Endometriosis (en-doe-me-tree-O-sis) affects roughly 10% (190 million) of reproductive-age women and girls globally. It is a disorder in which tissue resembling what normally grows inside the uterus (the endometrium) grows outside the uterus. This in itself would not be a problem except that endometrium-like cells thicken, break down and then detach as they would be in the uterus. However, it becomes trapped because the tissue has no way to escape. This causes severe pain and can even cause scar tissue to form that causes pelvic tissues and organs to stick to each other. The affected areas are usually the fallopian tubes, ovaries, and intestines.
It is a disease that can range from mild to extremely serious – affecting daily functioning and even impairing fertility.
Causes
Endometriosis is a complex disease that may affect a woman from the onset of their first period right through to menopause. It is not linked to any specific ethnic origin and transcends social status. The cause is thought to have multiple factors, and several hypotheses have been put forward to explain it as according to the WHO1:
- Retrograde menstruation is when menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity when 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 give rise to the disease, spreading through the body via blood and lymphatic vessels.
There are several other possible causes, but none have been proven definitively.
Common signs and symptoms of endometriosis:
- Painful periods (dysmenorrhea)
- Pain with intercourse
- Pain with bowel movements or urination
- Excessive bleeding
- Infertility
- Other signs and symptoms—You may experience fatigue, diarrhea, constipation, bloating, or nausea, especially during menstrual periods.
Diagnosis
Diagnosis of endometriosis is sometimes hindered by confusion with other illnesses such as IBS (irritable bowel syndrome) and ovarian cysts. OF course, the problem is that an individual may have both conditions simultaneously. At the moment, the only reliable way to diagnose endometriosis is through performing a laparoscopy. It is a simple procedure performed under a general anaesthetic. A cut is made in the belly button, and a tube with a light and camera is inserted into the abdominal cavity. It allows the doctor to see if there is any endometrial tissue within the pelvis.
There is hope that surgery will not be the only way to diagnose the condition soon. There is increasing research that ultrasound can help make a reliable diagnosis. However, there is a high amount of skill involved in this type of ultrasound, so it is not available everywhere.
Treatment
There is no cure for endometriosis, but there is effective treatment available. The approach you and your doctor choose will depend on how severe your signs and symptoms are and whether you hope to become pregnant.
Pain medication
Over-the-counter pain medication may help alleviate pain.
Hormone therapy
Hormone therapy depends on whether you want to conceive or not. Contraceptives are sometimes used to regulate hormones.
Conservative surgery
Conservative surgery involves only removing lesions and “cleaning” the pelvic cavity. This is, however, not very effective long-term as lesions can return within a few years.
Hysterectomy with removal of the ovaries
This is a radical step and involves the removal of both the uterus and ovaries. This is also only an option if you do not want children.
