Endometriosis is a condition where tissue similar to the lining inside the uterus, known as the endometrium, grows outside of its usual location. This tissue can attach to organs within the pelvis, such as the ovaries, fallopian tubes, and the outer surface of the uterus, or sometimes in other areas of the body. Despite being outside the uterus, this misplaced tissue responds to hormonal fluctuations. This response can lead to various symptoms, including those related to bleeding.
The Nature of Endometriosis Bleeding
Individuals with endometriosis often experience a range of unusual bleeding patterns. Heavy menstrual bleeding, medically termed menorrhagia, is a common symptom, where periods may last longer than seven days and involve soaking through pads or tampons every one to two hours. This heavy flow can also include blood clots, sometimes larger than a quarter. Beyond menstruation, irregular bleeding or spotting can occur between periods, manifesting as light red, pink, or brown discharge.
Painful periods, or dysmenorrhea, are frequently associated with endometriosis, often described as more severe than typical menstrual cramps. This pain may begin before and extend several days into the menstrual period, sometimes accompanied by lower back or abdominal discomfort. Bleeding during or after sexual intercourse can also be a symptom, contributing to discomfort and pain.
Why Endometriosis Causes Unusual Bleeding
The unusual bleeding observed in endometriosis stems from the behavior of the endometrial-like tissue located outside the uterus. This misplaced tissue is sensitive to the same hormonal changes that regulate the menstrual cycle within the uterus. During the menstrual cycle, particularly under the influence of hormones like estrogen, this tissue thickens and breaks down, just as the uterine lining does.
However, unlike the uterine lining, the blood and tissue shed from these external growths have no natural exit route from the body. This trapped blood and tissue can accumulate within the pelvic cavity or other affected areas. The presence of this unexpelled material triggers inflammation and irritation in the surrounding tissues. Over time, this chronic inflammation can lead to the formation of scar tissue, known as adhesions, which can further distort anatomy and contribute to irregular bleeding patterns and pain.
Blood Tests and Biomarkers for Endometriosis
Currently, no single definitive blood test diagnoses endometriosis. The cancer antigen 125 (CA-125) blood test is sometimes used as a marker, as its levels can be elevated in some individuals with endometriosis. However, CA-125 is not specific to endometriosis and can be high due to other conditions, including menstruation, pregnancy, or other gynecological issues. It can be considered alongside other clinical findings, especially in more advanced stages.
Research is ongoing to identify more accurate blood-based biomarkers for endometriosis. Recent studies have explored panels of protein biomarkers that show promise in detecting the condition, potentially even in its early stages. For instance, a proof-of-concept device capable of detecting a protein called HMGB1 in menstrual blood has been developed, offering potential for a rapid, at-home test. Despite these advancements, endometriosis diagnosis requires a surgical procedure called laparoscopy, where a surgeon visually inspects and may biopsy tissue.
Addressing Bleeding Symptoms in Endometriosis
Managing problematic bleeding in endometriosis often involves hormonal therapies aimed at suppressing the growth of endometrial-like tissue and reducing menstrual flow. Hormonal birth control, including pills, patches, or vaginal rings, can help regulate periods, make them lighter, and reduce associated pain. These can often be taken continuously to avoid bleeding altogether.
Progestin therapies, available in various forms such as pills, injections, or intrauterine devices (IUDs), also work by thinning the uterine lining and suppressing the activity of endometrial-like tissue, which can significantly reduce or stop bleeding. Another approach involves Gonadotropin-releasing hormone (GnRH) agonists and antagonists, which temporarily halt the menstrual cycle and lower estrogen levels, causing the endometrial-like tissue to shrink. Surgical removal of endometriosis lesions during laparoscopy can also alleviate bleeding symptoms and is often performed at the time of diagnosis.