Endometriosis Overview

Introduction

Endometriosis is a gynaecological condition in which tissues similar to the endometrial lining grow outside of the uterus. They mostly affect reproductive organs such as ovaries, fallopian tubes, and other parts in the abdominopelvic region causing severe pain. There's no way to prevent endometriosis, but several options can lower the risks and help to improve the quality of life.

What is endometriosis?

The word endometriosis is derived from the word endometrium, which is the tissue that lines the uterine wall (womb). In a regular menstrual cycle, the endometrial lining of the uterus thickens and sheds in the absence of pregnancy. People assigned females at birth with endometriosis develop issues due to endometrial-like tissues growing outside the uterine cavity and on nearby organs where they do not belong.

During the menstrual cycle, when the endometrium is preparing itself to host the implantation of an embryo, the misplaced tissues also react to the hormonal changes in the same way the uterine lining does, which means that during a menstrual period—it will build up, shed the lining, and bleed. However, since the endometrial cells are trapped, they cannot escape. Normally, the shredded womb lining exits through the vagina, however, in endometriosis, this will result in bleeding that remains inside the pelvic region. This causes inflammation and damage to normal tissues near the endometrial implants.¹

If endometrial tissues continue to expand, they can:

• Forms adhesions (fibrous tissue bands), causing pelvic tissues and organs to cling together.
• Irritates the normal tissues, which may develop scarring.
• Cause blockage of the fallopian tubes.
• Cause an ovarian cyst if a dark endometrial fluid-filled sac develops inside the ovary. The cyst is known as an endometrioma or a chocolate cyst. A chocolate cyst may threaten a female’s reproductive potential.

According to the World Health Organization nearly 10% of women of childbearing age, which translates to 190 million women, are affected by endometriosis globally. In the UK, a similar percentage is affected; nearly 1-10 women out of 100 are affected with endometriosis. Unfortunately, there is often a delay in diagnosis, as on average it takes 6.7 years to obtain a diagnosis after the onset of endometriosis symptoms.^1,2

Symptoms

The most common symptoms of endometriosis are the following:

• Dysmenorrhea (period cramps): people assigned females at birth with endometriosis experience severe pelvic discomfort and cramping, which often feels like a sharp and gnawing pain shortly before and during menstruation, lasting for several days. Medication does not relieve endometriosis-related dysmenorrhea.
• Pain during intercourse: Pain during sexual activity is the most prevalent symptom. Endometrial cells can sometimes attach to the lower part of the uterus and the area behind the vagina, resulting in excruciating and agonising pains during sexual intercourse.
• Painful bowel movements: People assigned female at birth, especially those who are menstruating, may feel extra discomfort when passing stool or urinating. In rare cases, endometriosis can cause blood in the stool or urine.
• Excessive bleeding: Endometriosis can hugely impact the length of the menstrual cycle. Excessive or heavy bleeding occurs, which is sometimes followed by irregular spotting at any time between periods (intermenstrual bleeding).
• Trouble conceiving (infertility): Endometriosis highlights a significant difficulty for women in conceiving. The adhesions and lesions may hinder implantation, especially when there are adhesions in the fallopian tubes, making achieving a pregnancy more challenging. Several studies have shown that endometriosis doubles the risk of infertility. Nearly 50% of women with endometriosis experience infertility.^1,3

Other signs and symptoms may include experiencing fatigue, diarrhoea, nausea, constipation, or bloating, particularly during periods.¹

Causes

The exact cause of endometriosis is still unclear. Research has put forward a few theories which may have a possible explanation for the condition. One theory proposes that retrograde menstruation may have a significant role since the blood containing endometrial cells flows back through the fallopian tubes into the pelvic cavity instead of exiting through the cervix and the vagina. These endometrial cells adhere to the pelvic parts and continue to grow throughout the menstrual phase. Other theories suggest that peritoneal cells (the lining of the inner abdomen) can turn into endometrial tissues, or sometimes they may travel to other areas in the abdominal cavity and implant themselves, similar to how cancer spreads.

Surgical procedures such as C-sections can also impact the occurrence of endometriosis. Endometrial tissues may attach at the site of the incision.³

Risk factors

Endometriosis can develop in any person assigned female at birth of reproductive age, however, the following factors may indicate a high risk for the disease:

• Genetic – having a first-degree relative.
• Faulty immune system – when immune cells fail to recognize endometrial cells.
• Hormonal changes, such as high oestrogen.
• Early menarche, where periods start at an early age or when having short menstrual periods.
• Low Body Mass Index.
• Irregular menstrual flow.
• Late menopause.
• Never giving birth or conceiving for the first time after the age of 30.³

You can reduce your risk of endometriosis by making a few changes to your lifestyle

The following lifestyle factors have the greatest impact on your risk of endometriosis. We will also look at what you can do to reduce your risk from today 

Nutrition

Nutrition plays a vital role in combating inflammation and balancing out your hormones, like oestrogen. Finding the right dietary pattern can reduce endometriosis symptoms. Adding a fibrous diet such as eating whole fruits and vegetables, beans, lentils, and chickpeas can significantly help healthy bowel movements. Additionally, it can help minimise inflammation because of its high antioxidant content. Scientific studies have indicated fish oil capsules with vitamin B12 could have a positive effect on endometriosis (especially dysmenorrhea). Omega-3, magnesium, and zinc-rich foods can also help to regulate your cycle.⁴ 

Physical activity

Physical exercise can act as a pain reliever. Regular low-to-moderate exercise releases feel-good chemicals, called endorphins, which have a positive impact on reducing inflammation, fatigue, improving mobility and pelvic floor cramping.³

Obesity

Some observational studies have reported a significant increase in the incidence of endometriosis in obese women because altered metabolism and high cholesterol may cause severe endometriosis in overweight patients. Maintaining a healthy weight can reduce endometriosis symptoms.³

Alcohol

Research has shown that alcohol consumption aggravates endometriosis symptoms. It is therefore recommended to cut out alcohol to reduce adverse effects.^3,4

Hydration

Staying hydrated can limit bloating and period cramps. Overall health can be improved by aiming for at least 8 cups (2 litres) of water per day.^3,4

Sleep

Endometriosis can cause severe insomnia due to changes in melatonin, which can have an adverse effect on the reproductive system. A study suggested cognitive behavioural therapy, improved melatonin, practising good sleep hygiene, and limiting artificial light exposure at night could enhance sleep quality.⁵

Mental health

Fluctuations in hormone levels (specifically oestrogen changes) could trigger anger and mood swings. People assigned females at birth suffering from endometriosis are more likely to suffer from depression and anxiety. Managing stress, alternative therapies, and lifestyle changes can help to improve mental health.^3,5

Wellness

Keeping your emotional health balanced is necessary for your physical health. Self-care is important for overall good health.  

You can manage your symptoms by modifiable factors such as limiting alcohol, and caffeine consumption. Discussing therapies and nutritional approaches with a healthcare provider could altogether help to lower the chances of endometriosis taking over your life and uplifting your well-being.^3,5

Conclusion

Endometriosis is a serious, chronic gynaecological disease in women. It can be debilitating, compromising the quality of life due to severe pain, menstrual irregularity, infertility, and depression. Adjusting to a healthy lifestyle such as a balanced diet and physical activity can act as a wonder drug. Support and counselling about understanding endometriosis and managing symptoms with health professionals could help to ensure significant well-being.

Diagnostic testing

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