Endometriosis is a chronic and a medical condition which majorly affects women of reproductive age. Usually, the tissue which lines the uterus is known as endometrium but in this condition, it grows outside the uterus in the other areas.
During a normal menstrual cycle, the endometrium thickens, breakdown and bleeds as a natural process. But in this case, it cannot exit the body due to which accumulation of blood and tissues in areas where it doesn’t belong takes place.
Genetic Factors along with hormonal imbalances, immune system dysfunction and environment play a major role in the development and progression of this condition.
It causes a lot of pain. Sometimes, the pain can get severe as well, especially during the time of periods.
It can also cause cysts to develop. These cysts are known as endometriomas.
Causes of Endometriosis:
The causes of endometriosis are not fully discovered but it can be the sum total of the following conditions:
Retrograde Menstruation: It suggests that some of the menstrual blood expelled every month which contains endometrial cells flows back through the fallopian tubes into the pelvic areas. These cells then grow in areas outside the uterus.
Hormonal Imbalances: Hormones mainly estrogen play an important role in regulating the menstrual cycle in women. So, high or abnormal levels of these hormones can also develop endometriosis.
Immune System Dysfunction: Immune System helps in identifying and eliminating the abnormal cells. But any dysfunction in the immune system can lead to inability to identify these cells giving them permission to grow outside the uterus.
Genetic Factors: Endometriosis is a genetic disorder which gets transmitted from parents to their children.
Environmental Factors: Exposure to various environmental factors like chemicals and toxins can risk the development of endometriosis.
Symptoms of Endometriosis
The symptoms usually vary from person to person. These include:
Pelvic Pain: It is the most common symptom. It can range from mild to severe. It is felt in the lower abdomen, lower back and in the pelvis region.
Painful Menstruation (Dysmenorrhea): Many women experience pain during their periods which is more intense than the period pain. This can be due to endometriosis.
Painful Intercourse (Dyspareunia): It can cause pain during sexual intercourse. This pain can be deep or cramp like.
Infertility: It can cause infertility as well. The presence of endometrium outside the uterus can affect the functioning of ovaries, fallopian tubes and makes it difficult for sperm to reach the egg for implantation.
Urinary Symptoms: In some cases, it can also affect the urinary system causing symptoms like frequent urination, pain during urination or blood in the urine.
Diagnosis of Endometriosis
The diagnosis typically involves the combination of medical history assessment, physical examination and a surgical procedure known as laparoscopy.
Medical History Assessment: The medical history,the pattern of the symptoms are checked by the healthcare provider.
Physical Examination: The examination of the pelvis takes place to check for the signs and abnormalities of the endometriosis.
Diagnostic Laparoscopy: It is a surgical procedure performed under general anaesthesia. A small incision is made and a thin, lighted instrument laparoscopy is inserted to check the pelvic organs. The surgeon examines the pelvic area to check for endometrial implants or cysts. Biopsies are taken to labs for the confirmation of endometriosis.
The treatment includes the following:
Pain Medications: Pain relievers must be taken to reduce pain while dealing with endometriosis. Strong medication may be required in case of severe pain.
Hormonal Therapy: They are used to control the growth of the endometrial tissue. It includes the following:
Birth Control Pills: Oral contraceptives can maintain the menstrual cycle and reduce pain to much extent.
Gonadotropin- Releasing Hormone (GnRH) Agonists and Antagonists: These suppress estrogen production and reduce pain by shrinking endometrial implants.
Surgery: It occurs when endometriosis cannot be treated with medications. It involves:
Laparoscope: It is a surgical method in which a laparoscope is inserted through a small incision to check the endometrial implants.
Laparotomy: A larger abdominal incision may be required in severe cases.
Hysterectomy: It occurs in very severe cases in which the ovaries are removed through surgery
Complementary Therapies: These therapies include the physical therapy and the dietary changes to lower the pain caused by endometriosis. It can not fully treat it.
Lifestyle Changes and Self-Care
In addition to the medications, lifestyle changes are equally very important to treat any disease. .Self care is equally very important to prevent any disease. It usually includes the following:
Exercise Regularly: A regularity in some kind of physical activity for at least 30 minutes is very important for the body to give relief in pain and to treat it.
Diet Modifications: Diet plays a very important role to maintain a healthy lifestyle. an anti-inflammatory diet rich in fruits, vegetables must be considered.
Manage Stress: Stress must also be managed by practising deep breathing exercises, meditation, mindfulness and yoga.
Sleep Hygiene: Sleep must be prioritised to promote overall well being of a person.
Fertility and Pregnancy Considerations
Endometriosis can cause fertility issues by affecting the function of ovaries, fallopian tubes and uterus. Due to this, it gets difficult for a woman to conceive and get pregnant. The management of endometriosis and fertility issues can be done through hormonal therapies and surgeries as well. The hormonal changes during pregnancy can raise the progesterone levels reducing the implant and pain to a much greater extent. Women with endometriosis have the higher risk of miscarriage and preterm birth compared to ones without this condition.
Complications and associated conditions
Pelvic Pain: It is a primary symptom of endometriosis. It can range from mild to severe. It can occur during menstruation, sexual intercourse or during urination.
Infertility: It is a significant cause of infertility. It affects the functioning of ovaries, fallopian tubes.
Ovarian Cysts: Endometriomas are the cysts which develop in the ovaries due to the presence of endometrial tissue. These cysts can be cancerous as well and cause pain.
Adhesions: These are the abnormal bands of scar tissue that cause organs and tissues to stick together which are developed due to endometriosis.
Chronic Fatigue and disrupted sleep: Chronic pain and hormonal imbalances can contribute to fatigue and disrupted sleep cycle.
Depression and Anxiety: Living with chronic pain and treatment of endometriosis can cause a great impact to one’s mental health which can ultimately lead to depression and anxiety.
Research and Future Directions
Since there is no permanent cure of Endometriosis, ongoing research aims to improve the diagnosis, understand the reasons and develop a novel treatment for it. Some of the ongoing research areas are as follows:
Early Detection and improved diagnosis: Early diagnosis of endometriosis is very challenging. Researchers are investigating biomarkers, genetic factors, blood tests, imaging techniques for the early detection of this disease.
Understanding disease mechanisms: The precise reason for endometriosis is not understood properly. Researchers are still investigating the disease mechanism so that it could be prevented on time.
Innovative Treatment options: Treatments like pain management, hormonal therapies and surgical methods are not beneficial for all the patients. So, the researchers are focusing more on drug targeted therapies, immunotherapies as a useful treatment.
Fertility preservation and reproductive outcomes: Endometriosis is one of the main reasons for infertility in women. Researchers are using assisted reproductive technologies (ART) to investigate the impact of endometriosis on fertility.
Quality of life and patient- centred care: Endometriosis can significantly affect the patient’s mental, physical and emotional health which can generally lead to anxiety and depression. So one must consult a health seeker for the patient’s care
Endometriosis is a condition in which the endometrium tissue start to grow outside the uterus creating problems in the body.
This condition affects millions of women worldwide concerning their fertility and ability to conceive.
The causes include retrograde menstruation, hormonal imbalance, immune system dysfunction, genetic and environmental factors.
The symptoms include pelvic pain, infertility, urinary problems, painful menstruation and intercourse.
The treatment could be through medications, hormonal therapy, complementary therapies and surgeries if incase of severe condition.
Researchers are still researching the mechanism of endometriosis so as to detect it at the early stages.
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