Endometriosis

Women's Health and Childbirth

Endometriosis is a benign condition in which tissues that are normally found lining the inside of the uterus are also present in other locations in the body – like the ovaries, fallopian tubes (tubes that connect the ovaries to the uterus), and/or the uterine ligaments (these ligaments help to keep the uterus properly placed). The cause of endometriosis is unknown, but the implantation theory has been suggested to better understand it. This theory suggests that during the menstrual cycle there is a small amount of reverse flow of menstrual blood containing uterine tissue into the fallopian tubes (usually the flow is out towards the vagina). Since one end of each tube is open to the pelvic cavity, the uterine tissue can spread from here and implant in other structures. These implants undergo the same cyclic changes seen in the uterus during menstruation but have no outlet for the blood. As they continue to bleed each month, inflammation and consequential scarring result. Endometriosis is most commonly found in women of the reproductive age group because it is estrogen dependent.

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Symptoms

Painful periods. The most frequent presentation is that of painful menstruation. As the individual implants undergo changes during menstruation and bleed, they cause localized inflammation. During this reaction, chemicals released may induce the pain response.

Pain with urination and bowel movements. The symptoms can vary depending on where the endometriosis is located. For example, if it were located on or near the rectum, painful bowel movements can be felt. Patients can also experience pain during urination.

Pain during intercourse. Women often experience pain during or after sexual intercourse.

Heavy bleeding. The flow of the menstrual cycle can become heavier and there may be premenstrual spotting. There may also be bleeding between periods.

Infertility. Endometriosis can be diagnosed when women are seeking infertility treatments.

Other symptoms. Include bloating, nausea, fatigue, diarrhea, and constipation (especially during menstrual cycles).

Risk Factors

  • History of infertility
  • Abnormal or heavy bleeding
  • Dysmenorrhea (irregular periods)
  • Early menarche (age at first period)
  • Prolonged menstrual flow
  • Pelvic pain
  • Family history of endometriosis
  • Low body weight
  • Late menopause
  • Never giving birth
  • High levels of exposure to estrogen for a longer period of time
  • Age
  • Alcohol use
  • Smoking
  • Low physical activity

Diagnosis

The initial step in reaching a diagnosis is to perform a pelvic ultrasound. This is an imaging study done at the bedside that allows internal structures to be seen. The different implants can be observed along with any scar tissue that may have formed. To confirm the diagnosis of endometriosis a laparoscopy is performed. Laparoscopy is a minimally invasive surgical procedure that serves a dual purpose: to diagnose and to treat. Through small incisions on the lower abdomen, tubes equipped with a light source and cameras are passed inside to allow for better visualization. Depending on the location of the lesions and other factors, the endometriosis is staged from one to four. The stage identifies the severity of the disease and its extent.

Treatments

To alleviate pain, non-steroidal anti-inflammatory drugs (also known as NSAIDs) are used. Hormonal therapies such as oral contraceptive pills (OCPs) are also used for pain reduction. OCPs can prevent menstruation if taken continuously and this can help to reduce the size of the lesions or eliminate them. Surgical options are available and vary depending on whether or not the woman wants to try to conceive. Laparoscopy is used to remove the implants along with scar tissue, and this is typically done when laparoscopy is performed for diagnostic purposes. If a woman does not wish to conceive, she can have her uterus and other affected reproductive tract organs removed.

Alternative Treatments and Home Remedies

If you are experiencing pain during sex, heavy or abnormal periods, and/or pelvic pain, make an appointment to see your doctor right away. Consult with your doctor about any alternative supplements or remedies you are using at home to make sure they are safe for you to use.

Herbal products. Turmeric is a powerful anti-inflammatory herb that has been shown in research to inhibit the growth of endometrial cells by reducing the production of the hormone estradiol (promotes endometrial cell growth). Chamomile, peppermint, and lavender are also beneficial herbs that help reduce menstrual cramps and relax the body and mind. Ginger tea is a wonderful remedy for nausea associated with endometriosis. You can use fresh ginger sliced in a cup of boiling water or tea bags.

Acupuncture. This form of treatment can be used to help with pain associated with endometriosis. Electroacupuncuture is a new acupuncture therapy that gives the body a trace current of electricity at acupoints. It has been effectively used to treat pain and symptoms of dysmenorrhea.

Heat. Using warm baths, heating pads, or hot water bottles can give you pain relieve and relax your pelvic muscles.

Diet. Increasing intake of omega-3 fatty acids (found in foods like salmon, tuna, flaxseed) may help reduce inflammation. Decrease your intake of trans fats. A study from 2010 showed a near 50% increased risk of endometriosis in women who ate a high amount of trans fats. Avoid highly processed foods and refined sugars. Eat natural fruits and vegetables instead.

Massage. Gently massage your pelvic muscles before you start your period, but not during. A gentle massage may help to reduce inflammation and relax the pelvic region, especially if you use a few drops of lavender oil in a carrier oil.

References

Kong, S., et. al. (2014, February). The complementary and alternative medicine for endometriosis: A review of utilization and mechanism. Evidence-based Complementary and Alternative Medicine, 10. Retrieved from: https://www.researchgate.net/publication/261374767_The_Complementary_and_Alternative_Medicine_for_Endometriosis_A_Review_of_Utilization_and_Mechanism

National Endometriosis Society. (2012, March). Understanding endometriosis. Retrieved from endometriosis uk: https://www.endometriosis-uk.org/sites/default/files/files/Information/Understanding-endometriosis.pdf

Mayo Clinic Staff. (2019, May 16). Endometriosis. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656#:~:text=Endometriosis%20(en%2Ddoe%2Dme,the%20tissue%20lining%20your%20pelvis

Parasar, P., Ozcan, P., & Terry, K. L. (2017, March). Endometriosis: Epidemiology, diagnosis and clinical management. Current Obstetrics and Gynecology Reports, 6(1), 34-41. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5737931/pdf/nihms847220.pdf

Peterson, C. P., et. al. (2013, February 27). Risk factors associated with endometriosis: importance of study population for characterizing disease in the ENDO Study. American Journal of Obstetrics and Gynecology, 208(6). Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4114145/

Schrager, S., Falleroni, J., & Edgoose, J. Evaluation and treatment of endometriosis. Retrieved from American Academy of Family Physicians: https://www.aafp.org/afp/2013/0115/afp20130115p107.pdf

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