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Endometriosis is a medical condition in which tissue resembling the lining of the uterus starts to grow in different body parts. When this tissue develops outside its usual location, it can lead to painful symptoms that affect both the menstrual cycle and everyday activities. In some cases, endometriosis can make it difficult to conceive because of scarring or blockages in the fallopian tubes.
The most common areas where endometriosis develops are the space behind the uterus, ovaries, the myometrium (a layer of the uterine wall), the peritoneum, and fallopian tubes. In rare cases, endometriosis can affect the rectum, intestines, bladder, diaphragm, lungs and the vagina.
In general, endometriosis is a widespread condition, affecting approximately 1 out of 10 women and individuals assigned female at birth (AFAB) globally. It is most commonly diagnosed in people in their 20s and 30s, and the symptoms are normally manageable with the right treatment.
While there are various symptoms of endometriosis, the most prevalent one is pelvic pain, which can range from mild to severe. This pain often intensifies just before and during menstruation because of inflammation caused by hormonal changes.
Common endometriosis symptoms include:
It’s also possible to have endometriosis without any noticeable symptoms. In some cases, individuals may only discover they have the condition when trying to get pregnant.
Normally, there isn’t any link between the severity of the disorder and the symptoms. Some individuals with few endometriosis patches may experience intense pain, while others with multiple patches may have little to no discomfort.
Endometriosis is an intricate condition affecting women worldwide, from their first menstrual period (menarche) and through menopause, irrespective of ethnicity or social background. Its development is brought on by various factors, although the exact causes remain unclear. Currently, several factors are believed to contribute to the onset of endometriosis. These include:
This occurs when menstrual blood with endometrial cells moves backwards through the fallopian tubes into the pelvic cavity instead of exiting the body via the cervix and vagina during menstruation. Retrograde menstruation may lead to the deposition of endometrial-like cells outside the uterus, whereby they could embed and grow.
With cellular metaplasia, cells outside the uterus transform into endometrial-like cells and begin to grow.
Stem cells may play a role in the disease, spreading abnormal tissue through blood and lymphatic vessels.
Additional factors, such as hormones, particularly estrogen, may also contribute to the persistence and growth of ectopic endometrial tissue. Estrogen is known to intensify inflammation, pain, and growth linked with endometriosis. However, the connection between estrogen and this condition is complex.
Certain factors can increase the risk of endometriosis. These include:
Endometriosis can lead to several complications. In most cases, it causes severe pain that interferes with one’s well-being and everyday life. Women with the condition might also find it difficult to conceive.
Apart from infertility and chronic pain, severe endometriosis may also result in other complications such as:
Your doctor will help you manage these complications to enhance your quality of life
Diagnosis of endometriosis often begins with a review of your symptoms, such as painful or heavy periods, which may prompt a visit to a GP. During the appointment, you may speak to a gynaecologist who will ask about your medical history and if other family members have endometriosis. A pelvic examination is usually performed, followed by imaging tests such as ultrasound.
The only definitive way to diagnose endometriosis is through a laparoscopy. This minimally invasive procedure involves the use of a small camera to examine the pelvis. Once the endometrial tissue is found, the provider can perform a biopsy to remove a small sample for more laboratory testing.
During the laparoscopy, the surgeon will attempt to take out or destroy any tissue that could be endometriosis. This procedure can be used for both diagnostic and treatment purposes. However, in some cases, the endometriotic lesions’ locations may make removal difficult without risking damage to critical structures. In such cases, a team of experts, including colorectal surgeons, minimally invasive gynecologists, or urologists, may be needed for the operation.
Occasionally, endometriosis is discovered by accident during examination. Not all individuals with the condition develop symptoms, and healthcare providers may identify it during other procedures.
Endometriosis treatment plan usually depends on several factors, such as:
Treatment for endometriosis often focuses on managing pain and addressing fertility issues if you wish to get pregnant in the future. Options usually include medications, surgery, or a combination of both.
Medications may be prescribed to manage endometriosis symptoms. Non-prescription nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help alleviate pain. Another alternative is hormonal therapy, which can help ease pain and suppress the menstrual cycle.
Hormonal therapy options include:
You should note that the symptoms may return if you stop these medications. Additionally, these treatments are not recommended for use during pregnancy or while trying to conceive. Discuss the benefits and risks of each option with your provider before you begin taking them.
Sometimes, surgery may be recommended to address endometriosis. While there are risks associated with the surgery for endometriosis, it may be the most effective way to ease pain and even improve fertility. Generally, this surgical procedure is often performed to take out the endometriosis tissues.
Surgery for endometriosis options include:
This procedure involves creating a small incision in the abdomen and inserting a tiny tube-like equipment known as a laparoscope inside the body. This tool provides a clear view of the body and enables the surgeon to locate endometriosis using a high-definitive camera. If necessary, additional surgical instruments may be inserted to remove the endometriosis tissue.
For severe endometriosis, removal of the uterus or ovaries may be necessary.
Endometriosis is considered a chronic condition, and while surgery can provide significant pain relief, the symptoms may recur after a few years. The likelihood of recurrence depends on the severity of this disease. Your doctor can recommend a combination of surgery and drugs for optimal results.
At times, endometriosis may resolve on its own without treatment. It could also go away after menopause when estrogen levels in the body naturally decline. However, for most people, the condition requires ongoing treatment to manage symptoms such as pain. Having regular check-ups with your healthcare provider is essential for long-term symptom management and enhancing overall health.
If left untreated, endometrial-like tissue that develops outside the uterus can lead to cysts, scar tissue, and adhesions. These complications may result in chronic, severe pain, particularly during menstruation. In addition, most women with endometriosis experience fertility issues, making it difficult to conceive.
While endometriosis cannot be completely prevented, some factors may lower the risk of developing the disease.
Endometriosis is less common in individuals who:
Endometriosis can significantly impact both your physical and emotional well-being. Although the symptoms can be mild for some and worse for others, the disease often presents varying challenges.
You may experience chronic pain that hinders you from enjoying things you love or even engaging in sexual activities with your partner. Endometriosis also causes painful emotional effects in various ways. For instance, if your goal is to get pregnant, you will need to hold off those plans while you address infertility. Those who aren’t planning to get pregnant and whose pain is under control may still require daily medication or a surgical procedure to treat endometriosis.
Despite these challenges, treatments are available, and there is hope for everyone. Most women find significant symptom relief with appropriate treatment.
Yes, it is possible to get pregnant with endometriosis, though it may not be easy compared to those without the condition. If you’re trying to conceive, consult your healthcare provider for a suitable treatment option. Surgery may be necessary to remove endometrial tissue, and your doctor will closely work with you to develop the best treatment approach to support your pregnancy.
It is advisable to see a doctor if you have symptoms like pelvic discomfort, heavy or prolonged periods and other endometriosis signs. An examination and some diagnostic tests will be done to determine if endometriosis is the reason.
Consider asking your doctor the following questions about endometriosis:
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