Endometrium is the inner lining of the uterus which sheds with each monthly period. When this endometrium, grows outside the uterus, it leads to a painful condition referred to as endometriosis. Endometriosis typically involves ovaries, bowels, and tissue lining of the pelvic region though in rare cases it can spread to other areas too. This abnormal tissue unfortunately continues to act as normal endometrium would and thus thickens, breaks down and bleeds too with each menstrual cycle. Since it has no way to exit the body, it becomes trapped. If endometriosis involves ovaries, cystic formations can form called endometriomas. It can also cause surrounding tissues to become inflamed causing pain and eventually developing scar tissue and adhesions which bind organs together. Endometriosis can cause a lot pain, especially around the periods.
What Are The Typical Symptoms of Endometriosis?
- The characteristic symptom of endometriosis is pelvic pain associated with menstrual periods. Though it is common for women to experience some cramping and pain along with their periods, the pain from endometriosis is far worse than that.
- Bowel movements and urination can also be painful during the time of periods for women suffering from endometriosis.
- Excessive menstrual bleeding may also be experienced and also bleeding in between periods may be reported.
- Pain associated with intercourse is also another common symptom for endometriosis.
- It is not uncommon for endometriosis to be diagnosed in women when they start seeking fertility treatment.
- Bloating, nausea, fatigue, constipation, diarrhea can also present as symptoms of endometriosis and become exaggerated during menstrual cycle.
Symptoms of endometriosis are often confused with pelvic inflammatory disease or ovarian cysts. It can also be mistaken as IBS (inflammatory bowel syndrome) if it causes episodes of diarrhea and constipation along with abdominal cramping.
What Are the Causes and Risk Factors for Endometriosis?
Though the exact causes of endometriosis remains undetermined, following are possible explanations:
- Immune System Disorder – It is possible that immune system is unable to recognize and destroy the endometrial tissue which is growing abnormally.
Estrogen – Endometriosis is also believed to be stimulated by hormone estrogen. - Retrograde Menstruation – As the name suggests this condition refers to menstrual blood going back up to fallopian tubes and pelvis instead of being expelled out of the body but causes of why this should happen are not very clear.
- Surgical Scarring – Endometrial cells get attached to the surgical incision site made for any surgery such as C-section.
- Embryonic Cell Growth – Embryonic cells lining the pelvis and abdomen are believed to develop into endometrial tissue causing endometriosis.
Though any woman can develop endometriosis but following are the risk factors which should be considered in medical history:
- Nulliparous status i.e. having never given birth.
- Pelvic infections.
- Family history of endometriosis.
- Abnormalities involving uterus.
- Medical condition preventing expulsion of menstrual blood from the body.
Does Endometriosis Affect Fertility?
When the endometrial lining grows outside of the uterus, it gets affected by monthly hormonal changes, first thickening and then shedding the superficial layer with menstrual periods. When this bleeding happens in peritoneal cavity, it does not have any route to exit from the body and the immune system tries to heal it with scar tissue formation, treating it like an open wound. As time elapses, these accumulated scar tissues become adhesions affecting internal organs and causing pain. The pelvic scarring and distortion of normal pelvic anatomy can result because of severe endometriosis. Cystic structures called endometriomas can adhere to the uterus, bowels, or pelvis. There can be blockage and damage of fallopian tubes. There might be cases where eggs in ovaries can be damaged and can become cause of decreased ovarian reserve along with diminished quality. Laparoscopy is the only way to confirm the diagnosis of endometriosis. It is believed that delayed pregnancy predisposes women to endometriosis in fact but at the same time endometriosis with any degree of severity poses fertility problems as well. Medical management is recommended before conception is planned. Surgical management of endometriosis is also an option. Women with severe degree of endometriosis often require IVF for a successful pregnancy.
What Is the Treatment Plan for Endometriosis?
It is believed that majority of enodmetriosis cases are mild. Typical treatment plan ranges from medical management to conservative surgery. The treatment options are decided based on patient’s symptomatology and plans for conception.
- Pain medications are including nonsteroidal antiinflammatory drugs are prescribed to help with cramping.
- Hormone therapy also can also be effective in reducing the pain as well as slowing down the abnormal endometrial growth and new tissue formation. Hormonal contraceptives can also be used in continuous cyclic plans in order to reduce the pain caused by endometriosis.
- Depo-provera or medroxyprogesterone is an injectable drug which can be effectively used to suppress menstruation as well as growth of endometrial tissue and thus relieving the signs and symptoms associated with it.
- Gonadotropin releasing hormone (Gn-RH) agonists and antagonists are the drugs that prevent menstruation and cause shrinkage of endometrial tissue. These hormones create artificial menopause but ability to become pregnant returns as soon as they are stopped
- Danazol is another drug which can halt menstruation and restrain endometrial growth but because of its side effects, not really considered first choice in patients who intend to conceive.
- Conservative surgery is another option where endometrial tissue is removed while preserving the uterus and ovaries in order to assist conception. This surgery may be done laparoscopically through a small incision near the navel to insert instrumentation and another small incision to remove the extra endometrial tissue.
- Assisted reproductive techniques including IVF (in vitro fertilization) are recommended over surgery at times to increase the chances of conception.
When we judge endometriosis on the scale of IVF, then we find that, IVF is a successful option in many ways. Endometriosis can be divided into two classifications, first is mild endometriosis and second is severe endometriosis. IVF treatments enter very late in the case of mild endometriosis because currently most of the experts go for controlled ovarian hyper stimulation treatment and IUI treatments. If these treatments fail, then IVF emerges as the last resort. In normal cases, they try IUI for three cycles; if it fails then they graduate on IVF treatments. When we check out the treatments of severe endometriosis, then we find that, surgical treatments can cure it; however, the pregnancy rates after surgical cures are very low. IVF treatments, on the other hand, entertains better success ratio. With the pre-condition that the age of patients is on a lower side, “lower the age, better the results” works as a clear-cut formula. This is why, most of the people are now bypassing the regular course of surgeries and less developed methods, they and directly heading towards IVF treatments and avoiding time-consuming procedures with obscure and uncertain results. This way they are attending a better treatment under a fertile age group.