Endometriosis – Causes, Symptoms and Treatment

What is endometriosis?

Endometriosis is a condition where the lining of the uterus (called Endometrium) that usually grows inside the uterus grows outside of it. This growth can be anywhere on the uterus, ovaries, bowels, tissues of the pelvis etc. The part of tissue that grows outside the uterus is called ‘Endometrial Implant’. Similar to the tissue that grows inside the uterus and then breaks down during periods, the external tissue also grows, becomes thick and breaks down from its attached area. The broken down tissue has nowhere to go and gets trapped in the pelvis region.

The fallen tissue can cause:

1. Irritation inside the pelvis region
2. Pain during periods
3. Fertility problems
4. Problems when the fallen tissue binds with other pelvic organs

What are the symptoms of endometriosis?

Symptoms of endometriosis differ from person to person and also depend on the size of the tissue that has grown/fallen. Women with lot of tissue may experience mild to no symptoms where as women with small growth may experience painful symptoms.  If you ever feel any two of the following symptoms, you must contact your gynaecologist immediately and get checked up.

1. Painful periods – Usually normal periods cause pain in the abdomen and lower back area. But in case when there is/are endometric implants, periods will be even more painful.
2. Heavy bleeding during menstruation and spotting
3. Painful sexual intercourse
4. Infertility

If you are experiencing unusual lower back pain during menstruation, it is better see your gynaecologist for a check up, especially if you plan to get pregnant in the future.

Causes of endometriosis

What causes endometriosis is not exactly known but there are different theories exist with specialists.

1. Retrograde Mensturation – Usually, a lining develops inside the uterus, it grows and if the egg doesn’t meet the sperm in that period cycle, the lining falls off through the vagina. In some cases, a part of this lining goes back through the fallopian tubes into the pelvic cavity and the tissue remains in the pelvis region outside the uterus.
2. In some cases, the hormones released by the body ‘convert’ the cells outside the uterus into the cells that are usually found inside the uterus. These cells are called ‘endometrial cells’ and they make the foundation for uterus lining to appear outside the uterus. If these endometrial cells gets displace and spread across different organs in the pelvis region, the endometric tissue can grow in all those regions where the cells get deposited.
3. As per another theory, some areas of the abdomen convert into endometrial tissue.
4. If you have had any surgery in the recent past and if there was any scarring to the uterus or cervix, the menstrual blood can leak into the pelvis region and cause the growth of endometric tissue.
5. Endometriosis can also occur when the endometrial cells are transported out of the uterus through the lymphatic system.
6. A faulty immune system that fails to kill the endometric cells that are present outside the uterus can also lead to this condition.

Stages of endometriosis

There are 4 stages of endometriosis (Minimal, Mild, Moderate and Severe) classified depending on how deep the endometric implants have grown in the pelvis region. In Minimal and Mild stages, the implants are lighter and fewer whereas in the severe stage, the implants would be deeper on the organs and present across many organs in the pelvis.

Diagnosis of Endometriosis

The symptoms of Endometriosis resemble those of ovarian cysts or pelvic inflammation disease. It is important that you pick a good gynaecologist, if you don’t have one already to report your problems.

Physical Exam

An experienced gynaecologist can feel the cysts or scars in the abdomen area and the uterus by a simple physical examination.

Ultrasound testing

Your gynaecologist may use a TransVaginal Ultrasound (through the vagina) or Abdominal Ultrasound device to get the images of your reproductive system. This can give a picture about the presence and location of endometric tissues.

Laparoscopy

This is a better and all in one device using which the gynaecologist can precisely locate the endometric tissue and can remove it at the same time.

Importance of seeing an experienced gynaecologist for endometriosis

As said, the symptoms of many diseases overlap. Only an experienced doctor can narrow down to the exact problem in minimal visits and provide you with right treatment. In case of endometriosis, women with mild and moderate severity will be able to conceive a baby whereas in case of moderate and severe cases, women will have trouble getting pregnant. If your gynaecologist is able to figure out the problem sooner and remove them, the chances of getting pregnant will improve drastically.

After fixing the endometriosis problem, if you are still unable to conceive, you may have to opt for InVitro Fertilization.  It is always advisable to conceive immediately after getting rid of endometriosis because, the delay may cause the problem to reappear and may make you infertile.  Your gynaecologist will be able to talk to you about all the conditions and complications once he/she diagnoses the problem.