Endometriosis is a disorder in which the tissue that lines the inside of the uterus (the endometrium) starts growing outside the uterus – this tissue is called endometrial implant. Endometriosis most commonly involves the ovaries, bowel or the tissue lining the pelvis. Rarely, endometrial tissue may spread beyond the pelvic region.
Endometriosis is a chronic (long-lasting) and fairly common condition – more than 10 million cases are reported every year in India.
Endometrial implants behave the same way as the tissue would inside the uterus. They grow, thicken, and break down with the hormonal changes of each menstrual cycle. Since the displaced tissue has no way to exit your body (unlike the endometrium discarded via menstruation), it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal tissue that binds organs together.
Causes
The exact cause of endometriosis is not known. Possible causes include:
- Retrograde menstruation: Heavy bleeding or an abnormal structure of the uterus, cervix, or vagina result in the menstrual blood containing endometrial cells to flow back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
- Your immune system may not be getting rid of endometrial cells outside of the uterus like it should.
- The cells lining the abdominal and pelvic cavities come from embryonic cells. When one or more small areas of the abdominal lining turn into endometrial tissue, endometriosis can develop.
- After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
- The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
Symptoms
Symptoms of endometriosis vary for different women from mild discomfort to severe pain. However, the severity of pain does not always indicate the degree or stage of the condition. A woman may have a mild form of the disease, yet suffer from agonizing pain. It is also possible to have a severe form of endometriosis and have very little discomfort. Symptoms include:
- Pelvic pain
- painful periods
- pain in the lower abdomen before and during menstruation
- cramps one or two weeks around menstruation
- heavy menstrual bleeding or bleeding between periods
- infertility
- pain following sexual intercourse
- discomfort with bowel movements
- lower back pain that may occur at any time during your menstrual cycle
Since it is quite possible for you to experience no symptoms, it is very important for you to have your annual gynaecological exam do your doctor can monitor any changes.
Treatment
While endometriosis has no cure, several treatment options exist to relieve symptoms and manage potential complications. Since every case is unique, your doctor will recommended a treatment plan best suited for you. Treatment options include:
- Pain medication
- Hormonal therapy to regulate the monthly changes in hormones that promote the tissue growth that occurs when you have endometriosis, thereby providing some pain relief.
- Hormonal contraceptives like birth control pills, patches, vaginal rings, and medroxyprogesterone (Depo-Provera) injection decrease fertility by preventing the monthly growth and buildup of endometrial tissue, and can thus reduce or even eliminate the pain in less severe endometriosis.
- Conservative surgery to remove or destroy endometrial growths without damaging your reproductive organs. This surgery is suitable for women who want to get pregnant or suffer from severe pain. It can be done as a traditional open surgery or laproscopically.
- In some cases your doctor may recommend a hysterectomy if your condition doesn’t improve and no other treatment options are available.