Endometriosis is a condition where tissue that behaves like the lining of the uterus, known as the endometrium, establishes itself in locations outside the uterine cavity. This misplaced tissue is most commonly found on the ovaries, fallopian tubes, and the tissues lining the pelvis. Despite its prevalence, the condition often goes unrecognized for years, partly because its symptoms can be mistaken for normal menstrual discomfort.
This tissue, even though it is outside the uterus, responds to the hormonal fluctuations of the menstrual cycle. Each month, it thickens, breaks down, and bleeds. Because this blood has no way to exit the body, it can lead to inflammation, the formation of scar tissue, and cysts.
Symptoms and Common Indicators
The primary indicator of endometriosis is pelvic pain, which often aligns with the menstrual cycle but can also be chronic. This pain is described as being significantly more severe than typical menstrual cramping and may worsen over time. The discomfort can begin days before a period starts and continue for several days into it, sometimes accompanied by lower back and abdominal pain.
Another common symptom is pain experienced during or after sexual intercourse, a condition known as dyspareunia. Individuals may also have discomfort with bowel movements or urination, particularly during their menstrual period. These symptoms occur because the misplaced endometrial-like tissue can grow on or near the bladder and bowels.
Heavy menstrual bleeding is also a frequent sign, as are spotting or bleeding between periods. Beyond pain and bleeding, endometriosis can cause a range of other issues that impact daily life. These include:
- Persistent fatigue
- Diarrhea
- Constipation
- Bloating
In some cases, the condition is first identified when a person seeks treatment for infertility.
Theories on Causation
The precise origin of endometriosis remains a subject of scientific investigation, though several theories provide potential explanations. The condition likely results from a combination of factors, including genetic predispositions, hormonal influences, and immune system interactions.
One of the most widely cited theories is retrograde menstruation. This process involves menstrual blood, which contains endometrial cells, flowing backward through the fallopian tubes and into the pelvic cavity instead of exiting the body. These displaced endometrial cells may then adhere to pelvic organs and surfaces, where they can grow and continue to thicken and bleed over the course of the menstrual cycle.
Another theory involves cellular metaplasia, where cells outside the uterus change their form and begin to behave like endometrial cells. This transformation may be prompted by hormonal or immune factors. The immune system is also thought to have a role; a dysfunction might prevent the body from recognizing and destroying endometrial-like tissue that is growing in the wrong places.
The Diagnostic Process
Diagnosing endometriosis begins with a thorough discussion of symptoms and a physical pelvic exam. During the exam, a healthcare provider can feel for abnormalities, such as cysts on the reproductive organs or scars behind the uterus. However, a physical exam alone is often insufficient to confirm smaller endometrial implants.
Imaging tests are employed to get a clearer picture. A transvaginal ultrasound uses a small transducer placed in the vagina to create images of the reproductive organs and is effective for identifying larger growths and cysts, known as endometriomas. An MRI may also be used for a more detailed view of the pelvic organs, which helps in planning for surgery.
The definitive method for diagnosing endometriosis is a minimally invasive surgical procedure called a laparoscopy. Performed under general anesthesia, this surgery involves a small incision in the abdomen through which a thin tube with a camera (a laparoscope) is inserted. This allows the surgeon to directly visualize the pelvic organs and identify endometrial implants. During the procedure, a small tissue sample can be taken for a biopsy to confirm the diagnosis.
Management and Treatment Approaches
Treatment for endometriosis is tailored to an individual’s symptoms, the severity of the condition, and their reproductive goals. For mild discomfort, over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are recommended to lessen painful menstrual cramps.
Hormonal therapies are a common next step, as they regulate or suppress the menstrual cycle to prevent the monthly growth of endometrial implants. Hormonal contraceptives, including birth control pills, patches, and rings, can make periods lighter and less painful. Other options, such as GnRH agonists and antagonists, create a temporary artificial menopause, stopping the estrogen that fuels tissue growth.
When hormonal treatments are not effective or if there is extensive tissue growth, surgery is an option. Laparoscopic surgery is used to remove or destroy the endometrial implants, which can significantly reduce pain and, in some cases, improve fertility.
For severe cases where other treatments have failed and childbearing is complete, a hysterectomy, sometimes with removal of the ovaries, may be considered. It is not a guaranteed cure as small implants may remain.
Impact on Fertility
Endometriosis is closely linked with difficulties in conceiving, with some estimates suggesting it is a factor in up to 40% of infertility cases. The condition can interfere with fertility in several ways.
The chronic inflammation it causes in the pelvis can create a hostile environment for sperm and eggs. It can also lead to the formation of scar tissue, known as adhesions, which can distort pelvic anatomy and block the fallopian tubes. The presence of endometriosis on the ovaries can lead to endometriomas, which are blood-filled cysts that may affect ovarian function and egg quality.
The condition can also cause irregular menstrual cycles, making ovulation difficult to predict. A diagnosis of endometriosis does not automatically mean a person will be unable to conceive, as many individuals with the condition get pregnant without medical assistance.
Surgical removal of endometrial tissue via laparoscopy has been shown to improve fertility outcomes. If natural conception remains difficult, assisted reproductive technologies like in vitro fertilization (IVF) offer a path to pregnancy.