Endometriosis is a disease of the female reproductive system that affects approximately 1 in 10 women worldwide. Endometriosis occurs when the endometrial cells, or uterine lining cells, exist outside of the uterus. They can be found on the outside of the uterus, fallopian tubes or ovaries, or on surrounding organs in the abdomen such as the intestines, bladder or rectum. Each month, the endometrial cells act as they should, by swelling and thickening, then bleeding. However, since they are outside of the uterus, this leads to endometrial lesions, which worsen over time and can cause severe pain.
The uterus has three muscle layers: the perimetrium, myometrium, and endometrium. Each month, the innermost layer, or endometrium, grows and thickens, to prepare for a pregnancy. Most months, pregnancy does not occur and the endometrial cells shed, resulting in a period.
The figure above shows the uterus, fallopian tubes, and ovaries. The innermost layer of the uterus is called the “endometrium.”
Stages of Endometriosis
The American Society for Reproductive Medicine has defined four stages of endometriosis, based on the physical presentation of the disease:
Stage I: Minimal
Stage II: Mild
Stage III: Moderate
Stage IV: Severe
Although the disease is staged by severity, symptoms do not necessarily increase with higher stages. A woman with Stage I endometriosis may experience more pain than a woman with Stage III or Stage IV and vice versa.
Symptoms of endometriosis vary greatly from woman to woman. They might include:
- Chronic or intermittent pelvic pain
- “Killer Cramps”
- Cramps during a period are normal. They may be uncomfortable but over the counter pain meds allow a woman to go about her day. “Killer Cramps” are different. They are severe cramps that impact a woman’s ability to participate in daily activities. She may have to stay home from school, work, or other activities.
- Long and heavy periods
- Nausea and/or vomiting
- Diarrhea and/or constipation
- Chronic lower back pain
- Pain associated with sexual activities
- Infertility or pregnancy loss
For many women, symptoms will begin around the time of her first period. Some women with endometriosis will experience no symptoms of the disease.
What Causes Endometriosis?
Currently, there is no consensus in the medical and scientific communities on the cause of endometriosis. Many biological aspects are likely involved, including genetics, stem cells, and immune factors. Endometriosis has a known genetic component, meaning that a girl whose mother has the disease is 5 to 7 times more likely to have endometriosis herself. Endometriosis is also associated with other immune disorders.
If you suspect you or someone you know might have endometriosis, speak to a gynecologist about your symptoms. Most diagnoses are made through the clinical presentation of several of the symptoms described above. The only method of confirming a diagnosis is through a biopsy of the tissue, which would be conducted if you and your doctor determined that surgery was required for treatment.
Endometriosis is often mistaken for other diseases, resulting in a ten-year average delay in diagnosis. Seeing a gynecologist is the best way to ensure that endometriosis will be properly diagnosed.
Treatment and Pain Management
There are several options for managing the symptoms of endometriosis, including:
- Hormonal birth control
- Other hormonal therapies
- Alternative therapies, such as acupuncture, massage, or homeopathic remedies
These options effectively manage pain for many, but not all, patients. Currently, the best-known treatment for endometriosis is a procedure called “laparoscopic excision surgery,” in which a surgeon removes the endometrial lesions through tiny incisions in the abdomen. Other types of laparoscopic surgery exist as well, and it is advised to have multiple conversations with your surgeon to determine that he/she is best suited to conduct the surgery.
Unfortunately, despite surgical advances, many women experience recurrence of the disease. Laparoscopic excision surgery may produce lower rates of recurrence than other surgical procedures.
*Note: Historically, hysterectomy, or the complete removal of the uterus, was performed on some endometriosis patients. This procedure should not be considered a cure, and should only be considered in a very limited subset of patients, as a last resort.