ENDOMETRIOSIS - A COMPLETE GUIDE FOR WOMEN’S HEALTH

INTRODUCTION:

Endometriosis is often described as a painful disease involving intense pelvic pain affecting a

considerate percentage of women in reproductive age [1]. The condition Endometriosis is

derived from the word ‘Endometrium’ which is the tissue that lines the uterine wall. When a

similar tissue grows outside the uterus then this is referred to as Endometriosis. The lining

grows and eventually breaks down which leads to bleeding inside the pelvis and resulting in

inflammation and unbearable pain. Typically women gets confused this pain with menstrual

cramps in which case most of them goes undetected for a very long time. Endometriotic lesions are formed mostly in the ovaries and pelvic peritoneum but also found in other areas like fallopian tubes, abdominal wall and vagina [2]. Health care costs for endometriosis were

estimated over $10,000 per patient per year in the United States.

SYMPTOMS OF ENDOMETRIOSIS:

Long term symptoms of endometriosis include pain in the pelvic region and infertility. Others

common conditions include [3,4,5]:

• Painful menstrual cramps which gets worse over time.

• Spotting or bleeding between periods and excess bleeding during periods.

• Abdominal bloating and nausea.

• Painful intercourse.

• Secondary dysmenorrhea.

• Urinary symptoms- pain while passing urine or sometimes blood in urine.

• Mental health issues like anxiety and depression.

Some women with this condition have no symptoms and find out its existence at later stages of their life when are unable to get pregnant. For others, with symptoms like pelvic pain, seems like it is caused by other reasons like Pelvic Inflammatory Disease (PID) or Urinary tract infections or ovarian cysts.

CAUSES:

Though there are no specific causes for endometriosis, but this can be explained based on few theories which ultimately helps in finding the effective treatment [6].

1. Retrograde Menstruation (Sampson’s Theory): This is the condition when menstrual

blood flows backward into the abdomen through fallopian tubes instead of the vagina. It

is common in most women and does not cause problems. But in some cases, there is a

chance that cells from endometrium move into the abdominal or pelvic cavity and start

growing on the peritoneum in the respective organs resulting in endometriosis.

2. Benign Metastasis: This theory proposes that endometrial cells are transported outside

the uterus through lymphatic vessels. As a result, endometrial cells are spread to distant

organs causing a very presence of lesions.

3. Immune dysregulation: This condition is also known as Inflammatory theory as

endometriosis is a chronic estrogen- dependent inflammatory disease. This theory

explains how the immune cells are altered in patients with endometriosis. These altered

immune cells like macrophages, natural killer cells, T cells and B cells play a vital role in

the pathogenesis of endometriosis.

4. Coelomic Metaplasia: This theory indicates that when the pelvic peritoneal lining

transform into endometrial cells, then endometriosis arises. This often occurs under the

influence of estrogen or chronic inflammation.

5. Embryonic Rest Theory: When a small trace of embryonic cells differentiates into

endometriotic lesions, this is called as Embryonic Rest Theory.

DIAGNOSIS:

Women experiencing symptoms related to endometriosis can talk to a doctor and explain the

location of the pain. A variety of tests are available for diagnosing endometriosis [7,8].

1. Pelvic exam: This helps in finding any unusual changes in the pelvic area like cysts on

the reproductive organs, spots or irregular growths. But this exam becomes

uncomfortable if the patient is experiencing severe pelvic pain.

2. Ultrasound: If the pelvic exam detects abnormal mass, then ultrasound is performed to

check for cysts which are the signs of endometriosis. It is performed by a device called

transducer that captures the images of the masses.

3. MRI Scans: Scans are suggested in case of severe endometriosis which in turn helps to

plan for a surgery if necessary. Also patients who are identified with nodule like

structures during their pelvic exam can also benefit from these scans as they provide

detailed information on the extent of endometriosis.

4. Laproscopy: This is a surgical procedure performed to diagnose and treat various

conditions of abdomen and pelvis. If endometriosis is identified with this procedure, a

sample is removed for further examination to confirm the diagnosis. This helps to treat

the condition better. If a scar tissue is found, then it may be removed (procedure called

as excision). Another technique performed is the destruction of the cells (procedure

called as ablation).

TREATMENT:

Treatment for endometriosis depends on the severity of the pain, side effects, long term safety and also with women desiring to become pregnant in the future. Some medications help to manage the symptoms like pain killers. Hormonal medicines like oral contraceptives are also prescribed to reduce the severity of the pain. Surgery can remove endometriotic lesions and scar tissue. In patients who do not respond to various treatments, removing the uterus might be considered as an option if they are not planning to have children. This may not be a complete cure as some patients complain of still having the symptoms. Different fertility treatments like IVF, Ovulation induction and IUI are available for patients struggling to conceive due to endometriosis.

LIFE STYLE CHANGES TO MANAGE ENDOMETRIOSIS:

1. FOOD: Few research studies indicate that avoiding certain foods helps in managing the

condition from becoming worse. These include foods with more trans-fat like fried or

processed foods. High intake of red meat also increases the risk of developing

endometriosis. Some studies also showed that reducing the intake of gluten in the diet

also helped in pain management. It is advisable to include more fibrous foods in the

diet like fruits, vegetables and whole grains. Also iron rich foods and antioxidant rich

foods helps in fighting the inflammation and pain caused by endometriosis.

2. SUPPLEMENTS: A small study indicated that women with endometriosis who were

consuming vitamin E and vitamin C supplements showed a reduction in the pelvic pain

and decreased inflammation. Zinc supplements also help in decreased oxidative stress

markers and enhance antioxidant markers. Other supplements which are considered

beneficial are vitamin D, calcium and magnesium.

3. THERAPY: Pelvic floor therapy is a kind of physical therapy that focuses on the muscles,

ligaments and connective tissues in the pelvic region. It helps in relieving the symptoms

associated with endometriosis. This therapy uses a combination of techniques to

release muscle tension and improve tissue mobility. Stretching and strengthening

exercises are performed to enhance muscle flexibility and strength. This can be done

under the guidance of a physiotherapist who may also suggest pelvic floor exercises to

do at home. Potential benefits of this therapy include pain reduction after a series of

sessions and also improved sexual function as the therapy can alleviate pain during

penetration.

REFERENCES:

1. Johns Hopkins Medicine. Period pain: Could it be Endometriosis? Khara Michelle

Simpson, M.D.

2. Pubmed Central: Endometriosis: A review of clinical diagnosis, treatment and

pathogenesis.

3. American College of Obstetricians and Gynecologists. (2019). Endometriosis.

4. Heitmann, R. J., Langan, K. L., Huang, R. R., Chow, G. E., & Burney, R. O. (2014).

Premenstrual spotting of ≥2 days is strongly associated with histologically confirmed

endometriosis in women with infertility. American Journal of Obstetrics and

Gynecology.

5. Endometriosis: Office on Women's Health.

6. The main theories on the pathogenesis of Endometriosis by Jelizaveta Lamceva, Romans

Uljanovs and Ilze Strumfa.

7. Diagnosis of Endometriosis by Mayo Clinic.

8. Diagnosis and management of Endometriosis by Catherine Allaire, Mohamed A Bedaiwy

and Paul J Yong.