Endometriosis is a disorder that occurs when tissue similar to the uterine inner lining forms outside the uterus. Endometriosis is characterized by severe pain, particularly during menstrual periods, and can also cause fertility issues. While this condition can significantly impact a person’s life, treatments are available and effective.
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Endometriosis occurs in about 10% of females aged between 15 to 44. It mostly develops around the reproductive organs within the pelvic or abdominal region, such as:
In rarer cases, endometrial tissue may also form on the:
Unlike healthy endometrial tissue within the uterus, this abnormal tissue doesn’t shed during the menstruation cycle. Instead, it accumulates and causes inflammation, painful cysts, and scarring. This buildup can also result in fibrous tissues forming between reproductive organs, making them “stick” to one another.
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Pelvic pain is the primary symptom of endometriosis and is usually associated with menstrual periods. While most women experience cramping during menstruation, those who have endometriosis report more pain during periods than normal, which may worsen with time.
Common symptoms are:
It’s important to note that the severity of pain doesn’t necessarily signify the extent or number of endometriosis growths. You may experience intense pain with only minimal tissue growth or have widespread tissue with less to no discomfort.
On the other hand, some individuals with the condition may not have any symptoms at all. In such cases, endometriosis is usually discovered when it becomes difficult to conceive or during surgery for a different reason.
Additionally, the symptoms of endometriosis can, at times, be similar to those of other conditions causing pelvic pain (ovarian cysts or pelvic inflammatory disease). This disorder may also be mistaken for irritable bowel syndrome (IBS), which is associated with constipation, diarrhea, and abdominal cramping attacks. IBS might also occur alongside endometriosis, making it harder to determine the actual cause of the symptoms.
Although the exact cause of endometriosis is unknown, there are several theories of the potential cause:
Endometrial cancer prognosis differs significantly depending on the histologic subtype. The stage of the cancer is the most crucial factor influencing general survival. The 5-year survival rates for people who have endometrial cancer are:
Studies indicate that these factors are likely to increase the possibility of developing endometriosis:
Some factors that may reduce the likelihood of endometriosis are:
Endometriosis is among the most prevalent conditions associated with female infertility. According to the American Society for Reproductive Medicine, between 24% and 50% of women with infertility problems are diagnosed with endometriosis. In mild to moderate cases, infertility may be temporary, and surgery to take out endometrial tissue can improve the chances of pregnancy.
The exact way endometriosis impacts fertility isn’t fully understood. Scar tissue caused by endometriosis may interfere with the eggs’ release from the ovaries or obstruct their passage through the fallopian tube, preventing them from reaching the uterus. Also, endometriosis may harm sperm or fertilized eggs before implanting in the uterus.
Despite this, most women diagnosed with endometriosis-related infertility are still able to conceive and carry a pregnancy. Treatment options such as fertility preservation and in vitro fertilization (IVF) can increase the chances of getting pregnant. Generally, it’s important to discuss your fertility goals with your doctor when planning your endometriosis treatment.
To diagnose endometriosis, your healthcare provider will likely begin with a physical examination. They will also ask about your symptoms plus when and where you experience pain.
Common tests for diagnosing endometriosis include:
The doctor will physically examine your pelvic area using one or two gloved fingers to feel for abnormal changes like painful spots, cysts around the reproductive organs, irregular growths (nodules), or scarring behind the uterus. In most cases, small regions of endometriosis are often not detectable unless cysts have developed.
This imaging test employs sound waves to create images of the internal body organs. It can be done either by pressing a transducer on your abdomen or by inserting it into the vagina (transvaginal ultrasound). While ultrasounds can detect endometriosis-related cysts, known as endometriomas, they cannot confirm the presence of endometriosis itself.
MRIs utilize radio waves and magnetic fields to create detailed pictures of your organs and tissues. In some cases, an MRI assists with surgical planning by giving precise information about the size and location of endometrial growths.
In case a suspicious tissue is suspected, your doctor can scrape off some cells using a small equipment and take them to the lab for microscopic examination by a pathologist. A biopsy is usually necessary to make a conclusive diagnosis.
Sometimes, your provider can refer you to a surgeon for a laparoscopy procedure. It involves making a small incision around the navel and inserting a thin viewing tool called a laparoscope to examine the abdomen for endometrial tissue. You’ll receive medication during the procedure to make you sleepy and prevent discomfort.
Even though there is no permanent cure for endometriosis, medical professionals can provide treatments to help manage the condition. The ideal treatment plan depends on factors such as age and the symptoms you have. Whether or not you want to get pregnant will also determine the right treatment.
The prevalent nonsurgical treatments for endometriosis include hormone therapy and pain management.
Hormones affect the endometriosis tissue in a similar manner as the endometrial tissue within the uterus. Therefore, hormonal changes occurring during the menstrual cycle can worsen the pain.
Treatment options like hormone therapy work by altering hormonal levels or stopping the production of particular hormones in the body. However, these therapies can affect fertility, so they may not be suitable for everyone.
Hormone therapy may be administered as shots, pills, or nasal sprays. The prevalent options are:
For pain management, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce endometriosis-related pain. In more severe cases, prescription drugs may be necessary.
For advanced conditions or cases where other treatments fail to manage the pain, surgery may be required. Laparoscopy is the common surgical approach used to address endometriosis.
Laparoscopy is often performed by a surgeon and involves creating small cuts around the abdomen. A tiny tube attached to a camera and light is inserted in one incision while small equipment is placed in the other openings. The surgeon will use these tools to take out endometrial tissue (excision) or destroy it with strong heat (ablation).
The accumulated scar tissue is also removed from the region. Usually, laparoscopic surgery has a shorter recovery period and forms smaller scars, unlike laparotomy (traditional open surgery).
LaparotomyAlthough less common, a laparotomy may sometimes be recommended to treat endometriosis rather than a laparoscopy. This means that the surgeon will create bigger cuts in the abdomen to take out the endometrial tissues.
Just like laparoscopy, laparotomy also provides temporary pain relief, and endometriosis symptoms may return.
HysterectomyIn some cases, the surgeon may recommend a hysterectomy, the removal of the uterus, as a treatment option for endometriosis. The ovaries may also be removed (oophorectomy) either with or without hysterectomy surgery to stop hormone production and finally address endometriosis. However, this will instantly result in menopause.
In addition, ovary removal significantly reduces estrogen levels and stops or slows down the growth of endometrial tissue. Nevertheless, this can lead to menopause side effects and risks such as hot flashes, heart disease, bone loss, decreased libido, memory issues, and anxiety or depression. Because of this, the decision to undergo a hysterectomy or oophorectomy should be made carefully, in consultation with your doctor and taking into account your personal goals.
After the procedure, conceiving or carrying a pregnancy will be impossible since the uterus is absent. So, it’s important to discuss other options if you plan to have children. On the other hand, women who undergo an oophorectomy but still retain their uterus may achieve a pregnancy with in vitro fertilization (IVF). Eggs can be harvested before surgery and preserved for future fertilization, or an egg donor may be considered.
Most women find relief from pain and the symptoms caused by endometriosis through treatment. Even after surgery, endometrial tissue may regrow, and symptoms could also return. It is thus important to schedule routine check-ups with a GP to check for signs of tissue development or recurrence.
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