternative medicine (talk to your doctor first!)
  1. Pain Medication for milder symptoms and less severe stages
  • Hormonal therapy such as
    • birth control pills
    • gonadotropin-releasing hormone (Gn-RH) agonists and antagonists
    • progestin therapy and other hormone therapy
  • Usually, for milder and less severe stages, your doctor will only recommend “watchful waiting” to observe the response to medication before recommending further treatment procedures
  1. Surgery

Your doctor may advise you to undergo surgery if he/she finds it necessary.

These surgical treatments may include:

  • Laparoscopy– a minimally invasive procedure which is also a diagnostic tool using a device called laparoscope through an incision to view endometrial tissue growths—your doctor can remove endometrial outgrowths using this procedure.
  • Laparotomy– a major open surgery procedure where out-of-place endometrial tissues are removed. Doctors only opt for this procedure when endometriosis is severe, and laparoscopy is not enough to remove the endometrial tissues.
  • Hysterectomy– complete removal of uterus (talk to your doctor if you still want to have children because this procedure zeroes your chance of childbearing)
  • Fertility treatment directed by a fertility specialist (as recommended by your doctor)

Before committing to a surgical procedure, it is important to know that invasive procedures can sometimes cause additional problems like infections, bleeding or damage to affected organs. Also, surgeries require long recovery periods and should be taken into consideration.

That’s why proper dialogue with your doctor is very important. Typically, your doctor will primarily recommend trying conservative treatment methods and will only opt for surgery if initial medications do not work.

Is there a chance for endometriosis to recur after surgery?

Even after surgery, there is still a chance that endometriosis and pain may return.

Also, about 30 percent of surgically removed chocolate cysts recur. This recurrence happens when the endometrial tissues and cysts are very large and may leave traces that were not completely removed.

The risk of recurrence may be lowered if you get pregnant after surgery but there is no absolute guarantee.

Should I be worried about endometriosis turning into cancer?

By nature, endometriosis is a non-cancerous condition. However, studies have shown that ovarian cancer occur at higher rates in women with endometriosis. Though the risk of developing ovarian cancer in a woman’s lifetime is very low, research suggests that endometriosis increases the risk.

In extremely rare cases, women with endometriosis can develop a type of cancer called endometriosis-associated adenocarcinoma.

Is there anything else that might be useful when dealing with endometriosis?

Dealing with a disease can be very hard. In some women, the symptoms and complications brought about by endometriosis can bring a great weight on their emotional health and lead to depression.

It may be beneficial for you to look for support groups in your community and talk to other women experiencing the same condition to help you cope.

More questions about endometriosis?

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