Endometriosis: A Not-So-Silent Epidemic

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Endometriosis is a common gynecological condition in women. The name comes from the word “endometrium”, which is the lining of the uterus. About 20% of women of childbearing age develop endometriosis.

What is Endometriosis?

When a woman doesn’t become pregnant, the lining inside the uterus — the endometrium — sheds during every menstrual cycle. Endometriosis occurs when tissue that’s similar to the endometrium finds its way outside of the uterus. This tissue looks and acts like the endometrium’s cells, but attaches to other reproductive organs or parts of the abdomen.

Like the endometrial tissue in the uterus, this misplaced tissue sheds when hormones change during the menstrual cycle. This build-up and bleeding of tissue, where there shouldn’t be any, leads to swelling, scarring, inflammation and pain.

Misplaced endometrial tissue on the ovaries can form “blood blisters” inside a cyst (endometrioma). Other areas where this tissue can develop are:

  • Outside of the uterus walls
  • Fallopian tubes
  • Ligaments around the uterus
  • Vagina, cervix or vulva
  • Bladder
  • Intestines
  • Rectum
  • In rare instances, endometrial tissue might form in the brain, lungs or on the skin.

Causes and Risk Factors for Endometriosis

The exact cause of endometriosis remains unknown. However, some probable causes are:

  • Menstrual flow irregularities
  • Genetic inheritance
  • Surgery in the abdominal area
  • Hormonal disorders
  • Immune system disorders
  • Cancer

All women are at risk for developing endometriosis. However, the following groups appear to have higher rates for developing endometriosis.

  • Women who have a family history of endometriosis
  • Women with abnormally formed uteruses
  • Women who had their first childbirth after the age of 30

Signs and Symptoms of Endometriosis

Every woman experiences the symptoms of endometriosis differently, and some may not have any symptoms at all. They may experience very painful episodes, though this doesn’t represent the severity of the disease. The symptoms of endometriosis include the following:

  • Painful menstrual cramps in the lower back or abdomen
  • Painful urination, especially during menstrual periods
  • Abnormally heavy menstrual flow
  • Painful bowel movements, especially during menstrual periods
  • Pain during sex
  • Infertility
  • Diarrhea, nausea or constipation

Diagnosis and Staging of Endometriosis

Diagnosis for endometriosis starts with a general health assessment, which includes a medical history and a gynecological exam. A laparoscopy, where a fiber-optic instrument is inserted to check the area, also helps to see how large the growths are. The doctor might opt for a biopsy to evaluate any suspicious tissue and do further laboratory testing.

To make a correct diagnosis and treatment plan, various scans may be ordered, which could include an ultrasound, CT scan or MRI. Once endometriosis is diagnosed and assessed, staging is determined.

Endometriosis Staging (Classification)

The American Society of Reproductive Medicine classifies endometriosis into the following stages:

  • Stage 1: Minimal
  • Stage 2: Mild
  • Stage 3: Moderate
  • Stage 4: Severe

Each stage is based on a variety of factors related to the endometrial tissue, such as the location, size and amount of tissue involved. Other factors include:

  • How widely the tissue is spread;
  • How extensive the adhesions are;
  • Whether the pelvic structures are involved;
  • Whether the fallopian tubes are blocked.

Once endometriosis is diagnosed, evaluated and staged, treatment can begin.

Treatment for Endometriosis

Treatment for endometriosis is not a one-size-fits-all plan. Interventions are specific to each patient and determined by you and your healthcare provider. In some cases, if symptoms are mild then no treatment may be necessary, and a physician might only recommend monitoring for any changes. Treatments for endometriosis include:

  • Pain medication
  • Hormone therapy which may include contraceptive pills
  • Laparoscopy to remove any minimally invasive tissue growths
  • Laparotomy to remove more extensive tissue growth
  • Hysterectomy to remove the uterus and ovaries

Endometriosis and Infertility

Endometriosis is one of the three major causes of infertility. How exactly it causes infertility is still not known. Scar tissue from endometriosis might prevent eggs from adhering to the fallopian tubes. Another theory is that endometriosis changes the overall environment of the abdomen, making pregnancy much more challenging. In many cases, restoring fertility is possible through the surgical removal of adhesions and scar tissue. In a small percentage of cases, infertility may be permanent.

It’s essential to remember that a diagnosis of endometriosis is not a diagnosis of permanent infertility. Also, pain from endometriosis does not indicate the severity of endometriosis or infertility. The disease requires a nuanced and educated approach, specific to each individual. Speaking openly with your healthcare provider and working with them to develop the appropriate treatment plan will help you get you the best results possible.

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