Endometriosis

Endometriosis appears in three different forms:

• Superficial peritoneal endometritis occurs when small patches of endometrial tissue grow on the lining of the pelvic cavity.
• Ovarian endometriomas develop when cysts filled with dark, old blood (often called "chocolate cysts") form on the ovaries.
• Deep infiltrating endometriosis happens when endometrial tissue grows deep into pelvic organs such as the bladder, bowel, or ligaments of the uterus.

The most common symptoms of endometriosis include:

• Pelvic pain starts before your period and continues during it, and it is usually stronger than normal menstrual cramps.
• Pain during sex also called dyspareunia occurs when u feel pain during or after intercourse.
• Pain during bowel movements or urination are most common during your menstrual cycle.
• Heavy or irregular bleeding refers to unusually heavy periods or bleeding between periods.
• Infertility occurs because endometriosis can make it harder to conceive, and it is often diagnosed in women undergoing fertility treatments.
• Other symptoms may include fatigue, nausea, bloating, constipation, or diarrhoea, especially during your menstrual cycle.

The exact cause of endometriosis is still somewhat unknown, but several theories exist:

• Retrograde menstruation theory postulates that menstrual blood containing endometrial cells flow backwards into the fallopian tubes and the pelvic cavity, where the cells attach to the pelvic organs and begin to grow.
• Embryonic cell transformation occurs when hormones such as oestrogen cause embryonic cells, which can develop into any body tissue, to turn into endometrial-like cell implants during puberty.
• Immune system disorders occur when the immune system fails to recognise endometrial tissue growing outside the uterus, allowing it to keep developing.
• Surgical scars cause endometriosis when endometrial cells attach to incision sites.
• Genetics increases the risk of endometriosis if a patient’s mother or sister has the condition.

Doctors may use one or more of the following tests to check for endometriosis:

• A pelvic exam allows the doctor to feel for cysts or scar tissue around the reproductive organs may be felt
• An ultrasound scan (transvaginal or abdominal) can help identify cysts linked to endometriosis, called endometriomas.
• A magnetic resonance imaging (MRI) can provide a detailed image of the internal organs and help plan surgeries or other procedures.
• A laparoscopy, a minor surgical procedure that uses a small camera to visualise the inside of the abdominal cavity, is considered the gold standard for diagnosing endometriosis. 

The treatment depends on the severity of symptoms and whether the patient wants to have children. Options include:

• Pain relievers such as ibuprofen or paracetamol can help with mild pain.
• Hormonal therapy helps reduce or stop periods, slowing the growth of endometriosis:
  • Birth control pills can regulate cycles and reduce pain.
  • Gonadotropin-releasing (GnRH) agonists stop certain hormones and temporarily induce menopause.
  • Progestin therapy reduces or stop periods and shrinks tissue growth.
  • Surgery may be recommended if medicines are not effective or if pregnancy is planned. Laparoscopic surgery removes or destroys endometrial growths, scar tissue, and adhesions.
• Fertility treatment such as in-vitro fertilisation (IVF) may help if endometriosis is causing infertility.
• Hysterectomy (removal of the uterus) is considered in severe cases and only if the woman does not wish to have children in the future and is usually the last resort.

You should consult a doctor if:

• You have severe pelvic pain that does not improve with over-the-counter pain medications.
• You are unable to get pregnant after trying for over a year.
• Your periods have become unusually heavy or irregular.
• You experience pain during or after intercourse.

Currently, there is no guaranteed way to prevent endometriosis. However, regular check-ups, early management of symptoms, and discussing menstrual health with your doctor may help detect and treat it sooner, reducing complications.

Managing endometriosis often requires a team of health professionals:

• A gynaecologist diagnoses and treats the condition and performs surgery if needed.
• A fertility specialist provides care if endometriosis affects your ability to conceive.
• A pain specialist may help if chronic pain continues despite treatment.
• A dietician can recommend diet changes to reduce bloating and improve overall health.
• A psychologist or counsellor may provide support for the emotional stress and anxiety linked to chronic pain and infertility.