Endometriosis is a painful disorder that occurs when tissue that is similar to the tissue that lines the woman’s uterus grows outside the uterus. This tissue acts like regular uterine tissue does during your period – break apart and bleed at the end of your period cycle. However, in the case of endometriosis, this blood has nowhere to go, hence, resulting in being trapped in the pelvis. The trapped tissue in the pelvis can cause irritation, scar formation, adhesions in which tissue binds the pelvic organs together, severe pain that occurs during the menstrual cycle as well as fertility problems. 

Types of Endometriosis 

There are 3 main types of endometriosis, that is based on where it is:

1. Superficial peritoneal lesion is the most common type. Lesions will form on the peritoneum which is a thin film that lines the pelvic cavity. 
2. Endometrioma (ovarian lesion) are dark, fluid-filled cysts, also called “chocolate cysts” that form deep in the ovaries. They can cause damage to healthy tissue and don’t respond well to treatment. 
3. Deeply infiltrating endometriosis grows under the peritoneum and can involve organs near the uterus, such as bowels or bladder. An estimated 1-5% of women with this disorder have it. 

Symptoms of Endometriosis 

The symptoms of endometriosis vary.  Symptoms range from mild, moderate to severe. The severity of pain is not correlated to the severity of the condition. Some women experience excruciating pain but have a mild form of the disorder; some suffer little discomfort but with a severe form, whereas some do not experience any symptoms at all. 

Pelvic pain is notably the most common symptom of endometriosis. Nevertheless, there are also other symptoms that come with the disease, for example: 

• Heavy bleeding during or between periods. 
• Infertility 
• Painful menstrual cramps (dysmenorrhea)
• Cramps that last 1-2 weeks around menstruation
• Pain during sex
• Lower back pain or abdominal pain 
• Discomfort with bowel movements or urination. 
• Other signs and symptoms: fatigue, diarrhea, constipation, bloating, nausea (especially during periods)

What are the causes?

Experts have not found exactly what causes endometriosis. However, there are a few possible explanations: 

1. Some experts think period blood containing endometrial cells flows back through the fallopian tube and into the pelvic cavity instead of going out of the body. These cells stick to the pelvic walls as well as surfaces of pelvic organs, where they continue to grow, thicken, and bleed over the course of each menstrual cycle. This entire process is known as retrograde menstruation. 
2. Transformation of peritoneal cells – From the “induction theory”, experts propose that hormones or immune factors promote the transformation of peritoneal cells into endometrial cells.
3. Embryonic cell transformation – Hormones such as estrogen may transform embryonic cells into endometrial cell implants during puberty.
4. Surgical scar implantation – Endometrial cells may attach to a surgical incision after a surgery (hysterectomy or C-section).
5. Endometrial cell transport – The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
6. Immune system disorder may cause the body to be unable to recognize and destroy endometrial-like tissue that’s growing outside the uterus. 
7. Genetics could also play a role. For instance, if your mom or sister has endometriosis, there’s a high possibility that you might get it. Research has shown that the disorder tends to worsen from one generation to the next. 

Risk Factors

Endometriosis usually develops years after the start of a woman’s menstrual cycle. Understanding its risk factors might help you determine whether you’re at risk of developing this disorder and to take action ASAP! 

• Never giving birth 
• Menstrual history – starting your period at an early age
• Going through menopause at an older age 
• Short menstrual cycles (less than 27 days) 
• Heavy period bleeding that last longer than 7 days 
• Low BMI
• Family history 
• Reproductive tract disorders 
• Higher levels of estrogen in the body

Complications 

1. Fertility issues 

Endometriosis is the leading cause of infertility. When endometrial tissue wraps around the ovaries, it can block the eggs from being released, prevent sperm from making its way up the fallopian tubes, and stop a fertilized egg from sliding down your tubes to the uterus. The downside is that even though there are medications used to treat endometriosis, they do not improve fertility. Keep in mind that symptoms may worsen over time which make it more difficult to conceive. Your doctor will need to do an assessment before and during your pregnancy. 

2. Cancer 

Those with endometriosis might have a higher rate of developing ovarian cancer. However, the overall lifetime risk of contracting ovarian cancer is still relatively low to begin with. Although it is rare, another type of cancer known as endometriosis-associated adenocarcinoma may develop later in life in those who have had a history of endometriosis. Therefore, it is important to have regular check-ups! 

Stages 

There are 4 stages for endometriosis. Different factors determine the stages of the disorder. These factors can include the location, number, size, and depth of endometrial implants. 

Stage 1 (minimal): There are a few small lesions but no scar tissue. There may be inflammation in or around the pelvic cavity. 

Stage 2 (mild): There are more light lesions and shallow implants on the ovaries and the pelvic lining but no scar tissue. 

Stage 3 (moderate): The lesions may be deep. There may also be many deep implants on the ovaries and pelvic lining. 

Stage 4 (severe): Involves many deep implants on your pelvic lining and ovaries. There may also be lesions and scar tissue on the fallopian tubes or between the uterus and the lower part of the intestines as well as large cysts in one or both of the ovaries. 

*Note that these stages do not take pain or symptoms into account. 

When to see a doctor 

Endometriosis can be a challenging disorder to manage. It is important that you see your doctor ASAP if you have symptoms that may indicate endometriosis so you can better manage your symptoms, especially with the help of an early diagnosis, a medical team and a comprehensive understanding of your diagnosis. 

In addition, endometriosis is commonly mistaken for other diseases that can cause pelvic pain. For instance, ovarian cysts, pelvic inflammatory disease (PID), as well as irritable bowel syndrome (IBS) that often accompanies endometriosis which can complicate the diagnosis. 

Treatments 

Unfortunately, there is no cure for endometriosis but its symptoms can be managed. Everyone reacts differently to the treatment options available, but your doctor will choose one depending on how severe your symptoms are and whether you hope to become pregnant in the near future. Doctors usually advise trying conversative treatment methods first, resorting to surgery only if the condition worsens or doesn’t improve. 

• Pain Medications

Your doctor may recommend an over-the-counter pain reliever. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve) work for many patients to ease painful cramps. 

If you’re not trying to get pregnant, your doctor may recommend hormonal therapy together with pain-relievers. 

• Hormone therapy 

Hormonal therapy lowers the amount of estrogen your body creates but it may stop your period which prevents lesions from bleeding, causing a lower risk of inflammation, scarring, and cyst formation. 

• Conservation surgery

It is typically used for women who want to get pregnant or if hormonal treatments are not working and pain is still persistent. This type of surgery removes or eliminates endometrial growths without damaging the reproductive organs. Doctors usually opt for laparoscopy which is a minimally invasive surgery to remove the abnormal or displaced endometrial tissue. 

• Hysterectomy 

In severe cases, your doctors might have to resort to hysterectomy (removal of the uterus). It is for those who don’t want to become pregnant. However, it may have a long-term effect on your health, especially if the surgery is taken before the age of 35. 

*It is crucial that you find a doctor with whom you feel comfortable with. You can still seek second opinions before agreeing to start any treatment. 

Lifestyle Changes 

Eat healthy, eat right. 

Add more fresh fruits and vegetables to your diet and make them the heart of your meals. Foods rich in omega-3 fatty acids, such as salmon, and walnuts, are helpful. Besides that, the type of fat you eat matters. Women that consume the most trans fat had a 48% higher risk of developing endometriosis. Avoid alcohol and coffee. Exercise regularly to relieve symptoms and find healthy ways to manage stress.