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Endometriosis: Causes, Symptoms, Diagnosis, Treatment, and Prevention

Most women of reproductive age are affected by endometriosis, which is a painful and common condition. When the tissue that usually lines the inside of the uterus (endometrium) grows outside the uterus, such as on the ovaries, fallopian tubes, bladder, or intestines, it is considered endometriosis. There are various symptoms and complications associated with this, including inflammation, scarring, and adhesions (tissue that sticks together).

What are the symptoms of endometriosis?

The most common symptom of endometriosis is pelvic pain, especially during menstrual periods, ovulation, sexual intercourse, bowel movements, or urination. The pain ranges from mild to severe and may vary from month to month. Women can also experience heavy or irregular bleeding, spotting between periods, infertility, fatigue, bloating, nausea, or diarrhea during their periods.

There is no correlation between the severity of symptoms and the extent of endometriosis. Some women may have mild endometriosis but severe pain, and others may have advanced endometriosis but no symptoms at all.

What causes endometriosis?

The exact cause of endometriosis is not known. However, several factors may contribute to its development, such as:

  • Retrograde menstruation: This is when some of the menstrual blood and tissue flows backward through the fallopian tubes and into the pelvic cavity instead of leaving the body. This can implant and grow on other organs and cause inflammation and pain.

  • Hormonal imbalance: Endometriosis is influenced by estrogen, the female hormone that regulates the menstrual cycle. Excess estrogen or low progesterone may stimulate the growth of endometrial-like tissue outside the uterus.

  • Surgical scars: Endometrial-like tissue may attach to surgical scars after procedures such as a cesarean section or a hysterectomy.

  • Immune system problems: A weakened or dysfunctional immune system may fail to recognize and eliminate the endometrial-like tissue that grows outside the uterus.

  • Genetics: Endometriosis tends to run in families. Women who have a mother or sister with endometriosis are more likely to develop it themselves.

How is endometriosis diagnosed?

The symptoms of endometriosis are often similar to those of ovarian cysts, pelvic inflammatory disease, irritable bowel syndrome, or interstitial cystitis. To diagnose endometriosis, a doctor may perform the following tests:

  • A pelvic exam: The doctor will feel for any abnormalities in the pelvic area, such as cysts or scars behind the uterus.

  • An ultrasound: This is an imaging test that uses sound waves to create pictures of the pelvic organs. It can help detect cysts associated with endometriosis.

  • A laparoscopy: This is a minimally invasive surgery that involves inserting a thin tube with a camera and light (laparoscope) through a small incision in the abdomen. The laparoscope allows the doctor to see inside the pelvic cavity and identify the location, extent, and size of the endometriosis. The doctor may also take a biopsy (a small sample of tissue) for further examination.

How is endometriosis treated?

The symptoms and complications of endometriosis cannot be cured, but there are treatments available. The main types of treatment depend on a number of factors, including the severity of symptoms, the extent of endometriosis, the patient's age, and the desire for pregnancy.

  • As a result of endometriosis, menstrual cramps can be relieved with painkillers like ibuprofen or naproxen. Birth control pills, patches, injections, implants, or intrauterine devices suppress ovulation and menstruation, thus reducing or stopping bleeding and inflammation. There are, however, side effects associated with hormone therapy, including weight gain, mood swings, and bone loss. Hormone therapy does not cure endometriosis.

  • In some cases, laparoscopy can be used to remove or destroy endometrial-like tissue outside the uterus, resulting in relief of pain and improved fertility. Surgery, however, does not guarantee that endometriosis will not recur or infertility will be resolved. To prevent further growth of endometriosis, a hysterectomy (removal of the uterus) and an oophorectomy (removal of the ovaries) may be performed in severe cases. Menopause and infertility are irreversible consequences of this surgery.

How can endometriosis be prevented?

There is no sure way to prevent endometriosis from developing or progressing. However, some lifestyle changes may help reduce its risk or impact on health and well-being. These include:

  • Taking birth control pills or other hormonal contraceptives to regulate the menstrual cycle and reduce the exposure to estrogen.

  • Exercising regularly to improve blood circulation, reduce stress, and maintain a healthy weight.

  • Eating a balanced diet that is rich in fiber, fruits, vegetables, whole grains, and omega-3 fatty acids, and low in saturated fat, red meat, dairy products, and caffeine. These foods may help modulate inflammation and hormone levels in the body.

  • Avoiding alcohol and tobacco, which can worsen the symptoms of endometriosis and increase the risk of other health problems.

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