For most women, the week of her period is uncomfortable. However, for some women, periods are associated with debilitating pelvic pain. This is usually the result of a condition known as endometriosis. This is a condition where the tissue that lines the uterus or the endometrium is found outside the uterus as well. It usually involves the ovaries, fallopian tubes and tissues lining the pelvic region. In rare cases, it may be found in other parts of the body as well. Endometriosis can lead to cysts in the ovaries, adhesion of pelvic tissues and organs and also cause infertility.
Quick Jump Table
What is Endometriosis?
Endometriosis is an extremely painful disorder where the tissues that lines the inside of the uterus (endometrium) start growing on the outside of the uterus (womb). Endometriosis usually includes the tissues lining the pelvis, fallopian tubes and ovaries.
During Endometriosis, the endometrial tissues break down and bleed. This tissue doesn’t have any way to exit from the body, so it gets trapped. Endometriosis causes chronic pain during your periods. Also, fertility can be affected as this condition might create issues during conceiving a baby.
4 Endometriosis Stages
Endometriosis is a reproductive disorder that normally shows different signs & symptoms in every patient and sometimes, there are no major symptoms. The condition of endometriosis is divided into four stages which are (1) Minimal, (2) Mild, (3) Moderate and (4) Severe.
In Minimal endometriosis, there is a presence of few small wounds, lesions or implants over the ovary with no scar tissue. If lesions are seen over the ovary and the pelvic lining as light with shallow implants and scar tissues, it is mild endometriosis.
Under Stage- 3, many deep implants and lesions are present on one or both ovaries whereas severe endometriosis is a presence of thick bands of scar tissues, adhesions with many deep implants on both ovaries, fallopian tubes and in the bowel region.
Signs of Endometriosis
Endometriosis is a condition where an overgrowth of the endometrium occurs outside the uterus and grows over ovaries, fallopian tubes, bowel, and tissue linings of the pelvis. This abnormal growth of endometrium causes inflammation and other signs like pelvic pain, pain during intercourse, excessive bleeding, discomfort in bowel movements, fatigue, nausea, diarrhea, etc.
A woman suffering from this condition may experience lower back pain during the menstrual periods, abdominal cramps before one or two weeks of menstruation and also during menstruation. Sometimes, women also face difficulties in getting pregnant.
5 Endometriosis Symptoms
It is necessary to understand and recognise the other symptoms of endometriosis as well. While some women may exhibit no other symptoms, others may experience:
- Painful intercourse
- Bleeding between periods
- Pain while passing stool
- Blood in the urine or feces
If the pain in the pelvic region is accompanied by any of the above symptoms for an extended period, you must consult a doctor immediately. Though endometriosis is not a cancerous condition, it can lead to further complications like blockages in the bowel if left untreated. To confirm a diagnosis of this condition, you will usually be advised to undergo laparoscopy.
The Endometriosis Causes
The exact cause of Endometriosis is not yet known, but studies suggest it can be caused because of some factors such as
- Retrograde menstruation- In this condition, menstrual blood that contains endometrial cells usually flows back into the pelvic cavity through the Fallopian tubes instead of passing out from the body. These endometrial cells stick to the pelvic organs and pelvic walls, where they thicken and start bleeding over the course of the menstrual cycle.
- Changing of the peritoneal cells- This is also called induction theory. Endometriosis can be caused because of the transformation of peritoneal cells.
- Embryonic transformation of cells- Hormones like estrogen can transform embryonic cells in the early stages.
- Surgical scar implantation- After a surgery like C-section or hysterectomy, the endometrial cells can attach itself to a surgical incision.
- Endometrial cells transport- The tissue fluid (lymphatic) or blood vessels can transport the endometrial cells to other body parts.
- Immune system disorder- If there is a problem with the immune system, it may make the body impossible to destroy and recognize the endometrial tissue which grows outside the uterus.
The pain associated with endometriosis is caused because the tissue that is outside the uterus behaves as that inside the uterus, but has no way of being removed from the body. Hence, it causes an inflammatory reaction that can be felt as a dull ache or muscle cramps. Cysts formed because of endometriosis may also additionally pressure pelvic organs while urinating, passing stool or during intercourse and hence cause pain. However, endometriosis is not the only cause for pelvic pain. Some of the other causes of pain in the abdomen include;
- Pelvic inflammatory disease
- Rupture of an ovarian cyst
- Fibroids in the uterus
- Irritable bowel syndrome
- Muscle and bone problems
Endometriosis Risk Factors
- Unable to conceive
- Starting your period very early in life.
- Having your menopause at an ancient age.
- Menstrual cycle of less than 27 days.
- High levels of estrogen in your body or exposure to a high level of estrogen produced by your body.
- Low body mass
- Excessive Alcohol consumption
- One or more family members having Endometriosis.
- Abnormalities in the uterus (womb).
The symptoms of endometriosis can end permanently if you experience menopause and can end temporarily if you get pregnant. Taking estrogen supplements can also trigger endometriosis in some women.
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Treatment for Endometriosis
Endometriosis can reoccur subsequently, and its treatment controls the abnormal growth of the endometrium. The treatment has an aim of reliving symptoms and enhancement of fertility. The course of treatment depends on the age of the patient, pain associated with the condition and stage of the disease.
Pain medications (Non-steroidal anti-inflammatory drugs) such as ibuprofen or naproxen are prescribed as an over-the-counter medication. Hormonal therapies as pills, injections or nasal sprays are advised that include hormonal contraceptives (birth control pills or patches), progestin therapy, Gonadotropin-releasing hormone agonist and antagonists, etc.
At Stages-03 and 04, conservative surgeries or hysterectomy (with or without removal of the ovaries) are performed to treat this condition.
Laparoscopy for Endometriosis
Laparoscopy is a minor surgical procedure that involves making a small incision in the abdomen through which a telescope-like instrument is passed into the body. This allows the doctors to look inside and identify any patches of endometrium tissue. Once confirmed, your doctor may advise you to leave it under observation, give you a course of painkillers or advise hormone replacement therapy or surgery to remove the extra endometrium tissue.
Endometriosis Blood Test
A CA-125 blood test may be done to see if you have an elevated level of a certain blood protein, which can show advanced endometriosis. The test is less able to detect the disease in its early stages. Elevated CA-125 levels can also be caused by other conditions, such as fibroids, benign tumors and ovarian cancer; therefore, elevated levels do not mean you have endometriosis. A CA-125 blood test can produce false positives and false negatives.
For these reasons, the test is not used to give a definitive diagnosis. It is usually used in other diagnostic tests. For example, if your symptoms and pelvic exam suggest endometriosis, your doctor may recommend a CA-125 blood to confirm this suspicion before doing a laparoscopy.
Foods to Avoid During Endometriosis
A woman should take care of her diet if she is suffering from endometriosis. Foods rich in fiber (fruits, vegetables, legumes), foods containing fatty acids (salmons, walnuts) and anti-oxidant foods like oranges, spinach, berries, green tea are recommended for patients.
On the other side, those who suffer from this condition should avoid consuming Trans fat, gluten-containing foods, red meat, high FODMAP diet (Fermentable oligo-, di-, mono-saccharides and polyols), alcohol and caffeine-containing items.
Natural Remedies for Endometriosis
There are some natural remedies that can help in dealing with endometriosis. Hydrotherapy or heat can be included in methods to treat pain associated with endometriosis. Taking a warm water bath or placing hot water bottles in the lower abdomen region can provide relief from cramps and pain.
Stress reduction therapies like relaxation response, mindfulness meditation, diaphragmatic breathing can be useful for decreasing cortisol levels in the body because endometriosis causes hormonal imbalance.
Doing pelvic massage with castor oil also gives relief from the pain of endometriosis. Other remedies can be the use of herbal supplements, light exercises and selection of anti-inflammatory foods, rest, etc.
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