Endometriosis is a painful condition due to an abnormal growth in the female reproductive system. The endometrium is the tissue that normally lines the inner walls of the uterus. However, in endometriosis, endometrial tissues grow outside the uterus. The tissue exits the uterus through the open fallopian tubes and spread on the ovaries, fallopian tubes, linings of the pelvis, and cervix. In severe cases, it can spread beyond the pelvic organs and affect the abdominal wall, kidneys and urinary bladder.
Even though the endometrial tissue is outside the uterus, it still responds to changes in the hormones. During each menstrual cycle, it thickens, breaks down and bleeds. The tissue becomes trapped inside the body, irritates other tissues and leads to scar formation and adhesion of pelvic tissues and organs. This manifests as severe pelvic pain, especially before the menstrual period.
Several possible causes of endometriosis are being considered such as:
- Retrograde menstruation. It occurs when the menstrual blood does not exit the body but back flows through the fallopian tubes and into the pelvic cavity. The endometrial cells adhere on the pelvic organs and continue to thicken and bleed throughout each menstrual cycle.
- Transformation of peritoneal cells. Some studies show that the cells lining the inner walls of the abdomen, the peritoneal cells, transform into endometrial cells due to hormones or immune factors.
- Embryonic cell transformation. During puberty, some hormones promote the transformation of embryonic cells into endometrial cells.
- Surgical scar implantation. Surgical incisions left after surgeries involving the female reproductive system such as hysterectomy can attract endometrial cells.
- Endometrial cells transport. The blood vessels and interstitial fluid can transport endometrial cells into other parts of the body.
- Immune system disorder. A problem in the immune system disables it from recognizing and destroying endometrial cells that form outside the uterus.
Endometriosis develops several years after the first menstrual period. Pregnancy temporarily halts the condition while menopause permanently stops it.
Diagnosis of endometriosis is based on the symptoms and physical exam. A pelvic exam or an ultrasound is done to feel or view the different reproductive organs for the presence of abnormalities such as cysts. A surgical procedure called laparoscopy is also an option for diagnosis.
Commonly Prescribed Drugs
- Pain medications such as ibuprofen and naproxen are prescribed to relieve pelvic pain and menstrual cramps.
- Hormonal contraceptives like birth control pills manage the levels of the hormones during each menstrual cycle. These medications can reduce the menstrual flow and duration and eliminate mild to moderate endometriosis. Side effects: nausea, weight gain, swollen breasts, lighter period
- Gonadotropin-releasing hormones (Gn-RH) agonist and antagonist. These drugs stop the release of ovarian-stimulating hormones. This leads to a decrease in estrogen levels and lack of menstruation. Since the hormones that thicken the endometrial tissues are absent, the tissues begin to shrink. These drugs are taken with low dose estrogen or progestin to reduce menopausal side effects. Stopping the medications resume menstruation and ability to become pregnant. Side effects: hot flushes, vaginal dryness, low libido
- Progestin therapy. The use of progestin-only contraceptive stops menstrual period as well as the growth and thickening of endometrial tissue. This can eliminate the signs and symptoms of endometriosis. Side effects: irregular bleeding, breast tenderness, acne
- Danazol. Danazol blocks the release of ovarian-stimulating hormones. It decreases estrogen levels while increasing androgen levels. This promotes a menopause-like state and prevents menstruation as well as the progression of endometriosis. This drug has serious side effects. Accidental pregnancy while using danazol harms the fetus. Side effects: weight gain, acne, bloating, irregular vaginal bleeding, increased body hair, enlargement of clitoris
Treatment and Management
Medications and surgery are the options for treatment of endometriosis. The choice of treatment depends on the severity of the symptoms and the goal of pregnancy.
Pelvic pain and menstrual cramps might be relieved by warms baths and a heating pad.
Regular exercise can improve blood flow and some of the symptoms like pelvic pain.
Place a pillow under the knees while lying down to reduce back pressure.
Surgeries are the last option for endometriosis. It is only considered when medications cannot resolve the symptoms.
- Conservative surgery. In this type of surgery, endometrial tissue outside of the uterus is removed without affecting the uterus and ovaries. This is beneficial for patients who plan to become pregnant. It can be done through a laparoscopy or a traditional abdominal surgery.
- Hysterectomy. Severe cases of endometriosis that is not responsive to any treatment have hysterectomy as a inal option. This surgery involves the total removal of the uterus, cervix and ovaries. Women cannot get pregnant after a hysterectomy.