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Endometriosis: Causes, Symptoms & Treatment

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What is Endometriosis?

Endometriosis is a painful condition in which the endometrium tissue grows outside of the uterus instead of inside it. The condition most commonly affects the ovaries, the tissue lining the pelvis and the Fallopian tubes. In rare cases, endometrial tissue can spread outside the pelvic organs. The dislodged endometrial tissue continues to thicken, fall apart and shed with every monthly cycle. However, the displaced tissue can’t find a way to leave the body, so it gets trapped. When endometriosis affects the ovaries, cysts called endometriomas can develop. Surrounding tissue can become irritated, eventually developing adhesions and scar tissue.

Endometriosis may cause pain—often severe—particularly during menstruation, causing the patient to have very painful periods. It can also cause fertility problems. Endometriosis affects about 11 percent of women in the United States between the ages of 15 and 44 (x). Around the world it affects 6 to 10 percent of women of childbearing age. Around 30 to 40 percent of women who suffer from endometriosis may experience difficulties with fertility (x). If any patient suffers from this condition, they are definitely not alone. Thankfully, there are effective treatment methods out there.

Stages of Endometriosis

There are four types or stages of endometriosis, ranging from minimal to severe. There are various factors that classify each stage, including the number, size, depth and location of the endometrial implants (x, x).

  • Minimal (Stage 1) – a few endometrial implants on the membrane that lines the abdomen
  • Mild (Stage 2) – implants and cysts on the ovaries, which can break and spread to the pelvic cavity
  • Moderate (Stage 3) – implants are deep within the pelvic lining, potentially involving the uterus
  • Severe (Stage 4) – deep implants in the pelvic cavity as well as outside of it. It may spread to the bowels, the appendix, the diaphragm, the heart and lungs. The implants may even spread to the patient’s brain

Symptoms of Endometriosis

Other medical conditions like ovarian cysts, irritable bowel syndrome (IBS) and pelvic inflammatory disease can mimic endometriosis symptoms (x, x). With many patients, endometriosis symptoms progress slowly and develop over several years. Each patient may experience a different level of pain, which may make the condition difficult to diagnose.

Severe Pain

The main symptom of endometriosis is extreme pain. It usually starts in the lower stomach area and intensifies during sexual intercourse, menstruation, urination and bowel movements. As the pain intensifies, it can begin to spread through the lower abdomen, legs and back. Patients describe the pain as very intense and painful period cramps (x).

Irregular Menstrual Cycles

The majority of the symptoms arise around menstruation.The condition may interfere with a patient’s menstrual cycles. Patients may experience excessive bleeding, irregular periods and bleeding or spotting between cycles (x).

Digestive Issues

Because endometriosis affects the abdomen, patients may experience digestive symptoms as well, including bloating, nausea, painful bowel movements, diarrhea and constipation.

Complications from Endometriosis

Unfortunately, infertility is a potential complication. After ovulation, the fallopian tubes pick up the egg, but endometriosis distorts the tubes so they are unable to. The condition also causes inflammation that affect the reproductive organs (x).

Symptoms of Endometriosis

Risk Factors for Endometriosis

Researchers have not identified the specific cause of endometriosis. Doctors have associated other health disorders with endometriosis, including asthma, allergies, chronic fatigue syndrome, certain autoimmune disorders and breast and ovarian cancer (x). Researchers have also managed to link endometriosis to exposure to some chemicals, including phthalates (x).

However, there are other possible conditions that physicians have identified that may also contribute. Endometriosis can affect anyone, but there are some factors that can make some people more likely to develop it than others. For example, age is a risk factor. Most commonly, patients are diagnosed in their 30s or 40s (x).

Retrograde Menstruation

If a patient has retrograde menstruation, some of the menstrual blood and tissue enters the fallopian tubes and into the pelvis, instead of leaving the body (x). 

Hormones

Estrogen is the hormone that may cause endometriosis. Researchers suggest that patients with endometriosis may have a hormonal imbalance that causes the endometrium tissues to grow outside the uterus (x). 

Fetal Development

According to studies, a developing fetus can have endometriosis. However, researchers think that the symptoms do not activate until puberty, triggered by shifting estrogen levels (x).

Embryonic Cell Growth

There are two different types of stem cells: adult and embryonic. According to studies, there are embryonic stem cells in the endometrium that turn into endometrial tissue if a patient has retrograde menstruation (x).

Surgical Scarring

Abdominal wall endometriosis is a rare form of the condition. But researchers hypothesize that a patient can develop endometriosis after a surgical procedure, such as a C-section (x).

Immune System

According to research, issues with immune system function can cause menstrual tissue to become displaced and fail to produce anti inflammatory substances to stop the inflammation (x).

Genetics

There could be a hereditary factor. A woman is more likely to have endometriosis if a relative also has the condition (x).

Menstrual Characteristics

Physicians conclude that if a patient has less than 27 days between each menstrual period or if the period lasts for more than seven days, the cycle is labeled abnormal. Each menstruation increases the risk for endometriosis, so an abnormal menstruation puts the patient at a higher risk (x).

Diagnosing Endometriosis

Endometriosis symptoms may be similar to other disorders, such as pelvic inflammatory disease and ovarian cysts. Patients will need an accurate medical diagnosis to treat the symptoms. First, the physician will take note of the patient’s family or personal history of endometriosis and their symptoms. The doctor may perform a general health evaluation to find out if the patient has signs of another disorder. If the symptoms do not match with any other condition, the doctor will perform a diagnostic test.

Laparoscopy

The best way to identify endometriosis is by looking at it directly, using a minor procedure called laparoscopy. A laparoscopy allows the doctor to insert a camera into the stomach through the belly button to observe the abdomen. Then the doctor can collect a sample of tissue (x).

Imaging Exams

Imaging exams, such as an ultrasound or transvaginal ultrasound, can also help a doctor identify signs of endometriosis. Both methods produce pictures of the reproductive system. They may help the doctor detect cysts linked to endometriosis (x).

Treatment for Endometriosis Symptoms

Currently, there is no cure for this condition. However, there are various treatments that may help relieve the symptoms and manage pain.

Pain Medications

Patients can try prescription medications for treating painful menses or over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs).

Hormone Therapy

A doctor may also prescribe medications that reduce the amount of estrogen the body produces. There are hormonal treatments that can stop or significantly reduce menstruation. This can reduce inflammation and decrease the risk of developing ovarian cysts and scars. For example, oral contraceptives that contain progestin and estrogen can help manage pain. A doctor may also prescribe GnRH agonists that induce the patient to a temporary state similar to menopause (x).

Aromatase Inhibitors

This is a more recent form of hormone therapy treatment. Aromatase inhibitors block aromatase, a chemical that increases estrogen production in the body. As opposed to oral contraceptives and GnRH medication, aromatase inhibitors do not suppress ovarian estrogen. Rather, they only suppress extra-ovarian estrogen synthesis. According to research, this makes the medication particularly useful for postmenopausal women (x).

Surgery

If a patient suffers from severe symptoms, a doctor may recommend surgery to remove or eliminate endometrial growths without destroying the reproductive organs.

Laparoscopy

This diagnostic procedure can also double as a surgical treatment. After the doctor diagnoses the condition, they can get rid of the endometrial tissue in the same procedure. The surgeon makes small incisions in the abdomen to remove the growths or destroy them with heat and reseal the blood vessels (x).

Hysterectomy

In severe cases, a doctor may recommend a full or partial hysterectomy. During a full hysterectomy, the surgeon completely removes the uterus and the cervix. In a partial procedure, the surgeon removes the upper portion of the uterus and leaves the cervix. If endometriosis spreads to the ovaries and fallopian tubes, the surgeon may remove those organs as well. It is a common procedure and very safe. But like any surgery, patients can experience complications, including fever, infection, heavy bleeding or blood clots. After a hysterectomy, the patient is no longer able to conceive. Patients should seek medical advice and consider their options very carefully before choosing to undergo a hysterectomy, especially if they are considering having children (x).

Home Remedies for Endometriosis

There are several different alternative and complementary treatment options, including acupuncture, herbal medicine and chiropractic methods. However, there is limited evidence to prove that these treatments work and to what extent. Patients must work to finding a pain management system that works for them.

Heat

Placing a hot water bottle or heating pad on the lower abdomen or having a warm bath can help relax contracting pelvic muscles, possibly reducing pain. Heat is a common remedy for menstrual cramps and may provide immediate or gradual relief for some patients. One study examined the effectiveness of heating pads on 81 patients suffering painful periods. The researchers discovered that a mild heating pad offered the same amount of relief as Ibuprofen (x).

Massage Therapy

In a 2010 study, researchers discovered that gently massaging the pelvic region—the abdomen, back and sides—helped reduce menstrual pain linked to endometriosis (x). Massaging this area immediately before menstruation starts may help make it a lot more comfortable.

Diet

Researchers also recommend making dietary changes to control endometriosis pain. One study suggests that consuming bladderwrack (a brown seaweed) may help reduce estrogen and the rate of tissue growth (x). Another study suggests that consuming large amounts of fruit in a sample size may increase the likelihood of endometriosis, as well as large amounts of dietary fat (x).

Light Exercise

Regular exercise releases endorphins, “feel good” hormones that can relieve pain. It may also help reduce the body’s estrogen levels and improve symptoms. Stretching before and after every workout can help, as well as support the body in exercise (x).

Stress Management

Researchers believe that stress has a negative impact on endometriosis. However, the condition itself may cause patients stress or anxiety from the pain and other potential side effects. But it may be possible to relieve symptoms by finding ways to control stress—whether it’s through meditation, yoga or simply find time for self-care. It is also wise to consult a therapist for techniques and tips on managing stress (x).

Supplements for Pain and Reproductive Health

Supplements, including herbal ones, may be able to help relieve symptoms and promote reproductive health. However, research is scarce so it’s essential to talk to a doctor before using herbal supplements. They are not an acceptable medicinal treatment, although they can benefit a patient’s health.

Diindolylmethane (DIM)

Research suggests that this antioxidant can help support overall female metabolism. Diindolylmethane (DIM) may also help relieve premenstrual syndrome (PMS) symptoms. Take 100 to 200 mg of diindolylmethane (DIM) powder once or twice a day, or following a doctor’s instructions.

Chasteberry

Experts claim that chasteberry may be able to boost female reproductive health. It interacts with the pituitary glands, balancing estrogen and progesterone levels. It might even regulate menstrual cycles and prevent some forms of cancer and symptoms associated with PMS and menopause. Take 800 mg of chasteberry extract powder once a day with a beverage, unless a doctor recommends a different dosage.

Soy Isoflavone

This supplement may benefit heart health, promote strong bones and relieve menopause symptoms. Take 150 mg of soy isoflavone powder once a day, or as instructed by a physician.

Milk Thistle

Milk thistle is a natural anti-inflammatory and antioxidant that promotes liver function and heart health. It can also boost skin health, which menstruation can interfere with. Additionally, it may also benefit breast milk production and improve milk supply. As a dietary supplement, take 250 mg of milk thistle extract powder a day, or as instructed by a doctor.

Melatonin

Melatonin is an extremely potent anti-inflammatory and antioxidant. Additionally, it can also help support sleep if endometriosis pain interrupts patients’ rest. Take 1 to 3 mg of melatonin powder before bedtime. Consult with a doctor before using melatonin regularly because overuse can have long term side effects.

N-Acetyl L-Cysteine (NAC)

Infertility is a possible complication from endometriosis. But N-acetyl L-cysteine (NAC) may be able to stimulate ovulation in women with polycystic ovary syndrome (PCOS) that struggle with fertility. As a dietary supplement, take 600 mg of NAC powder up to three times a day, unless a physician recommends a different dosage.

Pine Bark Extract

This powerful antioxidant helps fight damage from free radicals. Pine bark extract may lower inflammation, promote healthy skin and even address heart risks associated with menopause. As a dietary supplement, take 250 mg of pine bark extract per day. Consult with a physician before supplementing with pine bark extract.

Ginger Root

The natural anti-inflammatory properties in ginger root are ideal for reducing inflammation in the body. It may also relieve digestive discomfort, which some patients experience as a result of endometriosis. Take 1,000 mg of ginger root extract powder once a day, or as instructed by a doctor.

The Bottom Line

Endometriosis is a painful condition that causes the tissue that normally grows within the uterus to form outside of it. Because this excess tissue still responds to hormonal triggers, during the menstrual cycle it builds up and sheds as uterine lining is supposed to. However, because it forms outside of the uterus, it gets trapped and causes extremely severe pain. Those who have not experienced the condition commonly misunderstand the pain and assume it is just “bad cramps.” However, endometriosis pain can be very intense . If you are experiencing severe pain around the menstrual cycle seek medical advice to express any concerns.

The condition may also cause irregular menstrual cycles, digestive problems and even infertility in some cases. There is no identifiable cause for endometriosis, but risk factors include genetics, surgical scarring and embryonic stem cell growth. Thankfully, there are several forms of treatment, including simple home remedies such as exercise, massage therapy, stress management or heat for pain management. Patients may also find relief from pain medication and hormone therapy. However, the only way to completely prevent symptoms from returning is a hysterectomy, a procedure that removes the uterus. It is a very common and safe procedure.

Patients can also try supplements that can support overall female reproductive health and reduce inflammation in the body. Before trying any supplement, speak to a doctor and consider the potential side effects and drug interactions if the patient has any underlying or untreated medical conditions. Supplements are not a replacement for any medical condition, although they may have a positive effect on overall health.

About the author

Haron Omaita


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