What is Endometriosis?
Endometriosis is an often painful disorder that affects women. It occurs when the tissue that normally lines the inside of your uterus (endometrium), grows outside your uterus. Endometriosis affects the pelvic organs including the fallopian tubes, ovaries, and the tissue lining your pelvis.
Endometriosis causes the displaced endometrial tissue to continue acting as it normally would. That is, it thickens, breaks down and bleeds with each menstrual cycle. Since this displaced tissue is unable to exit your body, it gets trapped within.
Cysts called endometriomas may develop when endometriosis involves the ovaries. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions.
Endometriosis can cause severe pain, especially during menstrual flow. Endometriosis can also lead fertility problems.
Symptoms of Endometriosis
Most women experience mild cramping during their period. However, women with endometriosis report excruciating pain during their flow. Severe pelvic pain associated with menstrual period is the main symptom of endometriosis. They also tend to report that the pain increases over time.
Common symptoms of endometriosis may include:
- Painful periods (dysmenorrhea):Pelvic pain and cramping may start before your period and extend several days into your period.
- Lower back and abdominal pain
- Pain with intercourse
- Pain with bowel movements or urination
- Excessive menstrual bleeding
- Endometriosis is first diagnosed in some women seeking treatment for infertility.
- Constipation, fatigue, diarrhea, bloating, or nausea, especially during menstrual flow
Other medical conditions that mimic endometriosis includes
- Pelvic inflammatory disease (PID)
- Ovarian cysts.
- Irritable bowel syndrome (IBS)
These conditions, especially IBS can accompany endometriosis, which can complicate the diagnosis.
Causes of Endometriosis
Although the exact cause of endometriosis is not certain, possible explanations include:
- Retrograde menstruation: This occurs when menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of exiting the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
- Embryonic cell transformation:During puberty, hormones such as estrogen may transform embryonic cells (cells in the earliest stages of development), into endometrial cell implants.
- Transformation of peritoneal cells:In this case, hormones or immune factors promote transformation of peritoneal cells (cells that line the inner side of your abdomen) into endometrial cells.
- Surgical scar implantation.After hysterectomy or C-section, endometrial cells may attach to a surgical incision.
- Immune system disorder:Though rare, but a problem with the immune system may make the body unable to recognize and destroy endometrial tissue growing outside the uterus.
Several factors place you at greater risk of developing endometriosis, such as:
- Never giving birth
- Starting your period at an early age
- Going through menopause at an older age
- Uterine abnormalities
- Short menstrual cycles — for instance, less than 27 days
- Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces
- Low body mass index
- Alcohol consumption
- One or more relatives with endometriosis
- Medical condition that prevents the normal passage of menstrual flow out of the body
Endometriosis usually develops several years after the start of menstruation. Symptoms of endometriosis end temporarily with pregnancy and end permanently with menopause. This may be different for women who are on estrogen.
The main problem of endometriosis is infertility. For pregnancy to occur, an egg must be released from an ovary, travel through the neighboring fallopian tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development. Endometriosis may obstruct the tube and keep the egg and sperm from uniting.
Though many women with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise women with endometriosis not to delay having children because the condition may deteriorate with time.
According to some studies, endometriosis increases that risk, but it’s still relatively low of a woman developing ovarian cancer. Ovarian cancer does occur at higher than expected rates in women with endometriosis. But the lifetime risk of ovarian cancer is low.
Your doctor will ask questions on your medical history, and to describe your symptoms, location of pain and when it normally occurs.
Tests to check for physical clues of endometriosis include:
- Pelvic exam.Your doctor manually feels areas in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus.
- Your doctor uses high-frequency sound waves to create images of the inside of your body using a device called a transducer. This device is either pressed against your abdomen or inserted into your vagina (transvaginal ultrasound).
- Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create detailed images of the organs and tissues within your body.
- This surgical procedure allows your surgeon to view inside your abdomen while you’re under general anesthesia. Your surgeon makes a tiny incision near your navel and inserts a slender viewing instrument (laparoscope), looking for signs of endometrial tissue outside the uterus.
Endometriosis is usually treated using medication or surgery. The approach you and your doctor choose will depend on how severe your signs and symptoms are and whether you hope to become pregnant.
Your doctor may recommend that you take an over-the-counter pain reliever, such as the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), to help relieve painful menstrual cramps.
This may be effective in reducing or eliminating the pain of endometriosis. The rise and fall of hormones during the menstrual cycle causes endometrial implants to thicken, break down and bleed. Hormone medication may slow endometrial tissue growth and prevent new implants of endometrial tissue.
Women with endometriosis can have trouble conceiving. If you’re having difficulty getting pregnant, your doctor may recommend fertility treatment supervised by a fertility specialist. Fertility treatment ranges from stimulating your ovaries to make more eggs to in vitro fertilization.
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