Is Endometriosis An Autoimmune Disease? 

Introduction

Endometriosis is a common gynaecological disorder that affects 176 million people worldwide.¹ It is a common long-term condition experienced during the childbearing stage of people assigned females at birth. Endometriosis occurs when tissue lining usually found in the womb area, grows outside of it. This abnormal tissue can further spread to other parts of the reproductive system.^1,2 Endometriosis is often known as a hidden disorder.³ 

Causes of endometriosis

Although the causes of endometriosis are still largely unknown, some potential risk factors include 

• Retrograde blood flow period: This is when a woman's menstruation blood flows backwards instead of passing through the vagina.⁴ 
• Scar tissue (adhesions): Surgery or scar tissues from infections, such as pelvic inflammatory disease (PID) can trigger endometriosis systems.⁵ 
• Hormonal changes: Overly high oestrogen levels are believed to be associated with endometriosis.6
• Low immunity: Some scientists believe that there is an unclear link between endometriosis and immunity disorders. ⁴
• Metaplasia: This is when cells transform into different types of cells and can be caused by inflammation, infections, hormone changes and environmental factors. However, Metaplasia is a natural process of an ageing body.⁴
• You started your period before the age of 11. ⁷
• Genetics: Endometriosis is known to run in families, especially if you have a mother, sister or daughter who has been diagnosed with it.⁴
• High cholesterol.⁸
• Stress.⁹
• Short monthly menstruation cycles.⁷
• Heavy periods, in which bleeding lasts for over 7 days.⁷

Symptoms of endometriosis 

The symptoms of endometriosis vary with each person and the pain can range from mild to severe. Some sufferers experience intense pain that becomes debilitating and they cannot function in their daily lives. Here are some of the more common symptoms of endometriosis:

• Long-term pelvic pain
• Nausea/vomiting
• Intense period pain
• Irregular menstrual bleeding
• Chronic fatigue symptoms
• Sometimes debilitating menstrual pain
• Unusually heavy periods or light periods 
• Bleeding after sex
• Pain during sex
• Spotting in between periods
• Lower back pain ( especially close to menstruation)
• Pain when urinating or releasing bowels (especially during menstruating)
• Issues with fertility
• Constipation
• Fatigue
• Period type pains and cramps when not on period feeling period pain (such as cramps) when you are not menstruating
• Less common symptoms include nerve pain(such as sciatica) And Hip and/or leg pain.^11,12

Endometriosis and autoimmune conditions

 Although endometriosis is currently not classified as an autoimmune disorder, it is strongly linked to autoimmune and inflammatory diseases. This is because endometriosis can upset the natural balance of the immune system. Many patients with endometriosis have also been diagnosed with autoimmune disorders such as lupus, multiple sclerosis, underactive thyroid disease, and coeliac disease.¹²

Endometriosis and other coexisting conditions

In addition to autoimmune disorders, endometriosis is linked to other health conditions including fibromyalgia and chronic fatigue syndrome.¹²

Mental health

Due to the complex nature of endometriosis, suffering from low mood/depression or other mental health disorders is common. Some people may struggle with self-esteem issues and other psychological factors, caused by chronic pain.¹³

Long-term pelvic pain can potentially have a detrimental effect on your sex life and your completion of day-to-day activities. For example, it is more difficult to predict how you will feel on a day-to-day basis, which can cause difficulty in planning events and being spontaneous.¹⁴

Research has shown that people with endometriosis have been observed to suffer more from heightened pain sensitivity, compared to non-sufferers. The trigger of this has not been determined as yet. 

Cancer

Studies show that there is only a slightly higher risk of developing cancer if you have endometriosis. Sometimes endometriosis is confused with cancer, because of the symptom of abnormal developing cells, however, the likelihood of endometriosis turning into cancer is below 1%.¹⁵

Endometrial cancer

Endometrial cancer is usually diagnosed in women who have passed their reproductive years. Endometrial cancer spread through the lymph nodes into other parts of the body. The sooner endometrial cancer is treated, the more positive the outcome.¹⁵

Asthma and allergic reactions

In 2018, Doctor Joe Zein from Cleveland clinic conducted an experiment that showed a link between women who have endometriosis and also asthma. The study involved examining over 3 million women between the ages of 20 and 40 years of age. Zein found that 24% of women with endometriosis also had asthma.¹⁷ 

Cardiovascular conditions

Researchers from Harvard University discovered a correlation between females with heart disease and endometriosis. They found that 91% of women with endometriosis had a higher risk of chest pain. 52% had a higher risk of a heart attack than people who have not been diagnosed with endometriosis. These findings suggest that people with endometriosis should actively seek to reduce their risk of cardiovascular disease, by living a healthy lifestyle and having a healthy diet.¹⁸

Diagnosis

Endometriosis can take a while to be diagnosed, due to its complex nature. There are 4 different stages to this condition and the symptoms range from mild to severe. Stage 4 is the final stage; by this point dense adhesions are present and large cysts may appear on the ovaries. 

Endometriosis is often diagnosed by a pelvic exam, ultrasound, MRI (magnetic resonance imaging), and then lastly a laparoscopy(the most accurate diagnostic tool).^18,2

Treatment

Even though there is currently no cure for endometriosis, there are treatments and measures that can help to reduce the symptoms and/or prevent further endometrial tissue from spreading. Another main treatment priority is to improve the fertility of those with endometriosis who are currently trying for a baby or have hopes of having some in the future.

Here are some examples of the treatments used:

• Pain relief: Pain relief prescribed medications for endometriosis.
• Autoimmune treatments: Even though endometriosis has not been proven to be an autoimmune disease, it shares similar traits to immunity disorder symptoms. Using anti-inflammatory medication may help to reduce endometriosis symptoms. 
• Hormone medication: Hormone medicines can be offered, to reduce or block the amount of estrogen circulating in the body. This should prevent the endometriosis tissue from developing further and hopefully reduce symptoms.
• Surgery: One of the main surgical procedures for endometriosis is called laparoscopy. This is keyhole surgery where the surgeon will place a laparoscope (video camera) to search for endometriosis scarring along your internal organs. A laparoscopy is usually performed under general anaesthesia. A laparoscopy is usually classed as day surgery, where you will be able to go home on the same day. But Sometimes the patient will be expected to stay in the hospital overnight if complications occur. Unfortunately, 20% of sufferers do not benefit from any relief from a laparoscopy. 80% should experience an improvement of symptoms for at least 2-5 years before the endometrial tissue begins to grow back. 

• Contraceptives: This treatment helps to stop the growth of endometrial tissue from spreading. although it can not help reduce the current scar tissue or help with fertility issues.  

Complications of endometriosis

• Low fertility/infertility
• Chronic pelvic pain
• A potential risk of ovarian cancer
• Low mood/depression

Summary

Even though endometriosis is a chronic condition, some treatments can help to reduce chronic pain and other symptoms. However, more research is required to determine the cause of endometriosis and its link to other diseases.