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Endometriosis refers to the presence and abnormal growth of endometrium lining-like tissue (endometriotic tissue) outside the uterus. This overgrowth of tissue can cause a variety of health problems, including pelvic pain and infertility.
In response to the ovary’s hormonal changes, the endometriotic tissue causes localized bleeding like a period. This triggers inflammation in the surrounding tissue, resulting in scar tissue formation and adhesions.
The Endometriotic Tissue
While the endometriotic tissue resembles the endometrial tissue, it is actually different.
First, the endometriotic tissue uniquely makes its own estrogen and it lacks enzymes to degrade the estrogen locally. Second, this tissue is resistant to progesterone, which is the hormone that counters the effect of estrogen.
The endometriotic tissue invades local tissue and is capable of slowly destroying nearby organs, including the ovary, fallopian tubes, intestines, ureter, and bladder.
How Common Is Endometriosis?
More than 176 million women are diagnosed with endometriosis on a global scale, with approximately 1 in every 10 women affected by this disorder. (1)
Endometriosis affects the female population across various age groups, ranging from the start of puberty (12 years old) to well after the menopausal age.
One study found the age group of 31–35 as the group with the most prevalence. (2) However, an accurate prevalence study is rather challenging to do because patients with endometriosis have an average of delayed or missed diagnosis of several years.
Different Stages of Endometriosis
The American Society of Reproductive Medicine (ASRM) characterized four different stages of endometriosis, depending on the extent and involvement of the disease in the pelvic cavity and adjoining organs. (3)
- Stage 1 is called “minimum,” which is characterized by superficial lesions, commonly in the pelvic sidewall or the pouch of Douglas area.
- Stage 2 is “mild,” which is characterized by superficial lesions and some deep lesions, with some adhesions.
- Stage 3 is “moderate” and includes some ovarian chocolate cysts and adhesions in the ovaries and pelvic sidewall area.
- Stage 4 is “severe,” which results in the development of large chocolate cysts and severe adhesions in the bladder and intestines. Some severe cases of stage 4 are called “frozen pelvis,” in which the pouch of Douglas is already obliterated.
Common Symptoms of Endometriosis
The symptoms of endometriosis depend upon the location, extent, and depth of the disease.
The common symptoms and various side effects of endometriosis include:
- Pelvic pain, low back pain, leg pain, groin pain, pain during intercourse
- Heavy periods, prolonged periods, passing blood clots, premenstrual spotting, intermenstrual spotting, irregular periods, spotting after sex
- Chronic fatigue, abdominal bloating (also known as “endo belly”)
- Frequent urination, an urgency to urinate, painful urination, hematuria, flank pain (endometriosis in the bladder and ureter areas)
- Bloody stool, nausea, vomiting, pain with bowel movement, diarrhea, constipation (endometriosis in the intestines and near the gastrointestinal area)
- Migraine headache, joint pain, skin breakdown, acne, heart pain, chest pain, shoulder pain
- Infertility, subfertility, recurrent miscarriages, failed IVF
- Depression, anxiety, insomnia, lack of concentration, brain fog, forgetfulness
Medical Treatment for Endometriosis
There is NO cure for endometriosis, neither for the short term nor for the long term. However, both medical and surgical treatments are available to help manage the symptoms.
Medical treatments include:
- Birth control pills
- Progesterone treatment (such as IM Depo-Provera)
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen
- Intrauterine device (IUD)
- Lupron and Orilissa, which are GnRH agonist and antagonist, respectively (both produce significant menopause effects)
All of these medical treatments are for symptomatic relief. It means they only reduce the symptoms of endometriosis by helping relieve pain or suppressing hormones, rather than treat it.
Surgical treatments for endometriosis (4) are aimed at removing (excision) or destructing (ablation or burning) the endometriosis lesions. These surgical approaches include:
- Operative laparoscopy ablation – This involves the superficial burning of endometriosis lesions using a laser beam or electrical cautery.
- Da Vinci robotic surgery – A mechanical robot is used to excise visible lesions in this method.
- Operative laparoscopy excision (4)(5) – This method enables the excision of deep endometriosis lesions from their roots.
The best surgical option is the high-definition 4K laparoscopic excision. However, not all excision surgeries produce the same result.
Successful excision depends upon the experience, strategy, meticulousness, skills, and techniques of the surgeon. Thus, it is crucial for all patients with endometriosis to do diligent research on a surgeon before deciding to undergo surgery.
After successful excision surgery, the patient is expected to adopt several lifestyle changes to manage the condition. These changes usually include switching to a healthier endometriosis diet, exercising regularly, and using stress reduction techniques.
What You Should Know About Endometriosis Treatments
Endometriosis is a very complex disease, which can manifest with a variety of many different symptoms. If women become educated about endometriosis, they can protect themselves from any wrong medical advice or unwise treatment choice.
- Lupron and Orilissa both cause menopause without affecting endometriosis lesions and patients will suffer new sets of tremendous drug side effects.
- Hysterectomy is not the right treatment approach for endometriosis, as all endometriosis lesions are located outside the uterus.
- Removing the uterus (and/or ovaries) does not remove the endometriosis lesions (which are located outside the uterus) and, thus, does not provide a cure for endometriosis.
Finding the right doctor or a true specialist is the most important first step. A doctor who has previous experience of successfully treating this condition can catch the disease even in its early stage and guide you to the proper and timely excision treatment.
All patients with endometriosis are unique and different, so their care and treatments need to be carefully individualized. Please educate yourself and spread awareness about endometriosis.
Endometrial cysts (endometrioma) of the ovary are also known as chocolate cysts. Chocolate cysts get their name from the fluid they contain, which resembles fudge chocolate both in color and texture. Chocolate cysts are caused by an invasion of endometriosis inside the ovarian follicular cyst (ovulation).
Often, the actual origin of chocolate cysts is endometriosis implants on the pelvic sidewall area, behind the ovary. Your surgeon needs to identify the root cause of your ovarian chocolate cysts before treating them accordingly.
Can Endometriosis Lead to Weight Gain?
Weight gain or weight loss has not been directly attributed to endometriosis itself. Still, the condition can cause abdominal bloating. Weight gain actually can result as a side effect to specific treatment modalities for endometriosis.
Also, weight gain may be caused by a lack of regular exercise as patients with endometriosis find it difficult to remain physically active.
Complications Associated With Endometriosis
Endometriosis can widely affect the patient’s mental and physical health.
1. Anxiety and depression
Patients with endometriosis have increased risks of developing depression and anxiety in their lives. (6) Just coping with repeated, stressful, painful episodes is often draining emotionally, physically, and socially.
Besides pain attacks, endometriosis produces various symptoms that may contribute to depression, including chronic fatigue, brain fog, lack of energy, lack of concentration, nausea, lack of appetite, and feeling of heaviness.
For patients, joining an endometriosis support group or awareness group is also important to find a sense of community and to know that they are not suffering alone.
2. Chronic stomach problems
Many people do not know endometriosis may cause various gastrointestinal and stomach symptoms. (7) These symptoms may vary according to the location, depth, and extent of endometriosis lesions, but these are some of the commonly reported ones:
- Rectal pain and cramps
- Painful bowel movements
- Nausea and vomiting
- Pain with passing gas
- Abdominal bloating
- Bloody stools
- Abdominal pain
Many times, endometriosis that is accompanied by gastrointestinal symptoms is misdiagnosed as irritable bowel syndrome (IBS), which further delays the correct diagnosis and subsequent start of proper treatment.
Some statistics suggest that patients with endometriosis are 80% more likely to suffer a miscarriage as opposed to women who do not have this condition. (8)
One of the mechanisms that increase the chance of miscarriage is the development of endometriosis lesions around the uterus, tubes, and ovaries. This triggers a significant inflammatory environment within the uterine cavity.
Also, more immunological and chemical activities are detected in patients’ peritoneal fluids. These activities are sperm toxic and have an embryotoxic effect.
Endometriosis is essentially a benign (non-cancer) disease. However, the incidence of two forms of ovarian cancer, namely, clear cell carcinoma (9) and endometrioid ovarian cancer, (10) has been linked with the endometriosis chocolate cyst.
But there is a less than 1% chance that the chocolate cysts will turn cancerous.
Endometriosis, or the abnormal growth of tissue outside the uterus, is most common among women in their 30s and 40s. The cause of endometriosis is not precisely known, but various treatments can help manage your symptoms.
It is advised to consult your doctor if you experience chronic pain. You may either be prescribed medications or surgery. It is useful to have a support system to help manage the psychological and physical impacts endometriosis can have on your life.