Many of us have heard the word endometriosis thrown around a few times here and there. But chances are, if you ask someone to break down what it is, they’d have a little trouble. Heck, even doctors have trouble diagnosing this painful condition that impacts approximately 176 million women worldwide. So right here and right now, we’re going to break it down for you.
Understanding the Endometrium
Before I jump into what endometriosis is, I think it’s important to address the endometrium. The endometrium, also known as endometrial lining, is sort of like wallpaper. It lines the inside of the uterus and plays a major role during the menstrual cycle and pregnancy.
For instance, the endometrial lining thickens and becomes enriched with blood close to ovulation to prepare for a fertilized egg. When conception doesn’t take place, the blood and endometrial tissue shed, which is your period.
If you have endometriosis, then tissue very similar to your endometrial lining grows on the outside of your uterus. And guess what? It thickens, breaks down, and sheds blood just like the endometrium. When this happens, the shedding tissue and blood have nowhere to go and are basically confined. This leads to cysts, scar tissue, and fibrous tissue that forces pelvic tissues and organs to join together.
So What Causes This?
Now, the truth is, we haven’t really figured out what causes endometriosis yet. Some researchers think it’s an issue with the immune system and others think blood vessels send endometrial cells to other parts of the body. Here are a few other possible explanations:
- Retrograde menstruation: This is when menstrual blood that includes endometrial tissue drives back up through the Fallopian tubes instead of out of the body. Researchers think the endometrial tissue attaches itself to the pelvic wall and makes itself at home. Over time, it grows, thickens, and sheds.
- Peritoneal cells: Researchers suggest that the peritoneal cells, which line the inner side of the abdomen, evolve into endometrial-like cells.
- Embryonic cells: It’s thought that the hormone estrogen, transforms embryonic cells into endometrial-like cells during puberty.
- Surgical scarring: After a C-section, hysterectomy, or similar surgery, researchers believe endometrial cells attach to a surgical incision.
Symptoms Are No Joke
The most common and well-known symptom of endometriosis is severe cramps. Most of us can agree that menstrual cramps are no fun at all, but endometriosis causes the extreme, I-literally-can’t-do-a-thing-today type of pain. If you’ve ever had cramps that bad, it might be worth mentioning to your doctor. Especially if you also notice these symptoms:
- Heavy bleeding during or between periods
- Lower back pain
- Painful sex
- Pain when you pee or poop
According to the Mayo Clinic, infertility is the main complication of endometriosis. Conception is more challenging due to scarring and adhesions. The sperm and egg have difficulty uniting because endometrial-like tissue creates a barrier around the area. However, many women with endometriosis go on to conceive and carry their baby to term. In fact, 50% of women with endometriosis don’t report any complications with fertility.
The other major complication is cancer. Women with endometriosis are at an increased risk of developing ovarian cancer. However, although endometriosis increases one’s risk for ovarian cancer, the risk is still pretty low. Another type of cancer, endometriosis-associated adenocarcinoma, could also develop, but this is rare.
So, how does one figure out if endometriosis is affecting them? To start, begin making note of your symptoms and where you feel pain. Then schedule an appointment with your doctor and share what’s going on. If you have excruciating cramps, don’t dismiss that as a normal part of being a woman. And don’t let your doctor dismiss it either. It could mean something more serious is going on. Your doctor will probably conduct the following tests:
- Pelvic exam: During this test, they’ll feel for abnormalities like cysts and scarring.
- Ultrasound: A transducer is placed against the abdomen or inside the vagina to capture images of your reproductive organs. This will allow the doctor to check for any abnormalities.
- MRI: This test captures more detailed images of your organs and tissues.
- Laparoscopy: A surgeon will make a small incision in your navel and insert a laparoscope to check for endometrial tissue outside the uterus. It’s not uncommon for a tissue sample to be taken as well to be examined.
Today, there is no known cure for endometriosis but there are options to alleviate your symptoms. The go-to option is over-the-counter painkillers to help with menstrual cramps. Your doctor may also suggest hormone therapy, as that could slow and stop endometrial tissue growth. The most common types of hormone therapies are:
- Contraceptives: Birth control pills, rings, and patches make for a lighter and shorter menstrual flow.
- Progestin therapy: This stops menstrual periods and the growth of endometrial tissue.
- Aromatase inhibitors: These reduce the amount of estrogen in your body. Remember, estrogen is thought to transform embryonic cells into endometrial cells.
- Gn-RH agonists and antagonists: These compounds make endometrial tissue shrink. In short, this creates artificial menopause to prevent menstruation. No menstruation means no thickening and shedding of endometrial tissue.
Surgery is an Option
Earlier we mentioned how laparoscopy is used to check for signs of endometrial-like tissue, but it can also be used in treatment as well. For treatment, another incision is made to actually remove the endometrial-like tissue. In some cases, a hysterectomy (removal of the uterus) or oophorectomy (removal of ovaries) is recommended. However, both approaches are usually last resorts.
If you think this is a condition that affects you, then the best thing to do is contact your doctor. While there is no cure, there are several ways to ease the pain, including massages. Yes, women are superhuman and yes, we go through a lot, but none of us should have to withstand extreme pain. Now that you know what endometriosis is, spread the word. Feel free to share this article with women you know who might be struggling in silence.
By Jessica Thomas, MPH