While womanhood comes with its blessings, it has its own problems too. And one of the most painful of such issues is endometriosis. Endometriosis is quite a common condition that can impact your daily life. It is not only painful, but it can lead to fertility issues too.

Today, let’s understand this condition in detail.

What is Endometriosis?

This is a gynaecological condition where tissues similar to the lining of the uterus grow on organs outside the uterus, in most cases the ovaries, fallopian tubes and the tissue lining the pelvis. Although uncommon, endometriosis growth may also be found beyond the pelvic organ area.

These endometriosis tissues work similarly to tissues inside the uterus. They thicken, break down and bleed during each menstrual cycle. However, when they grow outside the uterus, they don’t leave the body. And this creates problems.

When endometriosis develops in the ovaries, it leads to cysts known as endometriomas. As a result of the cyst, the surrounding tissue gets irritated and forms scar tissue. This leads to the development of bands of fibrous tissue known as adhesions, which can cause organs and pelvic tissues to stick to each other.

Endometriosis can be very painful, especially during menstrual periods. It can also lead to fertility issues. It is essential to get this treated on time to address the condition and avoid further complications.

Symptoms of Endometriosis

The symptoms of endometriosis vary from one person to another. Pain and infertility are the most common signs of endometriosis. The pain is mainly experienced as:

• Menstrual cramps experienced in lower back or abdomen
• During or after sex

However, it is important to remember that having a painful menstrual period does not necessarily mean that you have endometriosis. We have discussed more about this in the next section.

Apart from pain, other symptoms include:

• Low energy or fatigue
• Constipation or Diarrhoea during menstrual periods
• Irregular or heavy periods
• Pain while urinating or passing bowel during a menstrual period
• Bleeding or spotting in between menstrual periods.

A woman may have one or more of the above symptoms. Moreover, merely having these symptoms doesn’t mean that you have endometriosis. However, if you feel something is wrong, it is better to have a check-up with an experienced gynaecologist.

Is it Period Pain or Endometriosis?

Most women face pains during periods right from when they start getting them. This is normal. But when should you worry about them?

Keep a lookout for these 5 symptoms:

• Painful periods: Women suffering from endometriosis experience exhaustive pain that prevents them from living their everyday lives such as working, doing household chores and others. When period pains stop you from living a normal life such as going to work, going to school or pursuing other normal activities, it may indicate an endometriosis.
• Pain during sex: When endometriosis occurs beneath the uterus, penetration can be painful. Women may face localised pain that’s intense during penetration due to this condition.
• Ovarian cysts: Ovary is prone to developing cysts, which is normal sometimes and may resolve without treatment. However, cysts associated with endometriosis are painful and large and may need to be surgically removed. Cysts are a common symptom of endometriosis.
• Chronic pelvic pain: At times, women face severe pain in the pelvis that may appear to continue for long, even when they don’t have periods. This can be a result of scarring from endometriosis.
• Infertility: If you’ve been trying to conceive for one year or more without contraception, then it can indicate endometriosis. About 25% to 50% of women suffering from endometriosis suffer from infertility caused by the scarring of tissue and damage and inflammation to the fallopian tubes due to the condition. Endometriosis may also affect egg quality and reduce the number of eggs in the body.

Who can get Endometriosis?

Endometriosis commonly impacts women between the ages of 25 to 40. However, it can also happen to younger women. While menopause may provide some relief from the symptoms of endometriosis, some women still feel a certain amount of pain and discomfort.

Risk Factors of Endometriosis

Certain conditions may place a woman at a higher risk of developing endometriosis such as:

• The age of commencement of periods. Women who get their periods before the age of 11 are at a higher risk.
• The length of the menstrual cycle such as the gap between two periods or how many days does one last.
• Any defect in the uterus or fallopian tubes.
• A family history of endometriosis. Many experts have found a connection between family history and an increased risk of developing the condition at some point in their lives. If a woman in your family, such as your mother, grandmother or sister has endometriosis, it is a good idea to provide that information to your gynaecologist.

Causes of Endometriosis

Unfortunately, the exact causes of endometriosis are still unclear. However, some of the possible causes include:

• Retrograde menstruation: This is a condition where instead of flowing out of the body, menstrual blood flows back through the fallopian tubes. This blood contains endometrial cells from the inner lining of the uterus, which stick to the surfaces of the pelvic organs and pelvic walls. In time, these cells grow and thicken and bleed during each menstrual cycle.
• Embryonic cell changes: Sometimes, hormones such as estrogen may transform embryonic cells into endometrial cell growths during puberty.
• Transformed peritoneal cells: According to some experts immune factors or hormones transform peritoneal cells, cells that line the inner side of the abdomen, into cells similar to the lining inside the uterus.
• Complication from surgery: During any surgery in the stomach area, endometrial cells may attach to the scar tissues of the cut. This can lead to endometriosis.
• Endometrial cell transport: The tissue fluid system or blood vessel may move endometrial cells to other parts of the body, causing endometriosis.
• From the immune system: Sometimes, issues with the immune system may make the body unable to recognise and destroy endometriosis tissue.

Treatment of Endometriosis

The treatment of endometriosis will vary from one woman to another. To decide the treatment path, your gynaecologist may consider the following factors:

• Your age
• The severity of your endometriosis
• The severity of your symptoms, especially pain
• Your plans for pregnancy

Usually, the treatment plan is primarily focused on managing your pain and addressing fertility issues, in case you are planning on getting pregnant in the future. This is usually done through medication and surgery.

Medication

Medications are one of the most commonly used treatment procedures to treat endometriosis. In general, two kinds of medication are used – pain medications and hormone therapies.

Pain Management Medication

For pain management, your doctor may suggest over-the-counter pain relief medicines or non-steroidal anti-inflammatory drugs.

Hormone Therapies

Hormone therapies can include:

• Birth control pills: Various forms of hormonal suppression options are available including only progesterone or combinations of estrogen and progesterone. These are available in multiple forms such as oral birth control pills, vaginal rings, birth control shots, patches, etc. Birth control pills help women have lighter and less painful periods. However, they can only be given to women who are not planning to get pregnant soon.
• Gonadotropin-releasing hormone (GnRH) medications: These medications stop hormones that cause the menstrual cycle. They put the reproductive system on hold so as to provide relief from pain. These can be taken as an oral pill, a shot or a nasal spray.
• Danazol: This hormonal medication stops the hormones that cause periods. By taking this medication, you may get occasional menstrual periods or they may stop entirely.

However, in many cases, the hormonal medication provides relief from symptoms only till you take the medication. The symptoms may come back when you stop them. These medications are not recommended if you are planning to get pregnant actively.

Surgery

In some cases, your gynaecologist may suggest surgery to confirm endometriosis and treat it. Surgery can be an effective way to relieve the pain from endometriosis and often improve fertility. In rare cases endometriosis comes back within a few years after surgery, the likeliness of which depends on the severity of endometriosis. In many cases, your doctor may suggest a combination of surgery and medication to achieve the best outcome.

The most common surgical options include:

• Laparoscopy: This is a common procedure where your surgeon makes a small cut in your abdomen and inserts a thin tube-like tool called a laparoscope into your body. This tool is used to see inside your body with a high-definition camera and identify endometriosis. Another additional instrument is then used to excise and remove lesions.
• Hysterectomy: This is done in severe cases, where the extent of endometriosis is quite significant or other uterine conditions such as adenomyosis are found. During a hysterectomy, a surgeon removes your uterus.

For women who are trying to get pregnant but suffering from endometriosis, in vitro fertilization (IVF) can be an effective option.

Living with Endometriosis

Living with endometriosis is not easy. Always remember that you are not alone, 1 in 10 women deal with this situation. So how can you make living with the disease easier? Here are some tips that can help:

An anti-inflammatory diet

Eating the right kind of food can help deal with various diseases including endometriosis. Endometriosis has a close link with inflammation, hence eating an anti-inflammatory diet can be helpful.

Including more fruits and vegetables in the diet, instead of consuming a meat-based diet, has been found to reduce the symptoms of endometriosis. Avoiding food with a high content of FODMAP such as onion, garlic, rye, and baked beans can also provide relief from endometriosis symptoms.

Another important thing to consider is oils in your diet. Focusing on including more omega-3 fatty acids and reducing trans fats can help. You can incorporate food such as walnuts, flaxseeds and salmon to increase the intake of omega-3 fatty acids.

Reduce Stress

Increased stress has a direct link to endometriosis. Increased stress can worsen endometriosis symptoms. Taking proactive steps to reduce stress can be helpful. Pursue a hobby that you enjoy, practice yoga or meditation, read a book, listen to calming music, take a warm bath and focus on things that make you happy.

Sleep, sleep, sleep

Having a restful sleep is very important, especially when you are suffering from endometriosis. Poor sleep in women dealing with this disease has been linked to bladder pain, depression and a reduced quality of life. Practicing good sleep hygiene habits is important.

Stay active every day

Another important aspect is staying active. Getting at least half an hour of exercise is important. Routine exercise can decrease estrogen production, increase the circulation of blood to your organs, improve the flow of oxygen and nutrients into your organs, reduce stress, improve sleep and boost your mood by releasing endorphins.

A Final Word

Endometriosis can be a difficult condition to deal with. In most cases, it is diagnosed after the woman has suffered from it for at least four years. Till then, they are unable to understand what’s happening to their body and struggle silently. This can be stressful and severely impact your social and personal life.

It is important to remember that you are not alone in this. Many women across the world suffer from this condition. Having a candid conversation with your partner or seeking help from a professional counsellor can help you deal with this.

Most importantly, talk to your medical team about the symptoms you are facing and your goal as a woman such as whether you are planning to get pregnant or suffering from infertility issues. By working closely with your gynaecologist, you can improve your quality of life and deal with the disease in a better way.

Sources:

• https://www.who.int/news-room/fact-sheets/detail/endometriosis.
• https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/
• https://my.clevelandclinic.org/health/diseases/endometriosis
• https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis
• https://www.hopkinsmedicine.org/health/wellness-and-prevention/period-pain-could-it-be-endometriosis
• https://www.stlukeshealth.org/resources/5-tips-for-living-with-endometriosis