Endometriosis

ENDOMETRIOSIS pain

Last Updated December 20th, 2021

Overview

Endometriosis is a common gynecological problem and it is one of the major causes of infertility in women. In fact, it is reported in as many as 40% of women with fertility problems. Typically, it involves the abnormal growth of inner uterine lining or endometrium in locations outside of the uterus. Patients describe this as a very painful condition.

It can affect women of any age, although it is seen to occur more frequently in those of reproductive age. Symptoms can appear at any time following the onset of menses and last until menopause. Symptoms have been known to persist even after menopause particularly if there is significant scarring of pelvic tissues and organs.

 

What Is Endometriosis?

ENDOMETRIOSIS uterusEndometriosis is a gynecological disorder in which the endometrium or tissue forming the inner lining of the uterus begins to encroach into other locations outside of or around the uterus. Typically, this involves the ovaries, fallopian tubes, the cavity behind the uterus and the inner lining of the pelvic cavity. In severe cases, this condition may extend to the bowels or bladder as well. It is also possible, although extremely rare, for other parts of the body such as the diaphragm or skin to be affected. These growths (known as endometrial implants) are not malignant. Instead, they behave exactly as the inner lining of the uterus normally does.

In other words, they undergo changes associated with the menstrual cycle. As the cycle progresses, the implants thicken with blood and then break down. The discarded inner lining of the uterus is normally expelled through the vagina. This is what causes menstruation. However, ectopic endometrial tissue has no outlet and hence cannot be expelled. It accumulates and irritates the surrounding tissues and organs, causing inflammation and swelling accompanied by severe pain. Eventually, cysts appear on the ovaries and lesions can develop in the pelvic lining. The formation of scar tissue can even cause organs to become stuck to each other.

 

How Does It Develop?

It is not as yet known why endometriosis occurs. A number of theories have been put forward as to what causes endometrial tissue to grow outside of the uterus.

  • One possible explanation is that endometrial cells might get introduced into the fallopian tubes or pelvic cavity by means of a backward flow of menstrual blood. The reverse flow of menstrual blood is not uncommon but the presence of other factors such as impaired immunity can increase the risk of displaced endometrial cells becoming firmly implanted.
  • It is also believed that under certain conditions, particularly under the influence of hormones such as estrogen, other types of cells such as those of the pelvic lining may become transformed into endometrial cells.
  • Having an impaired immune response which is unable to recognize and destroy ectopic endometrial growths, allowing them to persist and develop into implants.
  • Following a surgical procedure such as a Caesarean section or a hysterectomy, it may be possible for endometrial cells to become implanted in the incision.

ENDOMETRIOSIS uterus painCertain risk factors are recognized in connection with endometriosis:

  • Having a close female relative with this disease can increase one’s own chances fivefold.
  • Irregular menstruation raises the probability of developing endometriosis.
  • Having a late first pregnancy or having no history of pregnancy at all.
  • Early onset of menses and delayed onset of menopause.
  • Having a low body mass index.
  • Consuming alcohol.
  • Pre-existing gynecological disorders affecting the uterus or causing obstruction in the normal elimination of menstrual blood.
  • Having an excess of the hormone estrogen.
  • A history of having undergone surgical procedures such as hysterectomy or Caesarean section.
  • A previous ectopic pregnancy.

 

How Do I Recognise The Signs?

The first signs of endometriosis may be felt some years after menarche (onset of menses). Some women experience no symptoms. Otherwise, the main complaint associated with endometriosis is extreme pain. Patients often report a pain far exceeding that of menstrual cramps in severity. Symptoms are particularly intense around the time of menstruation and intensity can vary from one month to the next. Symptoms can also subside temporarily during pregnancy. The following is a list of possible clinical indications:

  • Severe pain in the pelvic region around the time of menstruation.
  • Pain may also be experienced during or post vaginal intercourse.
  • Excessive menstrual bleeding.
  • Menstrual period lasting longer than 7 days.
  • Spotting or minor bleeding between periods.
  • Pain during urination or during bowel movements. This is more likely to occur around the time of menstruation.
  • Blood may appear in the urine during menstruation.
  • Lowered fertility.
  • Fatigue.
  • Constipation or diarrhea.
  • Bloating.
  • Nausea.

 

Are There Different Stages of Endometriosis?

The American Society for Reproductive Medicine has developed a scheme for identifying four stages of endometriosis. This scheme is based on diagnostic findings. Severity is graded based on the location, extent, and depth of endometrial implants, the extent of adhesions and cysts on the ovaries. Grading does not correlate with the intensity of symptoms that the patient may experience. Nor does it correlate with the extent to which the patient’s fertility may be affected. For instance, women with only mild endometriosis may actually experience severe pain. The four grades are:

  • Minimal: Endometrial implants are fairly shallow, generally located on the ovary, and the resultant lesions are small.
  • Mild: Slight lesions associated with shallow implants on the ovary and pelvic lining.
  • Moderate: Deep implants on the ovary and pelvic lining. The resultant lesions are larger and more in number.
  • Severe: Deep implants on the ovary and pelvic lining, accompanied by severe lesions on the fallopian tubes and bowels.

 

What Are The Complications That Could Arise?

This disorder is known to be one of the top causes of infertility in women. It can physically hamper the movement of sperm or ova through the reproductive tract or even damage them. In less severe cases, however, the patient may be able to conceive and successfully carry a baby to term.
The formation of scar tissue can cause adhesions when one section of injured tissue comes into contact with another and binds together. For instance, an ovary might become stuck to the pelvic wall. Women with endometriosis are at a higher risk of developing certain forms of cancer, particularly endometriosis-associated adenocarcinoma.

 

What Tests Help To Diagnose Endometriosis?

ENDOMETRIOSIS painEndometriosis is often diagnosed when a patient seeks medical help for infertility. Alternatively, the symptoms may be mistaken for those of primary dysmenorrhoea, pelvic inflammatory disease or irritable bowel syndrome. The patient’s family history may provide an indication of a possible case of endometriosis.

The first stage of diagnosis involves a pelvic examination. The physician may be able to feel lesions during a vaginal examination. This may be followed by a transvaginal ultrasound which helps detect abnormalities like cysts on the ovaries. This technique cannot, however, detect peritoneal lesions or scar tissue. Hence, a minimally invasive procedure known as laparoscopy in order to obtain visuals of the inside of the pelvic cavity. This procedure allows the collection of tissue samples for a biopsy which will help confirm a diagnosis of endometriosis.

 

Treatment and prevention

Treatment – depending on the severity of the symptoms that the doctor will decide if medication will be provided or a surgery would be done.

  • Pain medications – the doctor may suggest taking over-the-counter pain medications to help ease period cramp pains.
  • Hormone therapy – supplemental hormones are effective in reducing or eliminating the pain of endometriosis at times. The rise and fall of hormones during the menstrual cycle cause endometrial implants to thicken, break down and bleed.
  • Constructive surgery – in case you are trying to get pregnant, surgery to remove as much endometriosis as possible while preserving the ovaries and uterus can increase chances.
  • Hysterectomy – in severe cases of endometriosis, surgery to remove the uterus, cervix and both the ovaries is the best treatment.

Prevention – since there is no sure shot cure for this condition. There are certain risk factors that can help you understand if you have or will develop endometriosis –

  • Starting your period at a young age.
  • Short menstrual cycle.
  • Low body mass index (BMI)
  • Uterine abnormalities.
  • Any medical condition that prevents the normal passage of menstrual flow out of the body.

 

Dos and Don'ts

Dos
  • Eat well to make sure that there is sufficient nutrition in the body.
  • Consider eating an endo diet (a special diet for those diagnosed with endometriosis)
  • Join an endometriosis support group to help cope with the treatment.
Don'ts
  • Indulge in smoking as nicotine can worsening the pain and delay healing
  • Ignore the signs of depression. Depression and anxiety are common among patients of endometriosis.
  • Ignore the pain and symptoms. Maintain a record of the symptoms and explain it to the doctor.

 

 

 

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Bubble Tea: Bubbling with nutrition or a hidden sugar mine? The tapioca pearls present in the tea looks like bubbles and hence the name bubble tea became popular.…
Okra: How can this nutrient-dense vegetable help you fight diabetes? Okra is a food which is rich in nutrients and minerals which are extremely essential for a healthy…
black seed oil benefits
Black Seed Oil: What secret benefits could it bestow on your health? Black seeds or nigella seeds are tiny packets of health brimming with amazing benefits. Find out why should…
Quinine: How gin and tonic came to be known as a potent health elixir The discovery of quinine-containing tree bark is sometimes considered the most serendipitous medical discovery of the 17th century.
Barium-enema
Barium Enema Barium enema is also known as colon x-ray. Here, the patient is asked to consume small amount of…
lipase test
Lipase Test A lipase test is a blood test performed to quantitatively measure the level of the enzyme lipase in…
Tissue Transglutaminase Antibody (tTG) Test Transglutaminase is an enzyme present in our body and is involved in protein metabolism. A tTg test is…
Ca 19.9 test
CA19.9 Test CA 19.9 is a cancer antigen that exists on the surface of cancer-causing cells. The levels of CA…
The Shepherd's diet
Facts about the Shepherd’s diet Kristina Wilds promoted Shepherd's diet, a Christian-based diet that highlights Jesus Christ's diet as mentioned in the Bible.
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
carbamazepine
Carbamazepine / Tegretol test The carbamazepine is a drug that is used to treat epilepsy and the carbamazepine test is performed to…
HSV-IgM test
Herpes Simplex Virus (HSV)-IgM Test The HSV-IgM class antibody is produced by the body a few days after an initial HSV infection and…
Astaxanthin: Why experts believe it could be 550x more potent than vitamin E! What is astaxanthin and why is this new supplement on the block touted as the most powerful antioxidant…
diabetic foot ulcer remedy
Diabetic foot ulcer Read to know everything about diabetic foot ulcer,causes,symptoms,diagnosis,treatment prevention and outcome for patients
Hymenoplasty
Hymenoplasty Read on to find out all about hymenoplasty, the procedure, post-surgery care, the risks, and the benefits.
fructosamine test
Fructosamine Test A fructosamine test measures blood sugar glucose content. Fructosamine level can indicate blood sugar level in past 2-3…
Hepatitis A virus infected liver
Hepatitis A Virus (HAV) Total Blood test to look for IgM antibodies to know if you are infected with Hepatitis A virus (HAV),…
Tight phimosis ring
Phimosis Read to know everything about phimosis, types, symptoms, treatment, risks and prognosis for patients with this condition.
Isagenix diet weight loss
How are BMI and BMR different and what do these numbers mean? BMI and BMR are two important metrics that provide a clear picture of your body's metabolism and also…
Salt dangers
Sodium chloride: The wonders and dangers of the simple table salt Sodium chloride is a salt containing sodium and chlorine ions at a 1:1 ratio. It is edible and…

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