What is Endometriosis?

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Endometriosis is a painful condition in which the endometrium (tissue that lines the inside of the uterus) grows outside the uterus. It usually involves ovaries, fallopian tubes, and the tissue lining the pelvis. Endometriosis is a reproductive system disorder that affects mainly the ovaries, uterus, fallopian tubes, and the tissues lining the pelvis. It can also be found on the intestines, urinary bladder, appendix as well as other distal organs like the lungs.

 The hormonal changes of the menstrual cycle affect the misplaced endometrial tissue which means the tissue will grow, thicken, and break down. After some time, the tissue that has broken down has nowhere to go and becomes trapped in the pelvis.

Endometriosis is a very common debilitating disease. The exact prevalence is difficult to estimate as many cases go underdiagnosed and it requires invasive testing for diagnosis. About 25 to 50% of women suffering from infertility have endometriosis, and 30 to 50% of women with endometriosis are infertile.

The incidence of endometriosis in coastal Karnataka and Kerala is increasing because of better awareness of endometriosis symptoms in the public, early suspicion of the disease, and better imaging modalities. 

Endometriosis affects all age groups, right from puberty to perimenopause, but usually, it is found in the reproductive age group.

 What causes endometriosis?

The exact endometriosis causes are not known.

Possible causes could be:

1. Retrograde menstrual flow - some of the tissue shed during the period flows through the fallopian tube into other areas of the pelvis.

2. Genetic factors - Endometriosis clusters in the families. Multiple genes and environmental factors play a role. Sisters have a 5 percent greater risk of getting the disease.

3. A faulty immune system that fails to destroy the outside growing endometrial tissue.

4. Estrogen hormone appears to promote endometriosis.

Risk factors for developing endometriosis:

1. Never giving birth

2. Starting a period at an early age and going through menopause at an older age.

3. Shorter menstrual cycles (less than 27 days)

4. Heavy menstrual periods that last for more than 7 days.

5. Low BMI

Signs & Symptoms of endometriosis

  • Painful cramps during menstruation
  • Pain during intercourse(deep dyspareunia) 

  • Pain with ovulation 

  • Infertility

  • Chronic pelvic pain

  • Urinary symptoms, such as frequent urination or blood-stained  urine, especially around the time of menses

  • Bowel symptoms, such as pain and bleeding  during defecation, constipation, or diarrhea, especially around the time of menses

  • Lower back pain or leg pain, especially around the time of your periods

The symptoms of endometriosis can impact the patient’s general physical, mental, and social well-being.

How does endometriosis affect fertility?

Endometriosis can affect fertility in several ways. Most obviously, as the disease progresses, the fallopian tubes get distorted and adhere to the ovary and uterus, and the passage of sperm and eggs through the pelvis will be increasingly impaired. You will notice the change in the pelvic environment due to the endometriosis-related inflammation. These inflammatory substances and cells weaken the function of both eggs and sperm (fertilization, embryo development, and implantation). There is also increasing evidence that with endometriosis the quality and quantity of eggs in women is affected. 

Endometriosis associated pregnancy complications

Endometriosis always does not regress in pregnancy. Data shows a three-fold increase in the incidence of ectopic or tubal pregnancy and a two-fold increase in miscarriages. It can cause preterm births, placenta previa, small for date babies, postpartum hemorrhage, and ovarian cyst torsion.

Diagnosis of Endometriosis

There is no simple test to diagnose endometriosis. It can be diagnosed only by performing a laparoscopy and a biopsy of the tissue. 

 There are other tests, which the gynecologist may perform which include ultrasound, MRI scans, and gynecological examinations but none of these can definitively confirm endometriosis.

Treatment of Endometriosis

Endometriosis is a chronic disease characterized by pelvic pain and associated with infertility. The treatment of endometriosis requires a life-long personalized management plan with the aim of maximizing medical treatment and avoiding repeated surgical procedures. 

Choosing a treatment comes down to the individual woman’s wishes, depending on her symptoms, her age, and her fertility wishes. She should discuss these with her physician so that they, together, can determine which long-term, holistic, treatment plan is best for her individual needs. For some women, this can be a combination of more than one treatment.

If the pain seems to be the main concern we have several options like over-the-counter pain killers NSAIDs, etc, or hormonal tablets which can be beneficial. Even oral contraceptive pills for a continuous duration are considered effective to reduce the pain as well as putting a hold on the progression of the disease. Hormonal Injection, progestogens, and androgens are other alternatives to reduce the symptoms and can be used in severe forms of the disease. As a last resort, there are options to remove the endometriosis implants, ovarian cysts, or the uterus by surgery.

In early-stage disease and young patients, it is always better to opt for laparoscopy and try and correct the anatomy (position) of the pelvic organs to their actual position to prevent and treat infertility. As the chances per cycle are less, it is advised to have other treatment of using medication to produce more eggs. Performing an IUI(Intra Uterine Insemination) is a better option in certain cases to improve the pregnancy rates per cycle. If this doesn’t work, then there are other methods such as in vitro fertilization (IVF) to help improve your chances of having a baby.

Feel free to reach endometriosis treatment specialists and ask any questions you have regarding the treatment methods. consult the best gynecological hospital near you for endometriosis treatment in Bangalore.

 Can Endometriosis Be Prevented?

There is no way to prevent endometriosis, one can only lower the chances of getting it.

1. Lower the estrogen levels by taking birth control pills when indicated.

2. Regular exercise

3. A healthy nutritious diet which is rich in essential vitamins, mineral, and phytonutrients. Eat a diet that has more omega 3 fats like fish, walnut and flax and plenty of fruits, vegetables, and whole grains which increases the dietary fiber,

4. Avoid alcohol and cut down on caffeine and aerated drinks and intake of red meat and trans fat foods. Cut down the intake of processed food. Try a gluten-free and a low FODMAP diet.

5. Reduce exposure to polychlorinated biphenyl and dioxin.

Early intervention is the only prevention. Noah built his ark before it could rain.

Social Impact

Women with endometriosis are more likely to report an altered body image, describe reduced desire, arousal and pain. From a woman’s perspective, endometriosis is a disease surrounded by taboos, myths, delayed diagnosis, hit-and-miss treatments, and a lack of awareness, overlaid on a wide variety of symptoms that embody a stubborn, frustrating, and, for many, painfully chronic condition. It affects these women and girls during the prime of their lives. These individuals’ physical, mental, and social well-being is impacted by the disease, potentially affecting their ability to finish an education, maintain a career, with a consequent effect on their relationships, social activities, and in some cases fertility.

Conclusion 

Endometriosis is a disease that is rooted in a very real, highly complex hereditary, and truly multi-factorial disease. Women with endometriosis may struggle with the emotional distress brought on by the unrelenting symptoms of pain and infertility and a multidisciplinary approach with psychological support is essential for these women. 

 

Dr. Vidhyashree Kamath

Consultant OBG

Manipal Hospitals, Mangalore

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