Summary about Disease
Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrium) grows outside of the uterus. This tissue can be found on the ovaries, fallopian tubes, and other areas in the pelvic region, and even, in rare cases, beyond the pelvic area. This misplaced endometrial tissue thickens, breaks down, and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit the body, it becomes trapped. This can lead to inflammation, scarring, adhesions (bands of fibrous tissue that can cause organs to stick together), and pain. Endometriosis can affect fertility.
Symptoms
Common symptoms of endometriosis include:
Pelvic pain: Often associated with menstrual periods.
Painful periods (dysmenorrhea): Characterized by severe cramping that may start before and extend several days into the period.
Pain with intercourse (dyspareunia).
Pain with bowel movements or urination: These symptoms are more likely to occur during menstrual periods.
Excessive bleeding: Heavy menstrual periods (menorrhagia) or bleeding between periods (menometrorrhagia) may occur.
Infertility: Endometriosis can sometimes only be diagnosed in women seeking treatment for infertility.
Other symptoms: Fatigue, diarrhea, constipation, bloating or nausea, especially in association with menstrual periods.
Asymptomatic: Some individuals with endometriosis have no symptoms.
Causes
The exact cause of endometriosis is not fully understood, but several theories exist:
Retrograde menstruation: Menstrual blood containing endometrial cells flows back through the fallopian tubes into the pelvic cavity instead of exiting the body. These cells then implant and grow.
Embryonic cell transformation: Cells lining the abdominal and pelvic cavities may transform into endometrial-like cells.
Surgical scar implantation: After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
Endometrial cell transport: Blood vessels or the lymphatic system may transport endometrial cells to other parts of the body.
Immune system disorder: A problem with the immune system may make the body unable to recognize and destroy endometrial-like tissue that's growing outside the uterus.
Genetic factors: Endometriosis may be more common in women who have a close relative, such as a mother, sister, or daughter, with the condition.
Medicine Used
Medications used to manage endometriosis focus on pain relief and hormone regulation:
Pain relievers: Over-the-counter pain relievers, such as ibuprofen or naproxen, can help relieve painful menstrual cramps. Prescription pain relievers may be necessary for more severe pain.
Hormonal birth control: Birth control pills, patches, or vaginal rings help control the hormones responsible for the buildup of endometrial tissue each month. Many women have lighter and shorter menstrual flow when they're using hormonal birth control.
Gonadotropin-releasing hormone (GnRH) agonists and antagonists: These medications block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation. This causes endometrial tissue to shrink. Side effects may include hot flashes, vaginal dryness, and bone loss. Low-dose hormone replacement therapy may be given with GnRH agonists and antagonists to help reduce these side effects.
Progestin therapy: This medication can help stop menstruation and the growth of endometrial tissue.
Aromatase inhibitors: These medications reduce the amount of estrogen in the body. They are often used in combination with progestin therapy or hormonal birth control.
Is Communicable
No, endometriosis is not a communicable disease. It is not contagious and cannot be spread from person to person through any means.
Precautions
While there's no guaranteed way to prevent endometriosis, some factors may reduce the risk or severity of symptoms:
Lowering estrogen levels: Reducing the body's overall exposure to estrogen may help. This can be achieved through hormonal birth control (with a doctor's guidance), maintaining a healthy weight, and avoiding excessive alcohol consumption.
Regular exercise: Regular physical activity can help reduce estrogen levels and improve overall health.
Early diagnosis and treatment: If you experience symptoms suggestive of endometriosis, seeking early medical attention is crucial. Early diagnosis and appropriate treatment can help manage the condition and prevent complications.
Awareness of family history: If you have a family history of endometriosis, be vigilant about monitoring your symptoms and discussing any concerns with your doctor.
How long does an outbreak last?
Endometriosis is not characterized by "outbreaks" in the same way as infectious diseases. The symptoms can be chronic and fluctuate in intensity. Pain and other symptoms are often most severe during and around menstruation. However, some women experience pain and other symptoms throughout the month. The duration of symptoms can vary widely from person to person and can be affected by treatment. Without treatment, the symptoms may persist for many years, often throughout a woman's reproductive years.
How is it diagnosed?
Endometriosis is typically diagnosed through a combination of:
Medical history and physical exam: The doctor will ask about your symptoms, menstrual history, and family history. A physical exam, including a pelvic exam, may be performed.
Pelvic exam: The doctor manually palpates (feels) the pelvic organs to check for abnormalities, such as cysts on your ovaries or scars behind your uterus.
Imaging tests:
Ultrasound: A transvaginal ultrasound can help identify cysts associated with endometriosis (endometriomas), but it is not able to definitively diagnose the condition or detect smaller lesions.
Magnetic resonance imaging (MRI): An MRI can provide detailed images of the pelvic organs and can help identify larger endometriosis implants and differentiate them from other conditions.
Laparoscopy: This is the gold standard for diagnosing endometriosis. A surgeon makes a small incision in the abdomen and inserts a thin, lighted instrument with a camera (laparoscope) to view the pelvic organs. If endometriosis is suspected, a biopsy (tissue sample) can be taken and examined under a microscope for confirmation.
Timeline of Symptoms
The timeline of endometriosis symptoms varies significantly among individuals. Some women experience symptoms from their first menstrual period (menarche), while others may not develop noticeable symptoms until later in life. The progression of symptoms can also vary:
Early Stages: May involve mild pelvic pain or discomfort during menstruation, which may be dismissed as normal menstrual cramps.
Progressive Stages: Symptoms may gradually worsen over time, with increased pain intensity, longer duration of painful periods, pain during intercourse, and other associated symptoms.
Fluctuating Symptoms: Symptoms can fluctuate in severity, with periods of remission or reduced pain followed by periods of increased pain and other symptoms.
Silent Endometriosis: Some individuals may have endometriosis without experiencing any noticeable symptoms.
Important Considerations
Infertility: Endometriosis can significantly impact fertility. If you are trying to conceive and have endometriosis, discuss your options with a fertility specialist.
Pain Management: Effective pain management is crucial for improving the quality of life for women with endometriosis. A multidisciplinary approach involving medication, lifestyle changes, and potentially surgery may be necessary.
Surgical Options: Surgery to remove endometrial implants can be an effective treatment option, but it is not a cure. Endometriosis can recur after surgery. Hysterectomy (removal of the uterus) and oophorectomy (removal of the ovaries) may be considered in severe cases when other treatments have failed, but these options are not suitable for women who wish to preserve their fertility.
Mental Health: Living with chronic pain and infertility can take a toll on mental health. Seeking support from a therapist or counselor can be beneficial.
Individualized Treatment: The best treatment plan for endometriosis is individualized and depends on the severity of symptoms, the patient's age, their desire to have children, and their overall health. Close collaboration with a healthcare provider is essential.