Endometriosis may sound foreign to you, but it is actually a fairly common condition – it affects an estimated 1 in every 10 women worldwide, yet society all too often considers it a taboo.
In conjunction with the National Endometriosis Awareness Month 2021, we would like to illuminate facts about endometriosis and hopefully, empower our readers to start more conversations about endometriosis with healthcare providers and their loved ones.
The "endometrium" is the name for the inner lining of the uterus. In people with endometriosis, cells like those normally found in the endometrium grow outside of the uterus.
Image credit: Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436., CC BY 3.0, via Wikimedia Commons
This can pose a lot of problems for people who suffered from endometriosis, as when these endometriosis cells grow at a place they should not be, they cause inflammation, which can lead to symptoms that affect their lives. The most common places where endometriosis occurs are the ovaries, the fallopian tubes, the bowel (large intestine), and the areas in front, in back, and to the sides of the uterus.
Unfortunately, little is known about the causes of endometriosis. A common theory is that some menstrual blood and endometrium flows backward from the uterus through the fallopian tubes and into the pelvis during the monthly menstrual period. This tissue then grows where it lands in the pelvis. This is called the "retrograde menstruation theory", a very old theory that dates back to 1927. Other more modern theories exist as well, including genetics and cancer driver mutations. More studies are underway to better understand the causes of endometriosis.
Although we mentioned above that endometriosis is estimated to affect 1 in 10 women, but scientists suspect the actual number may be higher – partly because some women suffered from endometriosis do not have any symptoms, and those with symptoms have varied and non-specific presentations, which can be confusing for scientists who documented these data.
Endometriosis poses health threats to women, ranging from nuisance that affects their productivity at work, to disabling symptoms that reduce their quality of life. Therefore, it is important that we learn the health problems caused by endometriosis, and be more empathetic to individuals who struggled with the condition.
The most common symptom is pain in the pelvic area, especially with menstrual periods. The following may be some telltale signs of pain caused by endometriosis:
Pelvic pain occurs just before or during the menstrual period. In some cases, painful periods get worse over time. This is known as dysmenorrhea. Menstrual pain, especially the debilitating ones, should not be taken lightly and be dismissed as trivial pain. It is often underdiagnosed and undertreated even by doctors themselves. An endometriosis patient shared her experience in this article, saying that she started experiencing severe menstrual pain at the age of 12 to the point where she would even faint, but she was only prescribed painkillers and told by doctors that it was just normal period pain symptoms.
Between menstrual periods, with worsened pain during the period.
During or after sex.
With bowel movements or while urinating, especially during the period.
But not all pain experienced during menstrual periods are caused by endometriosis. Pelvic pain can be caused by many other conditions, including pelvic floor muscle spasm, pelvic infections, and irritable bowel syndrome. If you have pelvic pain, your health care provider can help to figure out if endometriosis may be the cause.
Endometriosis can make it more difficult to become pregnant. The difficulty getting pregnant might be because endometriosis may cause scar tissue to develop, which can damage the ovaries or fallopian tubes. Even people with endometriosis who do not have scar tissue can have difficulty becoming pregnant.
Numerous studies, including this systematic review and meta-analysis, found that women with endometriosis had a higher chances of preterm delivery and having a child with lower birth weights compared with healthy women. Another meta-analysis of 33 studies that included over 3 million pregnant women reported that women with endometriosis are more likely to suffer from pregnancy complications such as high blood pressure during pregnancy and resulting organ damage, diabetes during pregnancy, bleeding from or into the genital tract before the birth of the baby etc.
Good news is, in people who do become pregnant, endometriosis does not harm the pregnancy. In addition, symptoms of endometriosis often improve after pregnancy. If you have endometriosis and would like to get pregnant, not all hopes are lost; many people with endometriosis do get pregnant and successfully deliver healthy children. Consult a gynaecologist for more information on how to get pregnant despite endometriosis. There are several medications, procedures and fertilization techniques available for infertility treatment.
People with endometriosis can develop ovarian cysts containing endometriosis tissue; these are called endometriomas. Endometriomas are usually filled with old blood that resembles chocolate syrup; thus, they are sometimes called "chocolate cysts." Endometriomas are sometimes seen during a pelvic ultrasound or felt during a pelvic examination. They are benign (not cancerous) but can cause pelvic pain; if this happens, surgery is usually recommended to remove them.
If you think about it, the development of endometriosis shares some similarity with cancers: they involve growth of tissues at places they should not be at. As mentioned, endometriosis is not a type of cancer, but their link with other types of cancer is a bit confusing.
Scientists find that endometriosis appears to be associated with some epithelial ovarian cancers (EOC), but the overall risk appears to be low. On the other hand, a meta-analysis found that endometriosis was associated with a higher risk of thyroid cancer, and minimally (only 4% greater risk) with breast cancer, and with a lower risk of cervical cancer. The caveat of these kinds of studies is that they often have many publication biases and confounding factors that could affect the results of the studies.
All in all, scientists are still sceptical about the link between endometriosis and cancer. Healthcare providers worldwide also think that people with endometriosis do not have to be overly concerned with any specific cancer.
Because endometriosis is an inflammatory disease in nature, scientists have also been hypothesizing the possibility of increased heart disease risks among people with endometriosis. A study of over 116,000 women without heart disease or stroke reported that women with endometriosis had an increased risk of heart attack, and heart and blood vessels-related surgeries compared with women without endometriosis. More data are needed on the risk of heart diseases in women with endometriosis and potential benefits of heart diseases screening for these women.
There are several treatment options for endometriosis:
Surgery – Contrary to other medical conditions, surgery is done to diagnose endometriosis (and possibly remove it) before you try treatment with medication. Surgery can often be done "laparoscopically." For this approach, a doctor makes several small cuts to place instruments inside the abdomen and pelvis. One of these instruments has a light and camera, which allows the doctor to see the organs on a screen. Laparoscopy is less invasive than open surgery (in which a larger incision is made in the abdomen) and is often associated with a shorter recovery time.
Laparoscopic image of endometriotic lesions in the Pouch of Douglas and on the right sacrouterine ligament. Image credit: Hic et nunc, Public domain, via Wikimedia Commons
Nonsteroidal anti-inflammatory drugs (NSAIDs) – NSAIDs are a class of medicine that reduce pain and inflammation. They can be taken to reduce pelvic pain or pain during the menstrual period. Examples of NSAIDs are ibuprofen, mefenamic acid and diclofenac. You can get them from any pharmacy or GP. Taking NSAIDs long-term has many side effects and you can read them more here.
Hormonal birth control – Hormonal birth control methods, including oral pills, patches, and vaginal rings, are often helpful in treating pain because they reduce or prevent menstrual bleeding, especially when used continuously (only taking active pills or always using the ring in order to skip the monthly period). Daily oral progestin pills as well as injectable and implantable long-acting progestins may be very effective in managing endometriosis-related pain. A progestin-containing intrauterine device (IUD) can also be very effective in treating pain.
Image credit: Photo by C Technical from Pexels
Other forms of hormone treatment (gonadotropin-releasing hormone analogs) – Gonadotropin-releasing hormone (GnRH) analogs include GnRH "agonists" and GnRH "antagonists." Both types of medication cause the ovaries to temporarily stop producing estrogen. This causes the endometriosis tissue to shrink. This treatment reduces pain in over 80 percent of people, including those with severe pain. GnRH analogs are not used if you are trying to get pregnant.
Endometriosis can be hard for many, but it doesn’t have to be that way. With the help of professional healthcare providers, anyone with endometriosis can continue to live a productive life and get pregnant if desired.
Remember, do not attempt any unregistered, unproven or uncertified medical procedures or treatment that claimed to help you get pregnant or improve endometriosis. Always seek help from registered healthcare professionals only.
If you have any questions related to endometriosis, you can consult our professional doctors and healthcare professionals on Doc2Us. Doc2Us is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere. For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.
Download Doc2Us app on Apple App Store, Google Play Store and Huawei App Gallery; or use our web chat at https://web.doc2us.com/
Note: Doc2Us is not for medical emergencies. In the event of urgent medical conditions, please call 999.
Disclaimer: As a service to our users and general public, Doc2Us provides health education contents. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
UpToDate - Endometriosis: Pathogenesis, clinical features, and diagnosis
UpToDate - Patient education: Endometriosis (Beyond the Basics)
Parasar, P., Ozcan, P. and Terry, K., 2017. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Current Obstetrics and Gynecology Reports, 6(1), pp.34-41.
Cover image credit: Photo by C Technical from Pexels
Introducing Doc2Us, your personal pocket doctor at your fingertips. With its name synonymous to “talk to us”, Doc2Us is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere.