Managing Endometriosis: Navigating the Path to Diagnosis and Treatment

Endometriosis affects over 10%, or 190 million, biological women of reproductive age worldwide.

Endometriosis is a significant medical concern due to its widespread prevalence, impact on the lives of biological women, diagnostic challenges, association with infertility, ongoing research needs, and the importance of advocacy and support.

What is endometriosis?

Endometriosis, also commonly abbreviated as “endo,” is a medical disorder in which tissue similar to the lining of your uterus, called the endometrium, grows outside your uterus.

Normally, the endometrium thickens and sheds during the menstrual cycle, causing menstruation (your period). However, in those with endometriosis, this tissue can implant and grow on organs such as your ovaries, fallopian tubes, and pelvic lining, and, in rare cases, even spread beyond the pelvic region.

During each menstrual cycle, these abnormal tissue growths outside your uterus also respond to hormonal changes, including estrogen, leading to inflammation, pain, and scar tissue formation. This can result in various symptoms, including chronic pelvic pain, painful menstrual periods (dysmenorrhea), pain during intercourse (dyspareunia), heavy or irregular menstrual bleeding, fatigue, and/or infertility.

What causes endometriosis?

Although several suggestions have been brought out, the precise etiology of endometriosis is still not entirely known.

These include the following:

• Retrograde Menstruation: One of the leading factors thought to contribute to the development of endometriosis suggests that during menstruation, some menstrual blood containing endometrial cells flows backward through the fallopian tubes into the pelvic cavity instead of being expelled from your body. These displaced endometrial cells can implant and grow on the organs in the pelvic region, leading to the development of endometriosis.
• Hormonal Imbalance: Hormonal imbalances, particularly in estrogen levels, may contribute to the development of endometriosis. Estrogen is known to stimulate the growth of the endometrium. It’s believed that elevated levels of estrogen or an imbalance between estrogen and progesterone may promote the growth of endometrial tissue outside your uterus.
• Immune System Dysfunction: An abnormal immune response in those with endometriosis may allow the survival and growth of endometrial tissue outside your uterus. Normally, your immune system helps identify and eliminate abnormal cells or tissues, however, in those with endometriosis, it may fail to recognize and eliminate the ectopic endometrial tissue.
• Genetic Factors: Some evidence suggests that endometriosis may have a genetic component. It has been observed that those with a close family member, such as a mother or sister, with endometriosis, are at a higher risk of developing the condition themselves. Certain genetic variations or mutations may predispose individuals to endometriosis.
• Metaplasia: Metaplasia is a process in which one type of tissue transforms into another type. It has been proposed that certain cells in your pelvic region, such as the peritoneum, can undergo metaplasia and transform into endometrial-like tissue, leading to the formation of endometriosis lesions.

Although these features could shed light on how endometriosis develops, they do not account for every instance. Endometriosis may be a complex disorder impacted by a number of these variables as well as possibly other causes that are still unidentified. To better understand the causes of endometriosis and provide appropriate therapy, early detection, and therapeutic techniques, additional research is required.

What are the signs and symptoms of endometriosis?

A wide range of signs and symptoms associated with endometriosis can occur, and their severity might differ from person to person. Below are a few examples of typical endometriosis symptoms and signs:

• Chronic Pelvic Pain: Pelvic pain is one of the hallmark symptoms of endometriosis. It may vary in intensity and can be experienced as a dull, aching pain or sharp, stabbing pain in the pelvic region that may worsen during menstruation or intercourse.
• Painful Menstruation (Dysmenorrhea): Many individuals with endometriosis experience severe menstrual cramps that are often worse than typical menstrual pain. The pain may start before menstruation and persist throughout the menstrual period.
• Painful Intercourse (Dyspareunia): Endometriosis can cause pain during or after sexual intercourse. The pain may be deep, sharp, or cramp-like and can occur in the pelvis or lower abdomen.
• Heavy or Irregular Menstrual Bleeding: Some individuals with endometriosis may experience heavy menstrual bleeding or irregular periods, including shorter or longer menstrual cycles than usual.
• Gastrointestinal Symptoms: Endometriosis can affect the digestive system, leading to symptoms such as bloating, constipation, diarrhea, nausea, and abdominal pain, particularly during menstruation.
• Fatigue: Chronic fatigue or excessive tiredness is a common symptom reported by individuals with endometriosis, likely due to the physical and emotional toll of living with chronic pain.
• Infertility: Endometriosis can be associated with fertility challenges. The abnormal tissue growth and inflammation caused by endometriosis can affect the function of the ovaries, fallopian tubes, and uterus, making it more difficult to conceive.

The level of severity of endometriosis does not always correspond to the intensity of the symptoms. It's recommended that you speak with your doctor regarding a full assessment and diagnosis if you feel you may have endometriosis or are experiencing any of these symptoms. Specialists can evaluate your symptoms, carry out the required tests, and offer the best possible treatments.

How is endometriosis diagnosed?

Due to the symptoms' wide range and potential overlap with other illnesses, diagnosing endometriosis can be tricky. Still, the process of diagnosis entails a number of steps, including the following:

• Medical history assessment: Your doctor will begin by discussing your symptoms, their duration, and their impact on your daily life. They may also ask about your menstrual cycle, pain patterns, and any family history of endometriosis.
• Physical exam: A pelvic exam may be performed to check for any abnormalities, including cysts and/or tender areas, that could indicate the presence of endometriosis.
• Imaging tests: Ultrasound imaging, such as transvaginal ultrasound, may be used to visualize your pelvic organs and identify any endometriotic cysts (endometriomas) or other abnormalities. However, it's important to know that imaging alone cannot definitively diagnose endometriosis.
• Laparoscopy: The gold standard for diagnosing endometriosis is a surgical procedure called laparoscopy. It involves making small incisions in your abdomen and inserting a thin, lighted instrument (laparoscope) to view your pelvic organs directly. During laparoscopy, your doctor may take tissue samples, or biopsies, for further examination to confirm the presence of endometriosis.

  It's important to keep in mind that laparoscopy is an invasive procedure with potential dangers. Thus, it's typically reserved for situations when there is a high probability of endometriosis or when alternative treatments haven't brought about enough alleviation.

Are there risk factors for endometriosis?

Yes! Several known risk factors might increase your risk of developing endometriosis. Among them are the following:

• Family history: As mentioned, having a first-degree relative, such as a mother or sister, with endometriosis increases your risk of developing this condition.
• Early menarche (the first occurrence of menstruation): Starting menstruation at an early age, generally before the age of 11, may increase your risk of developing endometriosis. The longer the exposure to menstrual cycles, the greater the potential for endometrial tissue to implant outside your uterus.
• Short menstrual cycles: Having shorter menstrual cycles, with intervals of fewer than 27 days, may be associated with a higher risk of endometriosis. A shorter menstrual cycle means more frequent exposure to hormonal changes that can contribute to the development of this condition.
• Prolonged menstrual flow: Menstrual periods lasting longer than 7 days have been linked to an increased risk of endometriosis.
• Abnormal uterine structure: Certain structural abnormalities of your uterus or fallopian tubes, including a retroverted uterus (tilted backward) or blocked fallopian tubes, may increase your risk of endometriosis.
• Immunological Factors: An altered immune system response or dysfunction may contribute to the development of endometriosis.

It's important to remember that while these risk factors might make endometriosis more likely to occur, they can also affect individuals without any known risk factors. Furthermore, one or more risk factors do not guarantee that you will develop endometriosis.

Speak with your doctor

If you have endometriosis symptoms that worry you or are interfering with your daily activities, it's important to consult your doctor. A discussion with your healthcare provider should be prompted by symptoms such as persistent pelvic pain, painful menstruation, painful sexual activity, probable infertility, gastrointestinal problems, or a family history of endometriosis. You can get a proper exam, diagnosis, and advice on the best treatments by discussing your symptoms with your doctor. Keep in mind that prevention and early therapy can help you manage this condition and enhance your quality of life.