Endometriosis is the condition which pertains to endometrial cells – found in the lining (endometrium) of a woman’s uterine cavity – which begin to grow abnormally outside the uterus and spread to the pelvic region: the ovaries, fallopian tubes, bladder, rectum and bowel and are called endometrial implants. Endometrial implants can also reach up to the digestive tract, lungs and around the heart in rare cases. Endometriosis significantly affects and limits the quality of life for a woman due to chronic pain, fertility issues, relationships, cost of medical care, stress, anxiety, and depression, etc.
As per statistics available from 2019, over 176 million women in the age group of approximately 25-45 years the world over suffer from endometriosis, of which 26 million are Indian women. However, it is believed that a large number of cases go undiagnosed or unreported among Indians, due to lack of awareness and the social stigma attached to openly discussing women’s menstrual and sexual health issues. Endometriosis can occur from puberty also. The symptoms and pain subside after menopause.
Certain hormonal changes occur in a woman during her menstrual cycle. During normal menstruation, the tissue of the endometrial lining of the uterus breaks down and passes with the menstrual blood through the vagina.
In the case of endometriosis, the endometrial tissue (endometrial implant) growing outside the uterus becomes thick and breaks down, becoming trapped in the pelvic area with no way to pass out with menstrual blood, thus causing inflammation in the areas it is spread in, along with severe pain during menstruation. The debris of the decomposed endometrial implant causes scarring and the formation of cysts in the affected areas.
Causes & Risk Factors
The exact causes of endometriosis are not known, but the following are believed by some experts to be the most common and plausible theories of the causes:
- Genetics and heredity;
- Previous uterine infections;
- Environmental toxins;
- Faulty immune system;
- Certain conditions which block the normal passage of menstrual blood.
Risk factors include:
- High risk of ovarian cancer;
- Intestinal and bladder complications;
- Adhesion of pelvic organs.
The factors which determine the stages of endometriosis depend on the location, size, number, and how deeply embedded the endometrial implants are.
- Minimal: mild inflammation in the pelvic area; small lesions or wounds on and around ovaries along with shallow endometrial implants;
- Mild: shallow endometrial implants on ovaries and pelvic lining with light lesions;
- Moderate: Deeply embedded endometrial implants, considerable inflammation in pelvic area, with lesions on ovaries and pelvic lining;
- Severe: deeply embedded endometrial implants, with considerable number of lesions on pelvic area, ovaries, fallopian tubes and bowels, and development of cysts in the areas mentioned, as well as adhesion of pelvic organs by endometrial cells.
The symptoms are quite similar to other conditions like pelvic inflammatory disease, ovarian cysts and irritable bowel syndrome:
- Severe abdominal and lower back cramps and pain during menstruation;
- Heavy bleeding during periods;
- Bleeding between periods;
- Period lasting more than 7 or more days;
- Painful intercourse;
- Chronic pain;
- Pain and discomfort in passing urine and during bowel movement;
- Blood in urine or stool;
- Chronic fatigue;
- Low haemoglobin
- Infertility or difficulty in conception.
Endometriosis is difficult to diagnose because symptoms are similar to other conditions like pelvic inflammatory disease, ovarian cysts and irritable bowel syndrome, but is done by the doctor by screening the following:
- Family medical history;
- Physical pelvic examination;
- CA125 protein (a tumour marker) blood test which also indicates the presence of a specific protein present in endometriosis patients;
- Ultrasound and MRI scan.
There is no treatment for endometriosis, but the following treatment modalities can help control severe symptoms:
- Pain medication
- Hormone therapy
– Laparoscopic (keyhole) surgery) to scrape off endometrial tissue or growth;
– Laser surgery to burn or vaporize the endometrial tissue;
– Hysterectomy (surgical removal of cervix, uterus and ovaries).