Endometriosis is a condition where tissue resembling the uterine lining, known as the endometrium, grows outside the uterus. This misplaced tissue can develop on various organs within the pelvic cavity, including the ovaries, fallopian tubes, and the outer surface of the uterus, and in some less common instances, even in distant areas of the body. Though its exact cause is unknown, it is a chronic disease that can lead to a range of symptoms, including spotting between menstrual periods.
How Endometriosis Causes Spotting
Endometriosis can lead to spotting because the endometrial-like tissue growing outside the uterus responds to the body’s hormonal fluctuations, like the normal uterine lining. During the menstrual cycle, this displaced tissue thickens, breaks down, and bleeds. Unlike the uterine lining, which exits the body, blood and tissue from these external growths have no escape route. This leads to internal bleeding, inflammation, and sometimes scar tissue formation.
This trapped blood and tissue causes irritation and inflammation, resulting in spotting. Spotting is usually light and can vary in color from light pink to dark brown or black, indicating fresh or older blood. It can occur at various times in the menstrual cycle, including before, during, or after a regular period. Premenstrual spotting lasting more than two days may indicate endometriosis.
Other Indicators of Endometriosis
Beyond spotting, endometriosis presents with a variety of symptoms with varying severity. One common symptom is painful menstrual cramps (dysmenorrhea), which can be more severe than typical period pain and disrupt daily life. This pain can begin before a period and persist for several days, sometimes extending to the lower back and abdomen.
Chronic pelvic pain, not limited to menstruation, is also common. Pain during or after sexual intercourse (dyspareunia) is another frequent symptom. Endometrial-like tissue near the bowel or bladder can cause painful bowel movements (dyschezia) or painful urination (dysuria), especially around menstruation.
Heavy menstrual bleeding (menorrhagia), where bleeding is excessive or lasts longer than seven days, is common. Infertility or difficulty conceiving affects a significant portion of those with endometriosis. Other symptoms include chronic fatigue, bloating, nausea, and changes in bowel habits like diarrhea or constipation, which often worsen during the menstrual cycle.
Confirming an Endometriosis Diagnosis
Diagnosing endometriosis can be a multi-step process, as symptoms can overlap with other conditions. Initial steps involve a detailed medical history and a physical examination. During a pelvic exam, a healthcare provider may check for tenderness, nodules, or thickened areas in the pelvis.
Imaging techniques like ultrasound and Magnetic Resonance Imaging (MRI) can identify larger areas of endometrial-like tissue, such as endometriomas (cysts on the ovaries). However, these methods may not detect smaller lesions or adhesions. The only definitive way to confirm an endometriosis diagnosis is through a surgical procedure called laparoscopy.
During laparoscopy, a surgeon makes a small incision and inserts a thin tube with a camera (laparoscope) to visually inspect the pelvic organs for endometrial-like tissue. If suspicious tissue is found, a biopsy, a small tissue sample, is performed to confirm the diagnosis. Visible endometriosis tissue is often removed during this procedure.
Treatment Approaches for Endometriosis
Managing endometriosis symptoms involves various treatment approaches, tailored to individual symptoms, severity, and reproductive goals. Pain management often begins with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to alleviate menstrual cramps. For more severe pain, prescription medications may be used.
Hormonal therapies are common to suppress endometrial-like tissue growth and manage symptoms. These treatments control or prevent the menstrual cycle, reducing hormonal stimulation. Options include hormonal birth control pills, patches, vaginal rings, shots, implants, or intrauterine devices (IUDs), leading to lighter, less painful periods.
Gonadotropin-releasing hormone (GnRH) agonists and antagonists temporarily induce a “menopausal” state by blocking hormones, reducing estrogen levels and causing lesions to regress. Progestins, administered orally, by injection, or via IUD, also reduce symptoms by minimizing or stopping menstrual flow.
Surgical interventions remove or destroy endometrial implants and improve symptoms. Laparoscopic surgery is a minimally invasive procedure used to treat endometriosis. The two main surgical techniques are excision (cutting out tissue) and ablation (destroying lesions with heat or laser). Excision is preferred for deeper growths, allowing complete removal and tissue biopsy, while ablation treats superficial lesions. For infertility, surgical removal may improve conception chances, and fertility treatments like in vitro fertilization (IVF) may be considered.