Endometriosis: Symptoms, Causes & Treatments

The uterus is the organ in the reproductive system in females that accommodates the embryonic and foetal development of one or more embryos until birth. It is a hormone-responsive sex organ that contains glands in its lining that secrete uterine milk for embryonic nourishment.

When a tissue similar to the lining of the uterus grows outside it, it results in a disease known as endometriosis. In the pelvic area, this causes inflammation and the formation of scar tissue.

Endometriosis can cause severe pain in the pelvis and make it harder to get pregnant. There is no cure for endometriosis, but its symptoms can be treated with medicines or, in some cases, surgery. It is important to immediately contact your doctor if you feel you may have endometriosis to begin the process of getting an accurate diagnosis and eventually creating a plan based on your specific situation.

What is Endometriosis?

When endometriosis occurs, a tissue that mimics the lining of the uterus grows outside of the uterus. Your uterus’ lining is known as the endometrium.

Endometriosis occurs when endometrial-like tissue grows on the tissues lining your pelvis, bowel and ovaries. It is rare for endometrial-like tissue to spread beyond your pelvic region, but it is not impossible. An endometrial implant is a growth of tissue that resembles endometrium outside of the uterus.

The hormonal changes of your menstrual cycle affect the misplaced endometrial-like tissue, causing the area to become painful and inflamed. This implies that the tissue will swell, harden, and degrade. Over time, the tissue that has broken down has nowhere to go and becomes trapped in your pelvis.

In your pelvis, the tissue that is stuck may cause:

• fertility problems
• severe pain that occurs during the menstrual cycle
• adhesions, which are tissue connections that hold your pelvic organs together
• scar formation
• irritation

What are the Symptoms of Endometriosis? 

Pelvic discomfort, frequently related to menstrual cycles, is the main symptom of endometriosis. Although many experience cramping during their menstrual periods, those with endometriosis usually describe menstrual pain that is far worse than usual. Pain also might increase over time.

Common symptoms and signs of endometriosis include:

• Infertility 

Sometimes those seeking therapy for infertility are the ones who are initially diagnosed with endometriosis.

• Excessive Bleeding

You might experience occasional bleeding between periods (intermenstrual bleeding) or heavy menstrual periods.

• Pain with Urination or Bowel Movements

You are most likely to experience these symptoms during a menstrual period.

• Pain with Intercourse

Pain after or during sex is common with endometriosis.

• Dysmenorrhea (Painful Periods)

Cramping and pelvic pain might begin before and extend several days into a menstrual period. You might also have abdominal and lower back pain. 

• Other Symptoms and Signs 

You might experience bloating, constipation, diarrhoea, fatigue or nausea, especially during menstrual periods.

The degree of your discomfort may not be an accurate measure of the severity of your ailment. Endometriosis can range from moderate and excruciatingly painful to advanced and hardly perceptible.

Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as ovarian cysts or PID (Pelvic Inflammatory Disease). It might be confused with IBS (Irritable Bowel Syndrome), a condition that causes bouts of abdominal cramping, constipation and diarrhoea. Endometriosis and IBS can coexist, which makes a diagnosis more difficult.

What Causes Endometriosis?

Although the precise reason for endometriosis is unknown, the following factors may contribute:

• Immune System Disorder

A problem with the immune system might make the body unable to recognize and destroy endometrial-like tissue that is growing outside the uterus.

• Endometrial Cell Transport

The tissue fluid (lymphatic) system or blood vessels might transport endometrial cells to other parts of the body.

• Surgical Scar Implantation

After surgery, like a C-section or hysterectomy, endometrial cells might attach to a surgical incision.

• Embryonic Cell Transformation

Hormones like oestrogen might transform embryonic cells – cells in the earliest stages of development – into endometrial-like cell implants during puberty.

• Transformation of Peritoneal Cells

According to the so-called “induction theory,” hormones or immunological factors may encourage the transition of peritoneal cells, which line the inside of your belly, into endometrial-like cells.

• Retrograde Menstruation

Menstrual blood with endometrial cells travels back through the fallopian tubes and into the pelvic cavity during retrograde menstruation as opposed to leaving the body. These endometrial cells stick to the surfaces of pelvic organs and pelvic walls, where they grow and continue to thicken and bleed throughout each menstrual cycle.

What is the Treatment for Endometriosis?

Treatments to manage endometriosis can vary based on whether pregnancy is desired and the severity of symptoms. No treatments cure the disease.

Many different drugs are available to treat endometriosis and its symptoms.

NSAIDs (Non-steroidal anti-inflammatory drugs) and Analgesics (painkillers) are often used to treat pain.

Contraceptive (birth control) techniques and hormone-based medications like GnRH analogues can both reduce discomfort. These methods include:

• patches
• injections
• implants
• vaginal rings
• IUDs (hormonal intrauterine devices)
• pills

These methods might not be suitable for those wanting to get pregnant.

Fertility procedures and medicines are sometimes used for those having difficulty getting pregnant because of endometriosis.

Surgery is sometimes used to remove endometriosis scar tissues, adhesions and lesions. Laparoscopic surgery (using a small camera to visualise inside the body) allows doctors to keep incisions small.

Discuss your treatment options with a healthcare provider. Treatments are based on individual preferences and effectiveness, availability, costs, long-term safety and side effects. 

Increasing awareness can aid in early diagnosis. Early treatment can halt or slow the natural progression of the disease and reduce the long-term symptoms.

In addition to talking to their doctor, people might find emotional assistance and additional advice in local patient support groups.

Endometriosis-related symptoms can occasionally return after therapy is over, and some therapies come with adverse effects. The choice of treatment depends on effectiveness in the individual, availability, costs, long-term safety and adverse side effects. Because they interfere with ovulation, the majority of current hormone treatments are not suited for endometriosis patients who want to become pregnant.

Success in increasing pregnancy rates and reducing pain symptoms through surgery are often dependent on the extent of the disease. In addition, anomalies in the pelvic floor muscles can cause chronic pelvic discomfort, and lesions may return even after effective eradication. Secondary changes of the pelvis, including the pelvic floor, and central sensitization might benefit from complementary treatments and physiotherapy in some patients. Treatment options for infertility due to endometriosis include laparoscopic surgical removal of endometriosis, in vitro fertilisation (IVF) and ovarian stimulation with intrauterine insemination (IUI) but success rates vary.  

Conclusion

Endometriosis is caused by tissue lining growing outside the uterus. It is usually painful and forms scar tissue in the pelvic region, making it difficult to get pregnant. It is always advisable to seek medical help from an experienced gynaecologist. Timely care and help can ensure an appropriate diagnosis and treatment of your condition.

At the CK Birla Hospital, we ensure patients get holistic medical support which includes treatment in a compassionate environment. This patient-centric approach not only helps patients heal better but also ensures they are aware of the preventive measures as well. In case you need to consult a gynaecologist, reach out to us, or book a direct appointment with Dr. Anjali Kumar at the CK Birla Hospital. 

FAQs

Is Endometriosis a Serious Problem?

Endometriosis has significant economic, public health and social implications. It can decrease quality of life due to infertility, anxiety, depression, fatigue and severe pain. 

Is Endometriosis Curable?

There is no cure for endometriosis, but its symptoms can be treated with medicines or, in some cases, surgery. It causes a chronic inflammatory reaction that might result in the formation of scar tissue (fibrosis, adhesions) within the pelvis and other parts of the body.

Can Endometriosis be Cancerous?

Endometriosis is not a malignant condition, despite worries about how it affects cancer. The growth of abnormal tissues outside the uterine lining is not cancer. However, endometriosis can lead to several issues that can raise a person’s chance of developing cancer.