March is endometriosis awareness month! Menstruation is never easy for everyone and sometimes, conditions like endometriosis can aggravate it. It is certainly important to be aware of endometriosis which is very common and affects 1 in 10 women.
What is endometriosis?
This condition takes its name from the word “endometrium”, the tissue that lines the uterus. Usually, during the menstrual cycle, the endometrium sheds and builds up, if a woman doesn’t get pregnant. However, in endometriosis, a tissue similar to the endometrium develops outside of the uterus, usually on the other reproductive organs in the pelvis or sometimes even in the abdominal cavity. Each cycle, this misplaced tissue gets influenced by the hormonal changes that happen during the menstrual cycle and builds up and sheds just as the endometrium does. This, besides causing bleeding inside of the pelvis, also leads to inflammation and scarring of the normal tissue around it leading to period pain and irregular periods.
What causes this condition?
The exact cause of endometriosis is still unknown. Several theories have been formulated to rule out the cause. They are-
• The condition is genetic and affects people of certain ethnic groups more than others
• An issue with the body’s immune system
• Tissues shed during menstruation flow into other parts of the body
• Recent research shows that women with endometriosis have chemical changes in their DNA
However, none of these have been proved yet. But there are certain risk factors that have been put forth:
• Family history (first-degree relative)
• Having 27 days or fewer between each menstrual cycle or period.
• Abnormality within the uterus such as uterine growths like fibroids or polyps
• Surgery such as cesarean section which could sometimes cause misplacement of the endometrial tissue outside of the uterus
• Excessive menstrual or period cramps in the abdomen or lower back
• Pain during intercourse
• Painful bowel movements during the period
• Difficulty getting pregnant
• Heavy menstrual flow
• Pain when peeing or pooing during the period
• Pelvic examination – Your physician does a manual examination to check for cysts or scars behind the uterus
• MRI scan
• Ultrasound scan
• Laparoscopy – In some cases, a surgeon might make a tiny incision near the navel to view the inside of your abdomen and look for signs of endometrial tissue outside the uterus. They might also collect tissue samples (biopsy) from the area for further testing.
• Startups such as “Nextgen Jane” have emerged to easily diagnose endometriosis. The company mails a test kit with a smart tampon to the user. Women use the tampon during their period and send it to the lab for diagnosis. The kit is able to preserve the cells and blood squeezed from the tampon could detect early markers of endometriosis.
There is no cure for endometriosis. However, various medical and surgical treatment options are available to ease out the symptoms
• Period pain-relieving medications
• Hormonal therapy to prevent ovulation and reduce menstrual flow
• Stopping ovarian hormone production creating a sort of “medical menopause”
• Laparoscopy to remove the endometrial implants
• As a last resort, removal of uterus and cervix
• A study in 2018 at Yale University showed that gene therapy can be employed to suppress the genes causing endometriosis. However, the study has been conducted only in mice and is yet to be done with human beings.
Endometriosis and infertility
Endometriosis is listed as one of the common causes of infertility. The scar tissue from endometriosis can hinder the release of the egg from the ovary. Also, the altered pelvic environment can lead to impaired implantation of the fertilized egg. In mild cases, surgery to remove cysts, adhesions, and scar tissue can restore fertility. However, in some cases, women affected with endometriosis may remain infertile. In such cases, your doctor might advise you to go for in-vitro fertilization. Apart from managing physical pain and discomfort, it is equally important to address mental health during endometriosis.
It is true that endometriosis is a chronic condition without a cure. However, it doesn’t mean that the condition impacts daily life. There are always various therapeutic strategies to manage pain and issues concerning fertility. Also, endometriosis usually improves after menopause.
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About the author
Niranjana S. Rajalakshmi is a veterinary microbiologist turned science journalist, currently based in India. After her under graduation in Veterinary Medicine, she was curious to study diseases at a molecular level which led her to pursue a Master’s in Veterinary Microbiology. When the pandemic struck, she being a microbiologist felt the need to communicate about the hitherto unknown virus and its possible implications to a large audience. Subsequently, she produced several pieces on COVID-19 and other topics related to health, which are being published in leading news outlets in India.