Endometriosis

Endometriosis, sometimes shortened to “endo”, is a disorder in which tissue similar to the lining of the uterus (known as the endometrium) grows outside of the uterus. Most typically, it involves other reproductive organs including the ovaries and the fallopian tubes, as well as the tissue lining the pelvis. In rare cases, endometriosis can be found elsewhere in the body.

Endometriosis is a common condition, estimated to affect 1 in 10 Americans of childbearing age. At the same time, it is notoriously underdiagnosed. 

Signs and Symptoms of Endometriosis

The effects of endometriosis are typically most noticeable around the time of one’s menstrual period. The endometrial-like tissue acts the same as endometrial tissue would during a menstrual cycle, moving through the process of growth, thickening, breaking down, shedding, and bleeding. 

Unlike the endometrial tissue lining the uterus, this tissue does not have a clear exit from the uterus to the vagina and stays trapped within the body instead. For this reason, the pain associated with endometriosis is typically linked with menstruation, coinciding with or worsening menstrual cramps. However, the pain can express at any point in one’s menstrual cycle. The trapped endometrial-like tissue can go on to cause irritations, cysts, scars, adhesions (wherein the trapped tissue binds other organs together), further pain, and infertility. 

Pelvic Pain

Pelvic and abdominal pain is therefore the most prevalent symptom of endometriosis. As a result it is often misdiagnosed as pelvic inflammatory disease, ovarian cysts, or gastrointestinal problems. The severity and frequency of this pain can vary, and may fluctuate or increase over time. 

The degree of pain is not a reliable determiner of the severity of one’s condition as pain is subjective and thresholds vary. Furthermore, someone with advanced endometriosis may not feel much while someone with a mild condition may experience extreme bouts of pain.

Other common signs and symptoms of endometriosis can include:

- Dysmenorrhea (painful periods)

- Pain or bleeding during or after sex

- Pain with urination or bowel movements 

- Excessive bleeding during periods 

- Intermenstrual bleeding (bleeding between periods) 

- Fatigue

- Iregular bowel function (diarrhea or constipation) 

- Bloating 

- Nausea

- Infertility

Causes of Endometriosis

The cause of endometriosis remains uncertain. Some suggestions include retrograde menstruation – where the shed endometrial tissue somehow clogs the fallopian tubes and attaches somewhere in the abdomen, hormones influencing embryonic cells during puberty, circulatory systems transporting endometrial cells to other parts of the body, implantation during a procedure such as a C-section, or compromised immune function.

There is also a hereditary factor. People with endometriosis in their family are at an increased risk of developing endometriosis in their lifetime.

Treatment of Endometriosis

The best endometriosis treatment approach is determined with the help of a doctor and depends on the severity and advancement of the condition, as well as whether or not one is trying to get pregnant. Typically, doctors will suggest less invasive treatments and only opt for surgical treatment when the alternatives are not effective. 

Endometriosis treatments can include:

- Oral contraceptives or hormonal IUD: by managing or stopping the menstrual period, it can reduce or eliminate the symptoms of endometriosis. 

- Progestin: progestin inhibits estrogen and, with it, the growth of the endometrium.

- Danizol: a hormone derived from testosterone that can reduce endometriosis. 

- Gonadotrophin-releasing hormone agonists (Lupron): injected hormones that stop the production of estrogen and progestin and relieve the symptoms and advancement of endometriosis.

- Aromatase inhibitors: medicines that reduce estrogen in the body.