Endometriosis is a disease in which tissue similar to the lining of the uterus grows outside the uterus, causing severe pain in the pelvis and making it harder to get pregnant.
This leads to inflammation and scar tissue forming in the pelvic region and (rarely) elsewhere in the body.
According to the World Health Organization (WHO), the cause of endometriosis is unknown and there is no known way to prevent endometriosis. There is no cure, but its symptoms can be treated with medicines or, in some cases, surgery.
It causes a chronic inflammatory reaction that may result in the formation of scar tissue (adhesions, fibrosis) within the pelvis and other parts of the body. Several lesion types have been described:
- superficial endometriosis found mainly on the pelvic peritoneum
- cystic ovarian endometriosis (endometrioma) found in the ovaries
- deep endometriosis found in the recto-vaginal septum, bladder, and bowel
- In rare cases, endometriosis has also been found outside the pelvis.
Symptoms
Endometriosis often causes severe pain in the pelvis, especially during menstrual periods. Some people also have pain during sex or when using the bathroom. Some people have trouble getting pregnant.
Some people with endometriosis don’t have any symptoms. For those who do, a common symptom is pain in the lower part of the belly (pelvis). Pain may be most noticeable:
- during a period
- during or after sex
- when urinating or defecating.
Some people also experience:
- chronic pelvic pain
- heavy bleeding during periods or between periods
- trouble getting pregnant
- bloating or nausea
- fatigue
- depression or anxiety.
Symptoms often improve after menopause, but not always.
Endometriosis symptoms are variable and broad, meaning that healthcare workers may not easily diagnose it. Individuals with symptoms may not be aware of the condition.
Causes
Endometriosis is a complex disease that affects many women globally from the onset of their first period (menarche) through menopause, regardless of ethnic origin or social status. Many different factors are thought to contribute to its development. At present, endometriosis is thought to arise due to:
- Retrograde menstruation is when menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity at the time that blood is flowing out of the body through the cervix and vagina during periods. Retrograde menstruation can result in endometrial-like cells being deposited outside the uterus where they can implant and grow.
- Cellular metaplasia is when cells change from one form to another. Cells outside the uterus change into endometrial-like cells and start to grow.
- Stem cells can give rise to the disease, which then spreads through the body via blood and lymphatic vessels.
Other factors may also contribute to the growth or persistence of ectopic endometrial tissue. For example, endometriosis is known to be dependent on estrogen, which increases the inflammation, growth and pain associated with the disease. However, the relationship between estrogen and endometriosis is complex since the absence of estrogen does not always mean the absence of endometriosis.
Impact
Endometriosis has significant social, public health and economic implications. It can decrease quality of life due to severe pain, fatigue, depression, anxiety, and infertility. Some individuals with endometriosis experience debilitating pain that prevents them from going to work or school. Painful sex due to endometriosis can lead to interruption or avoidance of intercourse and affect the sexual health of affected individuals and their partners. Addressing endometriosis will empower those affected by it by supporting their human right to the highest standard of sexual and reproductive health, quality of life and overall well-being.
Prevention
At present, there is no known way to prevent endometriosis. Enhanced awareness, followed by early diagnosis and management may slow or halt the natural progression of the disease and reduce the long-term burden of its symptoms, including possibly the risk of central nervous system pain sensitization. Currently there is no cure.
Treatment
Treatments to manage endometriosis can vary based on the severity of symptoms and whether pregnancy is desired. No treatments cure the disease.
A range of medications can help manage endometriosis and its symptoms.
Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics (painkillers) like ibuprofen and naproxen are often used to treat pain.
Hormonal medicines like GnRH-analogues and contraceptive (birth control) methods can also help control pain. These methods include:
- pills
- hormonal intrauterine devices (IUDs)
- vaginal rings
- implants
- injections
- patches.
These methods may not be suitable for those wanting to get pregnant.
Surgery is sometimes used to remove endometriosis lesions, adhesions, and scar tissues. Laparoscopic surgery (using a small camera to visualize inside the body) allows doctors to keep incisions small.
Treatments are based on individual preferences and effectiveness, side effects, long-term safety, costs, and availability.
Some treatments are associated with side effects, and endometriosis-related symptoms can sometimes reappear after therapy ends.
The choice of treatment depends on effectiveness in the individual, adverse side effects, long-term safety, costs, and availability.
Most current hormonal management is not suitable for persons who have endometriosis who wish to get pregnant, since it affects ovulation.
Success in reducing pain symptoms and increasing pregnancy rates through surgery are often dependent on the extent of disease.
In addition, lesions may recur even after successful eradication, and pelvic floor muscle abnormalities can contribute to chronic pelvic pain.
Secondary changes of the pelvis, including the pelvic floor, and central sensitization may benefit some patients from physiotherapy and complementary treatments. Treatment options for infertility due to endometriosis include laparoscopic surgical removal of endometriosis, ovarian stimulation with intrauterine insemination (IUI), and in vitro fertilization (IVF), but success rates vary.
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