Endometriosis is a gynecological condition that is characterized by the presence of endometrial tissue in locations other than the uterus, where it is normally found. The usual locations that it can spread to include the ovaries, fallopian tubes, vagina, bowel, ligaments supporting the uterus, and other surrounding structures in the pelvis. They can also be found in any other area of the body, including the brain, lungs, liver, and old surgical scars.
It can be of 4 grades; mild, minimal, moderate and severe. Mild cases are usually asymptomatic. On the other hand, severe cases might present with urinary and rectal involvement. They are not cancerous in nature, but they can lead to discomfort and affect the quality of your life. They do, however, increase the risk of certain ovarian tumors.
The cause of endometriosis is not known. The endometrial implants form vesicles and cyst, and initiates inflammation at the site of their implantation, and leads to scarring of the tissue. These changes caused by this disease lead to the symptoms of this disease.
In many cases, it can be asymptomatic. But the following are the most common signs of endometriosis.
1. Dysmenorrhoea:
Dysmenorrhoea, or pain during menstruation is the most common symptom of endometriosis. The pain characteristically starts before the onset of menstruation, gradually increases and then begins to reduce and then subside once the flow starts. Backache may also be present.
With the progression of the disease, the intensity and the duration of pain might increase and may last for a few days after the onset of periods.
However, dysmenorrhoea is a common occurrence of healthy menstruation.”The pain associated with endometriosis is mostly related to the site of the lesion. So, say, if the lesion is present in one of the ovaries, the pain would be more around that ovary, says Dr.Karen Weldon, a gynecologist at Doctorspring, a telemedicine company.
2. Abdominal Pain:
Apart from dysmenorrhoea, you may also have a complaint of abdominal pain, that can start anytime. You may notice an increase in the intensity of pain around menstruation, however. The pain is usually dull in nature.
In some long-standing cases of endometriosis, endometrial implants in the ovaries may result in ovarian cysts known as the chocolate cysts of the ovaries. These cysts may occasionally rupture, causing sudden onset intense pain. A ruptured chocolate cyst would require emergency surgery.
3. Pain and Cramping During Intercourse:
If you have pain and cramping during intercourse, it could be a sign of endometriosis. This is caused mostly when the structures surround the uterus, like the ligaments supporting the uterus are involved.
4. Infertility:
Quite often endometriosis is totally asymptomatic and is diagnosed by chance when the woman undergoes investigations for infertility. So, for many infertility is the first sign of endometriosis. In fact, endometriosis is involved in
Though, why endometriosis causes infertility is not known exactly. But it could be due to decreased motility and blockage in the Fallopian tubes due to the inflammation and scarring caused by endometrial implants. It could also affect ovulation when the ovaries are involved. Also, painful intercourse may reduce the frequency of intercourse. All these could be the possible cause of infertility associated with endometriosis.
Also, not everyone who has endometriosis will have infertility. Infertility is mostly associated with a higher grade of the disease.
5. Irregular Menstruation
Irregular menstruation is also a common symptom of endometriosis. You may also experience heavy bleeding along with irregular bleeding as well. Polymenorrhea may also be present, i.e you may have shorter menstrual cycles. Instead of a 28-30 days cycle, you may have a cycle of fewer than 21 days. Endometriosis is also a common cause of abnormal uterine bleeding.
6. Chronic Pelvic Pain:
If you have persistent pelvic pain, you might have endometriosis. The lesions of endometriosis produce a certain chemical that causes pain and may result in chronic pelvic pain.
7. Others
Further, depending on the site, you may also have pain associated with the site involved. The involvement of the urinary system may lead to painful urination, especially during menstruation. You may also experience painful defecation if the rectum is involved. The disease may also result in complete blockage of the urinary tract. The lesions may also cause features of constipation when the rectum is involved. The involvement of the lungs may lead to hemoptysis.
The diagnosis of endometriosis requires laparoscopic exploration of the pelvis. This is the gold-standard investigation for its diagnosis. Ultrasonography may also reveal ovarian cysts. Blood investigations might also be done to detect certain antibodies and markers.
Treatment:
Endometriosis has no permanent cure. However, some treatment options are available to manage the condition. If left untreated, endometriosis may lead to certain complications like ovarian cysts, infertility, ureter and bowel obstruction, abnormal uterine bleeding, etc.
Treatment options range from hormonal therapy, medication, and minimally invasive surgeries– depending upon the severity of the disease. Infertility will need additional management.
Endometriosis is an estrogen-dependent condition. Therefore medications and hormones that have an anti-estrogenic effect are prescribed. Drugs like OCPs, oral progesterone, danazol, and other hormones like GnRH and anti-progesterones may be prescribed.
Surgeries may be done in those who are seeking to treat their infertility. The surgery will depend on the type of lesion. It can involve excision of the ovarian cyst, destruction of the endometrial implants, removal of adhesions caused as a result of scarring, etc.
Depending on the severity of your endometriosis, your doctor will prescribe you appropriate treatment.
