What to know about endometriosis

Endometriosis is a gynecological condition which is incurable, but manageable.

It happens when endometrial implants, consisting of tissue usually located within the uterus, occur in other areas of the body.

As the tissue begins to thicken, break down, react to hormones in the menstrual cycle and bleed throughout the menstrual cycle, endometriosis is developing deep within the body.

Scar tissue and adhesions are produced, and this can cause organ fusion and anatomical changes.

Endometriosis is thought to affect about 11 percent of women between 15 and 44 years of age in the United States.

Fast facts on endometriosis

Here are some key points about endometriosis. More information is in the main article.

  • Endometriosis affects between 6 and 10 percent of women of reproductive age worldwide.
  • The condition appears to be present in a developing fetus, but estrogen levels during puberty are thought to trigger the symptoms.
  • Symptoms are generally present during the reproductive years.
  • Most women go undiagnosed, and in the U.S. it can take around 10 years to receive a diagnosis.
  • Allergies, asthma, chemical sensitivities, autoimmune diseases, chronic fatigue syndrome, fibromyalgia, breast cancer, and ovarian cancer are linked to women and families with endometriosis.

What is endometriosis?

Endometriosis
Endometriosis sees the endometrial implant tissue, normally found in the uterus build up in other parts of the body.

Endometrial tissue is composed of the gland blood cells and connective tissue. It typically grows in the uterus, to prepare the womb’s lining for ovulation.

Endometrial implants are buildups of endometrial tissue, which develop outside of the uterus.

This is called endometriosis, as they develop outside the uterus.

They can grow in the body anywhere but they typically occur in the pelvic region.

They may affect:

  • the ovaries
  • the fallopian tubes
  • the peritoneum
  • the lymph nodes

This tissue is usually shed during menstruation but this can not be achieved by displaced tissue.

This leads to physical effects, for example, pain. They can affect bodily functions as the lesions grow larger. For example, it can block the Fallopian tubes.

The pain and other symptoms can affect various aspects of life, including the ability to function, the cost of medical treatment, and the difficulty of maintaining relations.

Symptoms

Other medical conditions such as pelvic inflammatory disease (PID), ovarian cysts and irritable bowel syndrome (IBS) can mimic endometriosis symptoms.

Symptoms of endometriosis include:

  • Severe menstrual cramps, unrelieved with NSAIDS
  • Long-term lower-back and pelvic pain
  • Periods lasting longer than 7 days
  • Heavy menstrual bleeding where the pad or tampon needs changing every 1 to 2 hours
  • Bowel and urinary problems including pain, diarrheaconstipation, and bloating
  • Bloody stool or urine
  • Nausea and vomiting
  • Fatigue
  • Pain during intercourse
  • Spotting or bleeding between periods

Pain is the most common symptom of endometriosis but it does not always correlate the severity of the pain with the extent of the disease.

After menopause, pain frequently improves, as the body stops producing estrogen. However, symptoms can continue if the hormone therapy is used during menopause.

Pregnancy may provide for temporary symptom relief.

Complications

Complications include:

  • infertility, which can affect 50 percent of those with the condition.
  • increased risk of developing ovarian cancer or endometriosis-associated adenocarcinoma
  • ovarian cysts
  • inflammation
  • scar tissue and adhesion development
  • intestinal and bladder complications

To avoid future complications it is necessary to see a health care provider about symptoms.

Treatment

endometriosis hysterectomy
A hysterectomy, or the removal of the uterus, will be considered when all other avenues of treatment have been exhausted.

Surgery is possible but it is typically only considered if other treatments are not successful.

Other solutions include:

Pain medications: either over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others) or prescription medications to relieve painful menstruation.

Hormones: Treatment can be with hormonal therapies such as hormonal birth control, agonists and antagonists of Gonadotropin-releasing hormone (Gn-RH), Medroxyprogesterone (Depo-Provera) or Danazol. It may also be advisable to position an intrauterine device (IUD).

Surgery: Initial surgery may aim to remove the endometriosis areas but will involve a hysterectomy with removal of both ovaries.

Fertility treatment: In-vitro fertilization (IVF) can be recommended for pregnancy.

Managing symptoms at home

Alternative and complementary therapies may include acupuncture, chiropractic, and herbal medicine, but there is little evidence to prove that they are effective.

Caffeine avoidance can help to alleviate discomfort, as caffeine can exacerbate symptoms.

Exercise, such as exercise, can alleviate discomfort by reducing estrogen levels and slowing the development of the disease.

Due to the long-term complications of endometriosis it is important to control symptoms. You should report unbearable pain or unexplained bleeding to a doctor.

While endometriosis is currently not healed, most women are able to alleviate symptom pain and will still be able to have children.

Diagnosis

Diagnosis can be difficult, as there is no standardized diagnosis method.

The only way to truly confirm the condition is with an operative laparoscopy.

A surgical laparoscopy is a minimally invasive procedure in which a thin, lighted tube with an attached miniature camera, called a laparoscope, is inserted into the pelvic region through a small incision.

A  diagnosis can be graded as follows:

  • Stage 1: Lesions are minimal and isolated
  • Stage 2: Lesions are mild. There may be several and adhesions are possible.
  • Stage 3: Lesions are moderate, deep or superficial with clear adhesions
  • Stage 4: Lesions are multiple and severe, both superficial and deep, with prominent adhesions.

A diagnosis will take several years to get.

Many potential screening techniques include a pelvic exam, or magnetic resonance imaging (MRI) radiological imaging, or ultrasound, and the use of other drugs, including birth control or hormone releasing gonadotropin (GnRH) agonists.

Diet

Dietary steps to manage the pain and endometriosis symptoms have been suggested.

A research published in 2004 indicates that a brown seaweed called bladderwrack may have an effect that decreases estrogen in women. This can reduce the endometriosis growth rate.

One author has reported a case study using a diet low in short-chain fermentable carbohydrates to reduce endometriosis symptoms. The diet has been shown to function on IBS and because endometriosis is also present, the diet may be beneficial for those with endometriosis alone.

There is a need for further research but there is no risk in pursuing this method.

Dietary choices have also been related to endometriosis growth. A 2011 study indicated that fruit consumption decreased the risk of endometriosis, and decreased total fat consumption reduced the risk.

The risk of endometriosis was also shown to be decreased by dairy products although these findings were not statistically important.

Eating yogurt, sauerkraut, and pickles, or having a good source of probiotics, can help to reduce gastrointestinal symptoms and contribute to improved digestion.

Caffeine avoidance can help to reduce discomfort, as caffeine can worsen symptoms.

Causes

Endometriosis cramps
Endometriosis can lead to painful cramps in the pelvis, but doctors do not understand its exact cause.

The precise cause of endometriosis isn’t well known at the moment.

Possible causes include:

Menstrual flow problems: menstrual blood flows into the fallopian tubes and pelvis instead of normally exiting the body.

Embryonic cell growth: Often in those cavities, embryonic cells lining the abdomen and pelvis develop into endometrial tissue.

Fetal development: The data indicate that endometriosis may occur in a developing fetus, but the symptoms are thought to cause pubertal estrogen levels.

Surgical scar: Endometrial cells may move like a hysterectomy or a c-section during a procedure.

Transport of endometrial cells: The lymphatic system brings endometrial cells to various parts of the body.

Genetics: A genetic aspect may be present. A woman who has an endometriosis with a nearby family member is more likely to develop endometriosis herself.

Hormones: Endometriosis is stimulated by the hormone estrogen.

Immune system: Immune problems can prevent the destruction of endometrial extrauterine tissue.

Risk factors

Endometriosis may be developed in anyone but certain risk factors raise risk.

These include:

  • Age: It is most common in women aged 30 to 40 years
  • Nulliparity: Never giving birth
  • Genetics: One or more relatives having the condition
  • Medical history: Having a pelvic infection, uterine abnormalities, or a condition that prevents expulsion of menstrual blood.
  • Menstrual history: Menses lasting more than 7 days or menstrual cycles of less than 27 days.
  • Caffeine, alcohol consumption, and lack of exercise: These can raise levels of estrogen.

Endometriosis has linked some of the health conditions. That include allergies, asthma and other chemical sensitivities, certain autoimmune disorders, chronic fatigue syndrome, and cancer of the ova and breast.

Researchers have found links to some chemicals, including phthalates, between endometriosis and exposure.

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