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What Are The Causes, Symptoms, Diagnosis, & Treatment Of Endometriosis?

Q: How do you mentally deal with endometriosis?

Coping with endometriosis requires, Eating a balanced diet Regular workouts Medications and managing stress levels

With inputs from

Updated on: November 2023

With inputs from

Updated on: November 2023

Reviewed by Dr Raja Indana

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Table of contents

What Is Endometriosis?

Endometriosis is a painful condition that involves ovaries, fallopian tubes, and tissue lining the pelvic cavity. It’s a common gynecological condition affecting 2 to 10 percent of women worldwide of childbearing age. The name endometriosis comes from the word ‘endometrium,’ which is the tissue that lines the uterus or the womb.

During the menstrual cycle, this endometrial tissue builds and sheds off if the woman doesn’t get pregnant and is expelled as menstrual blood through the vaginal canal. But during pregnancy, this endometrium tissue serves as a source of nutrition for the embryo as it develops and turns into a healthy fetus.

Women with endometriosis develop tissue that ‘looks and acts like endometrial tissue’ outside the womb, in places they’re normally not supposed to grow. i.e., the ovaries, uterine tube, urinary bladder, and peritoneal cavity.

Each month during the menstrual period, with changes in hormones, these misplaced tissues build up and shed off just like the endometrial tissues in the uterus, but unlike them, they have no place to exit the body. As a result, they’re shed within the pelvic cavity, causing pain, irritation, inflammation, lesion, and tissue damage.

Over time, the end product of endometriosis is that individuals become infertile and have severe menstrual cramps.

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Chapter 1: Who Gets Endometriosis?

Endometriosis is a widespread condition occurring in about 10% of women worldwide. Women in their 30s to 40s are more likely than others to develop endometriosis. As of date, nobody knows what exactly causes endometriosis, but there are many theories around it which we’ll be covering in a little while.

Where Does It Occur?

Endometriosis can occur in the following locations depending on the severity and stages of the disease:

– Ovaries

– Uterine tube

– Urinary bladder and

– peritoneal cavity

Occasionally, they’re also found in other places, such as:

– Intestines

– Rectum

– Brain

– Vagina

– Cervix

– Vulva and

– Abdominal surgery scars

Chapter 2: What Are The Causes Of Endometriosis?

As of date, nobody knows what causes endometriosis. But, there are many theories around it. Some of them are as below:

(1) Retrograde Menstruation Theory:

This theory says that when the uterus contracts, some of the endometrial tissues backtracks into the uterine tube and the pelvic cavity. Over time, these endometrial tissues accumulate and builds-up inside the surrounding pelvic cavity. However, this theory has a drawback. The problem with this theory is that almost 70% to 90% of women do this anyway. But not all of them have endometriosis.

(2) Auto-immune Disease:

Some consider endometriosis to be an autoimmune disease. Autoimmune diseases cause inflammation. With inflammatory response comes the WBCs — their role is to eat, recycle and destroy all those endometrial cells to set everything in place. But this theory says that WBCs stop doing their job and, in the process, actually promote the growth of endometrial cells.

(3) Genetics:

The genetic theory says that the disease is hereditary. If the mother has it, her daughter is more likely to have it. However, the drawback of this theory is that several cases of endometriosis have occurred in women with no familial history.

(4) Stem Cell Theory:

Experts consider stem cell theory to be the closest explanation for endometriosis. However, we still need more data before coming to any scientific conclusion.

Usually, the cells in our body, for example, the fat or the liver cells have unique functions; the fat cells store fats, and liver cells produce energy. In contrast, stem cells do not yet have any specific function. But they have a unique ability to transform into any cell type in the body — be it liver, heart, or even endometrial cells.

The endometrial stem cell theory says that there’s a bunch of stem cells deep in the endometrial tissues that slough off when they’re not supposed to. When the uterus contracts, these stem cells are pushed inside the pelvic cavity and the ovaries, later transforming into endometrial cells, causing endometriosis.

The stem cell theory also provides the closest logical explanation for cerebral endometriosis. I.e., when stem cells get into the bloodstream, and they usually do, they can travel to offsite locations such as the brain, causing endometriosis there.

Chapter 3: What Are The Stages Of Endometriosis?

The American Society for Reproductive Medicine (ASRM) has quantified endometriosis into a point system and has classified the disease based on the number of lesions and depth of infiltration.

There are four stages of endometriosis. In stage one, the individual has a minimal amount of endometriosis, and in stage four, they have a much higher amount.

Stage 1: Minimal

– 1 – 5 points

– Minimal manifestation of the disease

– Few superficial implants

Stage 2: Mild

– 6 – 15 points

– Mild manifestation of the disease

– More and deeper implants

Stage 3: Moderate

– 16 – 40 points

– Moderate manifestation of the disease

– Many deep implants

– Small cysts on one or both ovaries

– Presence of filmy adhesions

Stage 4: Severe

– >40 points

– A severe manifestation of the disease

– Many deep implants

– Large cysts on one or both ovaries

– Many dense adhesions

Chapter 4: What Are The Symptoms Of Endometriosis?

The following are the most common symptoms of endometriosis:

– Abdominal pain

– Pain in the lower back

– Painful periods

– High menstrual flow

– Painful bowel movements during menstruation

– Infertility

– Painful sex

– Painful urination

– Gastrointestinal problems such as diarrhea, constipation, nausea, and vomiting

It’s to be noted that the pain that women experience is not related to the severity or stages of the disease. We can’t really say how much an individual is hurting based on their stage alone. It’s not like you can say that stage 4 hurts more than stage 1. In fact, people with stage 1 condition can hurt more than stage 4.

Interestingly endometriosis stages are not static — maybe you are stage 1 and never progress to stage 2. Or, maybe you regress to stage 2 from stage 3 and so on.

symptoms of endometriosis

Chapter 5: What Are The Types Of Endometriosis?

There are three main types of endometriosis. They are

Peritoneal Superficial Endometriosis:

It’s characterized by lesions and spots of irritation, inflammation, and pain within the superficial tissues of the pelvic cavity.

Ovarian Endometrioma:

It’s characterized by endometrial cysts in and on the ovaries themselves. This type doesn’t respond well to medications and can damage healthy tissues.

Deep Infiltrating Endometriosis:

It’s characterized by lesions that are penetrating and pushing deeper into the body. It can involve other organs near your uterus, such as the bowels or bladder. But this is extremely rare. Only 1% to 5% of women with endometriosis have this condition.

Chapter 6: What Are The Risk Factors For Endometriosis?

Following are some risk factors for endometriosis:

Age:

The likelihood of developing endometriosis increases with age. Women aged 30 to 40 are at an increased risk for the disease than other age groups.

Family History & Genetics:

Daughters of mothers with endometriosis are six times more likely than others to develop the condition themselves.

Talk with your doctor if you have a family member with endometriosis.

Environmental Toxins:

Endometriosis also occurs when there’s an imbalance between estrogen and progesterone levels in the body. When women are exposed to environmental contaminants such as dioxins and polychlorinated biphenyls (PCB), it sometimes can cause an imbalance in their hormone levels, triggering endometriosis in women.

Pregnancy History:

Women giving birth for the first time after 30 are more likely than others to develop endometriosis.

Pregnancy may temporarily decrease the symptoms of the disease. But this is not always true, as endometriosis can still occur in women who’ve had children.

Menstrual History:

Irregular periods can put you at a higher risk for endometriosis. Consult a doctor if you have heavy & longer periods or if you’ve had menstruation that started at a younger age than is usual.

Race and Ethnicity:

According to a 2019 study by the U.S Department of Health and Human Services, Asian women are 50 percent more likely than white, Hispanic, and black women to receive a diagnosis for endometriosis.

risk factors of endometriosis

Chapter 7: What Are Some Complications Of Endometriosis?

The following are some complications associated with endometriosis.

Infertility:

The main problem of endometriosis is infertility. It occurs in one-third to one-half of women.

Infertility occurs when an obstruction in the fallopian tube due to endometriosis prevents eggs and sperm from meeting each other.

Also, in fewer cases, the condition itself may destroy the eggs or sperms.

Doctors usually advise women with endometriosis not to delay pregnancy as the disease worsens with age.

Cancer:

Ovarian cancer, although extremely rare, can occur at a higher rate than expected in women with endometriosis. But still, it’s relatively low.

Women with endometriosis also stand a higher risk of developing endometriosis-associated adenocarcinoma, another rare form of cancer, later in life than others, but this is very rare.

Chapter 8: Diagnosis of Endometriosis

Diagnosis of endometriosis involves a thorough evaluation of the patient’s medical history. Additionally, your gynecologist will also prescribe the following tests, procedures, or scans to diagnose endometriosis:

Laparoscopy:

It’s a minor surgical procedure in which a laparoscope, a thin tube with a camera at its end, is inserted into the pelvic cavity to observe and extract any suspicious tissue. Your doctor will then examine the tissues under the microscope and tell if you have endometriosis. A laparoscopy procedure also helps diagnose the size, extent, and location of misplaced endometrial tissues.

Ultrasound:

It’s a diagnostic imaging technique that uses high-frequency waves to examine your pelvic region, including your ovaries, fallopian tubes, uterine tube, urinary bladder, and peritoneal cavity.

CT Scan:

It’s a diagnostic imaging technique that combines X ray and computer technology to detect abnormalities in the pelvic cavity.

MRI Scan:

It’s another diagnostic imaging procedure that uses a strong magnetic field and computer-generated radio waves to produce 2D images of the organs in your pelvic region.

Blood Test:

Your gynecologist may also prescribe a CA-125 blood test to diagnose endometriosis. However, a negative blood test does not necessarily mean that you do not have endometriosis and will require further investigation.

Biopsy:

It involves examining tissue biopsies under the microscope. Histopathologists look for abnormalities in the tissue structure to confirm the disease.

Pain Quantification Tests:

Psychometric response scales such as the Visual Analogue Scale (VAS) and the Numerical Rating Scale (NRS) are tools used in questionnaires to quantify or measure pain objectively.

Pain is a subjective word meaning it cannot be measured or numbered. However, there are other smart ways to do so — based on your responses in the questionnaire, the doctor can cleverly gauge the intensity of your pain and treat them accordingly.

Chapter 9: Treatment Of Endometriosis:

Endometriosis has no cure, but you can effectively manage it through medication, diet, and lifestyle changes. Depending on your condition and symptoms, the doctor will first use conventional means to help reduce your symptoms. However, if that doesn’t help, they may recommend surgery as a last resort. Remember, people respond to treatments in different ways. What works for you may not necessarily work for the other person and vice versa.

Treatment options include:

Pain Medications:

It includes over-the-counter medication such as ibuprofen to ease your pain. However, these aren’t effective in all cases.

Hormone Therapy:

Supplemental hormones can help reduce or eliminate the pain of endometriosis. They also help slow the growth of endometrial tissue growth and prevent the formation of new implants.

Hormone therapy includes:

(1) Hormonal contraceptives:

They help control the hormones in your body responsible for the build-up of endometrial tissues in the body. As a result, the individual may have lighter and shorter menstrual flow.

(2) Gonadotropin-releasing hormone agonists and antagonists:

These drugs prevent menstruation by creating artificial menopause, causing endometrial tissues to shrink. Your doctor may also prescribe additional medications such as a low dose of estrogen or progestin to help mitigate the menopausal side effects. Ability to get pregnant and have menstrual periods return when you stop taking these medications.

(3) Progestin Therapy:

They help reduce endometriosis pain by halting menstruation and the growth of endometrial implants.

(4) Aromatase inhibitors:

These drugs act by lowering estrogen levels in your body to bring about a balance between estrogen and progesterone levels to treat endometriosis.

(5) Danazol:

Danazol is another medication to stop menstruation and help reduce symptoms of endometriosis. However, these drugs come with certain side effects, including acne and hirsutism, i.e., growth of excess hair on your face and body.

Conservative Surgery

Conservative surgery is recommended for people who want to get pregnant or haven’t responded well to hormone therapy.

The whole idea of this treatment procedure is to remove the endometrial implants without damaging the ovaries.

Your doctor will perform a laparoscopy to remove, burn, or vapourize the endometrial tissues surgically.

Nowadays, lasers are more commonly used to destroy endometrial implants.

Hysterectomy

When all other options have failed, your doctor will perform a

hysterectomy as a last resort to treat endometriosis. It involves the removal of the uterus, cervix, and ovaries. It also involves the removal of other endometrial implants.

Remember, once a hysterectomy is performed, you’ll not be able to get pregnant. Therefore, it’s advisable to take an informed decision before agreeing to the surgery.

Chapter 10: How Can I Prevent Endometriosis?

You can’t prevent endometriosis, but you can lower the chances of developing it by balancing the estrogen levels in your body through medication, diet, and lifestyle changes.

(1) Medication:

Over-the-counter medication such as ibuprofen can help reduce the pain, but they’re not always effective. Your doctor may then additionally prescribe supplemental hormones to manage your symptoms.

Surgeries are a last resort intervention when everything else has failed.

(2) Diet:

There’s a clear link between diet and endometriosis. What you have on your plate plays a crucial role in how your body responds to endometriosis.

Individuals with endometriosis often have unhealthy eating patterns. i.e., they’re more likely to eat food rich in red meat and low in fruits and vegetables. Some experts believe that fats present in red meat can stimulate your body to produce chemicals called prostaglandins, triggering more estrogen production. This extra estrogen is what causes endometriosis.

Research has also shown that when women consume trans fat, they have a 48 percent higher risk of developing endometriosis. Therefore, the type of fat you eat matters.

Include foods rich in healthy fats such as omega 3 fatty acids. They are present in walnuts, soybeans, flax seeds, chia seeds, and fatty fish such as salmon and mackerel.

Add more fruits and vegetables to your diet and avoid excessive consumption of alcohol and drinks high in caffeine. They are known to stimulate the excessive production of estrogen.

(3) Exercise:

Workouts are a great way to manage endometriosis. It improves blood circulation and transports essential nutrients and oxygen to your system.

Women who practice high-intensity sports such as running or biking produce less estrogen, have lighter periods, and are less likely to get endometriosis.

Exercise also helps reduce stress. It stimulates the production of chemicals called endorphins in the brain that helps cope with stress and relieve pain.

Low-intensity exercises such as yoga and stretching can ease the tension in your pelvic muscles and reduce your pain.

(4) Stress Management:

Stress is a major risk factor for endometriosis that can worsen your symptoms.

Consider yoga, meditation, or any other extra-curricular activity that you enjoy to cope with stress.

It also includes seeing a therapist who can offer tips for dealing with stress.

For more information on ways to prevent endometriosis, consult one of our gynecologists available online at MFine.

prevention of endometriosis

Chapter 11: Society & Culture:

What’s the impact of society and culture on Indian women with endometriosis?

According to a 2010 study by Elaine Denny and her team on endometriosis and cultural diversity, the role of women as mothers and homemakers formed an integral part of their identity — a strong emphasis was laid on motherhood, and childless women (whether voluntarily or involuntarily) were stigmatized. Therefore, women in the Indian subcontinent are more likely to seek medical help for fertility issues than pelvic pain resulting from endometriosis.

Further, only a very few women have heard of endometriosis. And, due to lack of awareness, women usually get diagnosed late.

Their health-seeking behavior is also associated with religion and culture:

– Women find it hard to discuss gynecological issues with their families as doing so may raise suspicion about the cause of their gynecological problems.

– Further, taking oral contraceptives (a treatment for endometriosis) might be interpreted as the woman being sexually active, compromising her marriage prospects.

Other factors include insensitivity shown by healthcare professionals towards women’s culture, and symptoms in general significantly impacting the health-seeking behavior.

Chapter 12: Myths & Facts About Endometriosis:

Myth: Women with endometriosis cannot have children.

Fact: Only about 30% of women with endometriosis have trouble getting pregnant. Getting a conservative surgery done to remove endometrial tissues can significantly improve your chances of conceiving.

Myth: Pregnancy cures endometriosis.

Fact: Pregnancy may offer some relief from endometriosis, but they tend to return. However, there are many treatments to help manage your condition.

Myth: Hysterectomy cures endometriosis.

Fact: There is no cure for endometriosis. Some women have severe symptoms not relieved by conventional treatment or conservative surgery. In such cases, hysterectomy may be considered to help relieve pain.

Myth: Endometriosis cannot be treated.

Fact: Endometriosis can be managed through a combination of diet, exercise, and medications.

Myth: It’s normal for periods to be extremely painful.

Fact: It isn’t normal for periods to be excruciatingly painful. If you’re experiencing pain that doesn’t go away with medication, kindly speak with your doctor.

Myth: You can’t get endometriosis when you are young.

Fact: Any woman of childbearing age can get endometriosis.

Myth: Your symptoms signal how severe your endometriosis is.

Fact: We can’t say how much a person is hurting based on the stage of endometriosis alone. A person with stage 1 disease can hurt more than stage 4.

Takeaway

Endometriosis is a chronic health condition occurring in about 2 – 10 percent of women of childbearing age worldwide. It affects their ovaries, fallopian tubes, and pelvic cavity lining. They can rarely affect other organs such as the brain, intestines, rectum, vagina, cervix, and vulva.

We don’t know what exactly causes endometriosis. But there are many theories surrounding their causes, such as genetics, stem cells, and other environmental factors.

As of date, there is no permanent cure for the condition; they may come and go throughout one’s lifetime. However, they can be effectively managed through medications, diet, exercise, and other lifestyle modifications.

If you already have endometriosis or are experiencing painful periods, pelvic pain, or high menstrual flow, you can easily consult one of our gynecologists available online using the MFine app.

References

(1) Does endometriosis go away after menopause?

Usually, endometriosis does go away with menopause.

(2) Can I get pregnant if I have endometriosis?

Studies suggest that only 30% of women with endometriosis have problems conceiving. Also, your doctor may recommend a conservative surgery to remove endometrial implants from the ovaries to improve your chances of conceiving.

(3) What are other health conditions linked to endometriosis?

Other health conditions linked to endometriosis are chronic fatigue syndrome, fibromyalgia syndrome, asthma, allergies, and skin conditions such as eczema.

(4) Does endometriosis worsen with age?

Endometriosis is a progressive disease meaning it can worsen with age.

(5) How do you mentally deal with endometriosis?

Coping with endometriosis requires,

– Eating a balanced diet

– Regular workouts

– Medications and managing stress levels

(6) How serious is endometriosis?

Endometriosis is a painful condition that can significantly impact one’s life. However, it isn’t fatal. But there are times when endometriosis can cause serious complications such as cancer and infertility.

(7) Can endometriosis be inherited?

Some studies suggest that daughters of mothers with endometriosis may inherit endometriosis. However, there is no one cause of endometriosis.

(8) Is chocolate good for endometriosis?

Chocolate in itself isn’t known to cause endometriosis flare-ups. However, sugar is known to worsen symptoms of endometriosis. It’s okay to have dark chocolate once in a while.

(9) Can stress make endometriosis worse?

Stress is a known risk factor for endometriosis. Exercise, meditation, and a balanced diet are some ways to help you manage your stress levels. Stress management also involves consulting a professional therapist to help you manage your emotions.

(10) Does endometriosis make you gain weight?

Weight gain and bloating are some symptoms associated with endometriosis.

(11) How likely am I to have endometriosis if my mom has it?

Some studies suggest that you are seven times more likely to have endometriosis if your mom has it.

(12) Are eggs good for endometriosis?

Doctors recommend having 75 gms of good quality protein from eggs, fish, and low-fat dairy products.

(13) Is green tea good for endometriosis?

Green tea has anti-angiogenic, anti-fibrotic, anti-proliferative, and proapoptotic mechanisms that help improve symptoms of endometriosis.

(14) Is endometriosis considered a disability?

Even though endometriosis is generally not considered a disability, it can significantly impact one’s life. Globally, Years Lived with Disability (YLDs) and Disability-Adjusted Life Years (DALYs) due to endometriosis stands were 56.5 and 56.6 per 100000 in 2019.

(15) Which patient has the highest risk for endometriosis?

Generally, endometriosis can occur in any woman of childbearing age, but women aged between 30 to 40 and those getting pregnant for the first time in their 30s stand a higher risk of developing endometriosis.

(16) Can endometriosis be cured by yoga?

As of date, there is no cure for endometriosis. However, practicing yoga can help reduce your stress levels, stretch your pelvic muscles, and even lose weight, and in the process, help manage your symptoms of endometriosis.

(17) What foods worsen endometriosis?

Alcohol, caffeine, red meat, trans fat, and other processed foods are some foods that can cause endometriosis flare-ups.

(18) Does birth control stop endometriosis?

Birth control pills can momentarily provide relief from your symptoms.

(19) How do you know when endometriosis is back?

Pelvic pain and pain during intercourse are the two most signs that suggest endometriosis is back.

(20) How long has society known about endometriosis?

Endometriosis was first discovered in 1860 by Karl von Rokitansky.

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