Overview
A benign but rapidly spreading condition that affects women of reproductive age group. Endometriosis is a disease that is caused due to presence of the endometrial lining, i.e., tissue that lines the inner side of the uterus wall, outside the uterus.
What is Endometriosis?
Endometriosis is a long-term condition that affects a woman’s physical, mental, and emotional well-being. It is often difficult to diagnose because its symptoms can mimic other gynecological issues, making awareness and education crucial.
It is essential to understand what is endometriosis to manage this disease effectively. Endometriosis is a disorder in which tissue similar to the uterine lining grows outside the uterus. This can lead to inflammation, scar formation, and pain.
The uterus is lined by three different layers of tissues. The innermost layer is called the endometrium, the middle layer, myometrium, is made up of smooth muscles, and the outer layer is called serosa.
This inner lining tissue is a specialised tissue which is very active and promptly responds to different types of hormones secreted by the ovary and sheds off once the period occurs and readily rebuilds after that. It is a cyclical process and happens every month.
When this endometrial tissue is present in places other than the inner lining, it responds in a similar way, causing pain and bleeding.
Causes of Endometriosis
Although the exact endometriosis causes are not fully understood, some known factors may include:
- Retrograde menstruation
- Immune system disorders
- Surgical scar implantation
A woman with a family history of endometriosis is more likely to have this chronic health issue.
Endometriosis commonly occurs in
- Ovaries
- Fallopian tubes
- Muscle layers of the uterus
- Ligaments that support the uterus
- Peritoneum, lining the whole abdomen and pelvis
- Bladder
- Ureter
- Intestines
- Other uncommon sites: lungs, vagina, previous scar, nerves
Endometriosis occurring in the ovaries is called chocolate cysts.
Signs and Symptoms of Endometriosis
These are common signs of endometriosis, though they can vary by individual and endometriosis stages :
- Pain: cyclical, pain before, during and after periods
- Irregular bleeding
- Abdomen distension
- Subfertility: Inability to conceive
- Obstruction to the intestine and urinary tract
- Pain and bleeding while passing urine
- Pain and bleeding while passing motion
Understanding endometriosis symptoms early can help in getting a faster diagnosis and better management.
Stages of Endometriosis
There are some endometriosis stages, classified based on the extent, depth, and areas of tissue growth. These include:
1. Stage I (Minimal) – Characterised by small lesions and shallow implants.
2. Stage II (Mild) – Involves more and deeper implants.
3. Stage III (Moderate) – Includes deep implants, small ovarian cysts, and more adhesions.
4. Stage IV (Severe) – Characterised by large cysts on ovaries and widespread adhesions.
Diagnosis of Endometriosis
- History and clinical examination
- USG (Ultrasound of the abdomen and pelvis): If there are chocolate cysts, endometriosis of the muscular uterine wall (adenomyosis), obstruction to the urinary tract causing enlargement of the kidneys.
- MRI & CT in endometriosis of other organs and abdomen
- Laparoscopy: Visualising the abdomen through a telescope & camera, through a hole made on the belly button to check for visible lesions. They appear as dark brown spots because of old blood clots.
- Biopsy of the lesion
- Endoscopy of Gastrointestinal tract in selected cases
Treatment of Endometriosis
Once a definitive diagnosis is made. Treatment is aimed at alleviating the most common symptom, that is pain, and treating the underlying cause.
When it comes to relieving pain, commonly used drugs are paracetamol and NSAIDs (non-steroidal anti-inflammatory drugs).
Effective endometriosis treatment depends on the severity and individual factors such as fertility goals and endometriosis stages.
Depending on the severity of symptoms and the patient's circumstances, treatment of Endometriosis involves:
- Pain Management
- Hormonal Therapy
- Surgical Treatment
Following methods can be used to treat the cause.
- Hormonal medications
- Progesterone (tablets and intrauterine devices)
- Combined hormonal contraceptive pills
- Medicine to totally cut off the hormones at the brain level (GnRH: gonadotropin-releasing hormone analogues)
Surgery
- Removal of chocolate cysts (open or laparoscopic method)
- Removal of ovaries
- Removal of uterus, tubes and ovaries
- Removal of lesions found elsewhere in the body
Adenomyosis vs Endometriosis
Many women confuse adenomyosis and endometriosis, but both are different conditions. Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, while adenomyosis is when endometrial tissue is found within the muscular wall of the uterus. Both conditions can cause heavy bleeding and severe cramping, but the treatment for both is different.
The endometriosis meaning extends beyond reproductive health issues. The misplaced tissue behaves like endometrial tissue. It thickens, breaks down and bleeds with each menstrual cycle. However, since this blood has no way to exit the body, it leads to the formation of cysts, adhesions, and chronic inflammation.
Conclusion
Though endometriosis is a non-cancerous condition majorly, it has an increased propensity to spread and make adjacent organs to stick together and restrict their movements.
Long-term or chronic ovarian endometriosis has a 2 in 1000 chance of becoming cancer. Endometriosis is another important cause of subfertility. Hence early diagnosis and prompt treatment of pain by consulting a doctor are more essential than taking over-the-counter medications.
