Endometriosis

• Chronic pain in the lower back and pelvis
• Abnormal or heavy menstrual flow or bleeding between periods
• Painful menstrual cramps
• Pain during sexual intercourse
• Painful bowel movements during menstrual periods
• Painful urination during menstrual periods
• Other gastrointestinal symptoms such as bloating, diarrhea, constipation, or nausea, especially during menstrual periods
• Infertility or difficulty conceiving
• Fatigue

Endometriosis is an idiopathic disease, meaning the cause is largely unknown. However, several theories explain the mechanism of endometriosis:

• Retrograde or Reverse Menstruation: This theory suggests that during menstruation, some blood and tissue containing endometrial cells from the uterus travel through the fallopian tubes into the pelvic cavity. These endometrial cells adhere to the walls of the pelvic cavity and continue to proliferate and bleed throughout each menstrual cycle. While most women experience some degree of reverse menstruation, only a few develop endometriosis, likely due to differences in their immune systems.
• Coelomic Metaplasia or Cellular Metaplasia: According to this theory, cells in the body outside the uterus transform into endometrial cells that line the uterus.
• Endometrial Cell Transport: This theory posits that endometrial tissue may travel through the blood or lymphatic system to distant areas or organs.
• Direct Implantation: Endometriosis can also occur due to direct transplantation in the abdominal wall. For example, during a cesarean section or pelvic surgeries like hysterectomy, some endometrial tissue may accidentally get implanted in the abdominal incision.
• Genetic Factors: Genetic factors also play a role, as the disease is much more common if a close relative, such as a mother or sister, has it.

The most common sites of endometriosis include:

• The ovaries
• The fallopian tubes
• Tissues that hold the uterus in place
• Outer surface of the uterus
• The lining of the pelvic cavity

Other sites of growth may include the vagina, cervix, vulva, intestines, bladder, or rectum. Very rarely, endometriosis can appear in distant parts such as the skin, lungs, and brain.

Stages of Endometriosis

Endometriosis occurs in four stages, depending on the depth and area it affects. These stages are described as follows:

• Stage 1: This is the minimal type of endometriosis, characterized by small lesions present on the tissue lining the pelvis or abdomen, with no scar tissue.
• Stage 2: This is the mild type of endometriosis, where more lesions are present in deeper tissue, along with some scar tissue.
• Stage 3: This is the moderate stage of endometriosis, marked by several deep lesions. Small cysts may also be present in the ovaries, along with scar tissue or thick bands known as adhesions.
• Stage 4: This is the most severe stage of endometriosis, characterized by widespread endometriosis associated with several deep lesions and thick adhesions. Large cysts may also be present in one or both ovaries.

Women are at higher risk for endometriosis if they:

• Have an immediate family member such as a mother, sister, or aunt suffering from endometriosis
• Started their period at an early age (before the age of 11), also known as early menarche
• Have short monthly cycles, which are less than 27 days
• Have heavy menstruation or periods that last more than 7 days
• Have never had a child
• Are giving birth for the first time after the age of 30 years
• Have an abnormal uterus
• Have a medical problem that prevents the normal flow of blood from the body during menstrual periods
• Have disorders of the reproductive tract
• Consume alcohol in excess
• Have intercourse during menstruation
• Have a low body mass index

Various ways by which endometriosis can be diagnosed are:

• A pelvic examination: Your gynecologist will carry out a routine pelvic examination after recording your medical history.
• USG whole abdomen: A diagnostic imaging technique that uses high-frequency sound waves to produce pictures of the internal structures of the abdomen.
• CT scan: A noninvasive diagnostic imaging tool that uses a combination of X-rays and computer technology to create images of the pelvis to detect any abnormalities.
• MRI scan: To gain visuals of the organs of the pelvis and lower abdomen.
• Laparoscopy: Laparoscopy is considered the gold standard for diagnosing endometriosis. In this procedure, a laparoscope, which is a thin instrument with a light and a camera, is used to view the pelvic region and its organs.
• Histological examination: In certain cases of endometriosis, your doctor can take a biopsy or sample of tissue during laparoscopy and send it to a lab for evaluation.

Endometriosis can be treated by medicines and surgery. Here are some common treatment options for endometriosis:

• Pain medication: Nonsteroidal anti-inflammatory drugs, such as Ibuprofen or other over-the-counter analgesics, can provide temporary relief from pain. If these do not help, a doctor may prescribe stronger medications.
• Hormonal therapy: Hormonal therapy can lower the amount of estrogen, which is directly linked to endometriosis. This helps reduce bleeding, inflammation, scarring, and cyst formation. Common hormones used include:
  • Oral contraceptives: Function by suppression of ovarian function. Examples include Desogestrel and Etonogestrel.
  • Danazol: A synthetic derivative of testosterone (a male hormone).
  • Progestin: These medicines suppress the activity of the ovaries by modulating female hormones in the body. An example is Medroxyprogesterone.
  • GnRH analogues: GnRH analogues are administered in injection form to suppress ovarian activity, thereby decreasing hormone levels in the body. One of the most common GnRH analogues is Leuprolide.
• Devices: Intrauterine devices, such as the levonorgestrel system, are placed in the uterine cavity, where they suppress endometrial activity and help regulate menstrual blood flow.
• Surgery: Surgical procedures are often the last resort for treating endometriosis. Surgery is typically performed laparoscopically or through an open procedure. This process involves the removal (excision) or burning (fulguration) of endometriotic tissue. Removal of scar tissue can provide significant pain relief. Additionally, relocating the ovaries and fallopian tubes to their normal position in the pelvis during surgery can greatly increase a woman's chances of becoming pregnant.

If you are suffering from endometriosis, you can follow these simple tips to ease the symptoms of this condition:

• Take adequate rest. You can also use a hot pack, heating pad, or hot water bottle to alleviate the pain.
• Consider taking long warm baths to relieve pain and associated symptoms of endometriosis.
• Prevent constipation. Constipation is common in women suffering from endometriosis; therefore, it is advised to hydrate and include fiber-rich foods to relieve symptoms.
• Engage in regular exercise. Exercise improves blood circulation and helps nutrients and oxygen flow to all systems of the body. Regular exercise can help reduce pelvic pain associated with endometriosis.
• If the pain becomes severe, consult your doctor about taking painkillers.

Endometriosis may have certain complications if it is severe in nature or is diagnosed or treated at a later stage. Some of the common complications of endometriosis are:

• Fertility issues

Endometriosis can lead to fertility problems. The following ways are thought to cause infertility:

• Endometriosis can change the shape of the pelvis and reproductive organs, making it difficult for sperm to find the egg. It can also deform the fallopian tubes, preventing them from picking up the egg after ovulation.
• It can cause inflammation that affects the normal function of the ovary, egg, fallopian tubes, or uterus.
• The immune system, which normally protects the body against infection, may begin to attack the embryo.
• The endometrium, or uterine lining where implantation occurs, may not develop normally.

Some women suffering from endometriosis do not have any fertility issues and eventually get pregnant without treatment. However, for many, it can be harder to conceive. Sometimes, medication alone fails to improve fertility. Surgery can help improve fertility by removing patches of endometriosis tissue.

• Ovarian cysts and adhesions

Endometriosis leads to adhesions, which are areas of endometriosis tissue that are sticky and glue the organs together. Endometriosis can also result in ovarian cysts, which are fluid-filled sacs that can become large and painful. These can be treated with surgery.

• Bladder and bowel problems

Endometriosis can also affect bladder or bowel movements. This condition may require major surgery, which may involve removing a small part of the bladder or intestine.

• Cancer

Women suffering from endometriosis might be at risk of developing ovarian cancer, but the risk is still relatively low. Another rare type of cancer, endometriosis-associated adenocarcinoma, can develop later in life in those who have had endometriosis for a long time.

Most couples do not have significant symptoms of infertility. In fact, it is not until they try to conceive that they discover infertility. The signs of infertility in women could be related to the underlying cause of the condition.

Here are a few of the most common herbal and home remedies for the treatment of endometriosis:

• Curcumin: Curcumin, or turmeric, has anti-inflammatory, antioxidant, and antiproliferative properties that are useful in treating the symptoms of endometriosis. You can take turmeric in the form of tablets or by mixing a teaspoon of turmeric into your tea or milk.
• Puerarin: Puerarin is a compound found in kudzu plants. It contains isoflavonoid compounds that possess estrogenic effects. This component binds to the estrogen receptors (ERs) and alleviates some of the symptoms of endometriosis.
• Resveratrol: Resveratrol is a polyphenol compound primarily found in grapes, peanuts, mulberry, and some other plants. These foods have strong antioxidant properties and may be beneficial for endometriosis.
• Green tea: Green tea is a potent antioxidant that helps prevent new blood vessel formation (antiangiogenesis) and inhibits the function of microvessels present in endometrial lesions. This action helps reduce the size and weight of these lesions, thereby hindering the growth of endometriosis.

If you are suffering from endometriosis, you can follow these easy tips to reduce the pain and other symptoms of endometriosis:

• Use a hot pack: For the excruciating pain that comes with endometriosis, you can apply a hot water bottle or heating pad to your lower abdomen. This can help improve blood circulation and muscle relaxation. Warm baths can also be beneficial in treating endometriosis.
• Take proper rest: If the pain of endometriosis becomes intense, you must take proper rest. You can place a pillow under your knees while lying on your back. While lying on your side, keep your knees close to your chest. These positions can reduce the pressure on your lower back.
• Get regular exercise: Exercise is helpful in releasing natural painkillers in your body, known as endorphins. It also improves blood circulation and the flow of nutrients and oxygen to all the systems of the body.
• Include a healthy and balanced diet: Maintaining a healthy weight can be beneficial for endometriosis. Include plenty of fiber in your diet to help prevent painful straining during bowel movements.
• Make use of alternative treatments: Consider techniques that promote relaxation and may help relieve pain, such as muscle relaxation, deep breathing, biofeedback, and yoga. Acupuncture may also help alleviate painful periods.