Patches of endometrial tissue, which are ordinarily present only in the lining of the uterus (endometrium), arise outside the uterus in endometriosis. It’s unclear why endometrial tissue appears outside the uterus. Endometriosis can cause pain and affect fertility (especially before and during menstrual cycles and during sexual intercourse), but it can sometimes go unnoticed. A thin viewing tube is inserted through a small incision near the navel to examine for endometrial tissue (laparoscopy).To reduce pain and slow the growth of the misplaced tissue, drugs are employed. Surgery may be performed to remove endometrial tissue from outside the uterus, as well as the uterus and ovaries in some cases.
Endometriosis is a painful, long-term condition. Because endometriosis can only be identified by looking at the endometrial tissue directly, it’s impossible to tell how many women have it (which requires a surgical procedure, typically laparoscopy). Endometriosis affects about 6% to 10% of all women. Women who are infertile (25 to 50 percent) and have chronic pelvic pain are more likely to have endometriosis (75 to 80 percent ). Endometriosis can occur in teens, and the typical age upon diagnosis is 27.
The following are some of the most common sites for misplaced endometrial tissue (also known as implants):
- Ligaments that support the uterus
- The area between the rectum and the vaginal or cervix, as well as the bladder and the uterus.
The fallopian tubes, the outer layer of the small and large intestines, the ureters (tubes leading from the kidneys to the bladder), the bladder, and the vagina are some of the less common places. Endometrial tissue can develop on the membranes that protect the lungs (pleura), the sac that surrounds the heart (pericardium), the vulva, the cervix, or abdominal surgical scars.
Endometrial tissue that has been displaced responds to hormones in the same way that normal endometrial tissue does. As a result, it might bleed and hurt, especially before and during menstrual cycles. The severity of symptoms, as well as the disorder’s impact on fertility and organ function, differ significantly from one woman to the next.
The displaced endometrial tissue tends to grow in size over time as the condition worsens. It could also spread to new areas. However, the amount of tissue present and the rate at which endometriosis grows differ substantially. The tissue can either stay on the surface of structures or enter deeper and produce nodules.
Endometriosis has no known etiology, but there are a few theories:
- During menstruation, small fragments of the uterus’s lining (endometrium) may flow backward down the fallopian tubes toward the ovaries and into the abdominal cavity, rather than flowing through the vagina and out of the body.
- Endometrial cells (cells from the endometrium) can be moved to another site via the blood or lymphatic channels.
- Endometrial cells can develop from cells outside the uterus.
Endometriosis can run in families and is more likely among first-degree relatives of women with endometriosis, such as mothers, sisters, and children. It’s more common among women who have the following characteristics:
- After the age of 30, they have their first child.
- I’ve never had a child.
- Have brief menstrual periods and started menstruating sooner than normal or stopped menstruating later than usual (less than 27 days long) with longer-than-eight-day heavy periods.
- Have certain uterine structural anomalies.
- Have moms who taken the anti-miscarriage medicine diethylstilbestrol (DES) when they were pregnant? in 1971, the drug was banned in the United States.
Endometriosis appears to be less common in women who have the following traits:
- Have had several pregnancies
- Started to menstruate later than usual
- Breastfeed a long time
- For a long time, I’ve been using low-dose oral contraceptives.
- Exercise on a regular basis (especially if they started before age 15, exercise more than 4 hours a week, or both)
The most common symptom of endometriosis is pain.
Lower abdominal and pelvic pain are common complaints (pelvic pain)
The discomfort normally varies during the menstrual cycle, getting worse before and during periods. Heavy menstrual flow and spotting before menstrual cycles are two examples of menstrual abnormalities. Endometrial tissue that has been misplaced in the uterus reacts to the same hormones as normal endometrial tissue in the uterus: estrogen and progesterone (produced by the ovaries). As a result, the displaced tissue may bleed and create inflammation during menstruation. Cramping and soreness are common symptoms of misplaced tissue.
The amount of displaced endometrial tissue has no bearing on how severe endometriosis symptoms are. Some ladies with a lot of tissue don’t have any signs or symptoms. Others suffer incapacitating agony, even if it is only a small quantity. Endometriosis does not produce pain in many women until it has been present for a long time. Prior to or during menstruation, sexual intercourse can be painful for some women.
Symptoms can differ based on the location of the endometrial tissue. The following are examples of possible symptoms based on your area.
Abdominal bloating, pain after bowel motions, diarrhea or constipation, or rectal bleeding during menstruation are all symptoms of the large intestine.
Bladder: Pain above the pubic bone, pain during urination, blood in the pee, and the need to urinate frequently and urgently
Ovaries: Endometrioma is the formation of a blood-filled mass that might rupture or leak, producing severe abdominal agony.
The bleeding from the displaced endometrial tissue may irritate neighboring tissues. As a result, scar tissue may form, occasionally as fibrous tissue bands (adhesions) between abdominal components. Organs can be harmed by endometrial tissue and adhesions that have been displaced. Adhesions can occasionally clog the gut.
When misplaced tissue prevents the egg’s transit from the ovary into the uterus, severe endometriosis can lead to infertility. Mild endometriosis can also cause infertility, however, it’s unclear how.
Endometriosis may become dormant (go into remission) briefly or permanently during pregnancy. Because estrogen and progesterone levels drop after menopause, endometriosis becomes dormant.
- Laparoscopy to check for endometrial tissue
- Sometimes a biopsy
In a woman with usual symptoms or unexplained infertility, a doctor may suspect endometriosis. A woman may experience discomfort or soreness during a pelvic examination, or a clinician may detect a lump or mass of tissue behind the uterus or around the ovaries.
Endometriosis can be diagnosed noninvasively using ultrasonography or magnetic resonance imaging (MRI) (that is, no incision is required). Endometrial tissue has distinct properties that can be observed using MRI in specific cases.
To diagnose endometriosis, a doctor uses a thin viewing tube (called a laparoscope) to look within the abdominal cavity and see if endometrial tissue is present. A small incision is made immediately above or below the navel to put the laparoscope into the abdominal cavity (the space around the abdominal organs). The abdominal cavity is then inflated with carbon dioxide gas, which expands it and makes it easier to examine the organs. An examination of the entire abdominal cavity is performed. Laparoscopy is normally performed in a hospital and necessitates the use of general anesthesia. In most cases, an overnight stay in the hospital is not necessary. Laparoscopy produces mild to moderate abdominal discomfort, although most people can resume regular activities within a few days.
A biopsy is required if a doctor notices abnormal tissue and is unsure if it is endometrial tissue. Using equipment introduced through the laparoscope, a sample of tissue is extracted. A microscope is then used to examine the sample. Only if a considerable amount of aberrant tissue is removed does an overnight stay in the hospital become necessary.
A biopsy may be performed when the vagina is examined during a pelvic examination, or when a flexible viewing tube is put into the anus to check the lower section of the large intestine, rectum, and anus (sigmoidoscopy), or when the bladder is examined (cystoscopy). In some cases, a bigger abdominal incision (called a laparotomy) is required.
Ultrasonography can be used to detect the amount of endometriosis and track its progression, although its diagnostic utility is limited.
If a woman is unable to conceive, she may be tested to see if endometriosis or another ailment, such as fallopian tube problems, is to blame. Doctors divide endometriosis into four stages: minimal (stage I), mild (stage II), moderate (stage III), and severe (stage IV).
- The quantity of tissue that has gone missing
- Its placement geographically
- Its depth
- Adhesions and endometriomas
Treatment of Endometriosis
- Nonsteroidal anti-inflammatory medications (NSAIDs) are pain relievers.
- Drugs that inhibit the ovaries’ function
- The misaligned endometrial tissue is removed or destroyed during surgery.
- Surgery to remove simply the uterus or both the uterus and the ovaries is sometimes performed.
Treatment for endometriosis is determined by a woman’s symptoms, pregnancy goals, age, and endometriosis stage.
Endometriosis surgery is a procedure that is used to treat endometriosis.
The most successful treatment for most women with moderate to severe endometriosis is removing or eliminating misplaced endometrial tissue and endometriomas. These operations are usually performed with a laparoscope put into the belly through a tiny incision near the navel. The following scenarios may necessitate such treatment:
- When medications are unable to alleviate severe lower abdominal or pelvic pain.
- When there are substantial symptoms due to adhesions in the lower abdomen or pelvic.
- When endometrial tissue is displaced and restricts one or both fallopian tubes.
- When there are endometriomas present.
- When endometriosis is the cause of infertility and the woman want to conceive.
- When endometriosis creates discomfort during sexual activity.
Doctors remove as much misplaced endometrial tissue as possible without harming the ovaries during surgery. As a result, the woman’s capacity to conceive may be retained. 40% to 70% of women who have surgery for endometriosis may become pregnant, depending on the stage of the disease. Women may be treated with a GnRH agonist if doctors are unable to remove all of the tissue. However, it is unknown whether this medicine enhances their chances of becoming pregnant. Assisted reproductive procedures, such as in-vitro fertilization, can help some women with endometriosis become pregnant.