Endometriosis: Definition, Types, Causes, Symptoms, Risk, and Treatments

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30 June 2023

Endometriosis: Definition, Types, Causes, Symptoms, Risk, and Treatments - welzo

Overview of Endometriosis

Endometriosis is a chronic disease that affects the endometrium, the tissue that lines the interior of the uterus. Endometriosis is a condition in which this tissue develops outside the uterus, usually in the pelvic region but occasionally in other parts of the body. The endometrial tissue swells, degrades, and bleeds during the menstrual cycle, causing menstruation. However, hormonal adjustments cause the dislocated endometrial tissue surrounding the uterus to thicken, degrade, and bleed.

Endometriosis is estimated to affect approximately 10% of women of reproductive age worldwide, which translates to about 176 million women globally.

Endometriosis is broadly classified into three types: superficial peritoneal endometriosis (SPE), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE).

Contrary to endometrial tissue lost during menstruation, endometriosis-related blood and tissue are unable to leave the body. This might trigger inflammatory processes, fibrosis, and attachments to form, which would cause pain in addition to other symptoms. There are a number of hypotheses regarding the causation of endometriosis, including regressive periods (the passage of menstrual blood into the pelvic cavity backwards), deficiencies in hormones, immune system problems, and genetic reasons. All of these hypotheses fall short of explaining how endometriosis arises, though.

Endometriosis causes a variety of symptoms, but the most common ones include pelvic discomfort, difficult menstrual cycles, pain during or after sexual activity, heavy bleeding, fertility problems, exhaustion, and gastrointestinal problems like bloating, diarrhoea, or constipation. The severity of the condition's symptoms does not always correspond to its extent or stage.

Endometriosis is typically diagnosed using a combination of medical records evaluation, pelvic assessments, imaging studies like ultrasound or MRI, and, in some circumstances, a minimally invasive surgical procedure called laparoscopy that helps visualise and verify the existence of endometrial tissue outside the lining of the uterus.

Although endometriosis does not yet have a cure, there are several therapeutic options to control symptoms and enhance the quality of life. Painkillers, hormonal treatments (such as oral contraceptives or hormones that release gonadotropin agonists), conservative surgery to eliminate endometrial abnormalities or, in extreme situations, hysterectomy (the elimination of the uterus) and removal of the ovaries are some of these options.

It's crucial for people who have endometriosis-related symptoms to speak with a medical expert, like a gynaecologist, who makes a precise diagnosis and provides appropriate therapy for them based on their specific case.

What is Endometriosis?

Endometriosis is a condition where tissue that resembles the uterine lining develops outside of the uterus. Endometriosis makes getting pregnant more difficult and causes excruciating pelvic pain. Endometriosis affects a person starting with their first menstrual cycle.

Endometriosis is a chronic condition, and while there is no cure, we can work together to manage the symptoms and improve the quality of life for women. Treatment plans must be individualized and tailored to each patient's needs, stated by Dr Michael Brown.

A tissue that resembles the uterus lining grows outside the uterus when a person has endometriosis. Due to this, the pelvic area and (occasionally) other parts of the body experience inflammation and the formation of scar tissue. Intense pelvic discomfort is a common sign of endometriosis, particularly when menstruating. Some females experience pain during sexual activity or while going to the toilet. Some women experience difficulties in getting pregnant.

On average, it takes 7-10 years for a woman to receive a proper diagnosis of endometriosis from the onset of symptoms. This delay is partly due to the lack of awareness and the tendency to dismiss menstrual pain as normal.

How common is endometriosis?

Endometriosis is a complex illness which impacts a large number of women worldwide from the start of their first period (menarche) until menopause and endometriosis does not depend on ethnicity or social standing. According to the world health organization (WHO), Around 10% (190 million) of women and adolescents of reproductive age suffer from endometriosis worldwide.

Endometriosis has substantial social, economic, and public health effects. Extreme pain, exhaustion, sadness, worry, and fertility problems, lower the standard of life. Some endometriosis victims are incapacitated by excruciating pain that keeps them from attending jobs or school. Endometriosis-related pain during sex causes discontinuation or avoidance of intercourse, which harms the sexual health of both the affected person and their partners.

The general population and the majority of front-line healthcare professionals are frequently unaware that unpleasant and detrimental pelvic discomfort is not normal, which results in the normalizing and stigmatization of symptoms as well as an extensive delay in diagnosis. Due to the lack of knowledge about endometriosis among primary healthcare practitioners, patients who could benefit from medical symptomatic therapy are not often given medical treatments. Delayed diagnosis frequently prevents patients from receiving available treatment options like non-steroidal analgesics and oral contraceptives.

What are the types of endometriosis?

The common types of endometriosis are based on the locations where the endometrial tissue is found. The common types of endometriosis are superficial endometriosis, deep endometriosis, endometriomas, and adenomyosis. About 70–80% of all cases of endometriosis are superficial, making it the most prevalent type. A more serious kind of endometriosis is deep infiltrating endometriosis. It incorporates the entry of endometrial tissue into the innermost parts of tissues, including the rectum, bladder, and sometimes the colon. It results in bowel and bladder problems and is extremely painful. Listed below are the common types of endometriosis.

1. Superficial endometriosis

Superficial endometriosis is the most common type of endometriosis which makes up around 80% of all endometriosis. Superficial endometriosis (SE) appears as a peritoneal superficial lesion. Lesions are often visible along the uterine/peritoneal outside wall and are red, black, or white in colour. Although there is presently no treatment for endometriosis, there are a number of medications, therapies, surgeries, and self-management techniques that help with symptom relief and quality of life enhancement. Currently, work is being done to create and enhance diagnostic methods so that SE be identified rapidly and non-invasively.

2. Deep endometriosis

Deep endometriosis is a severe form of endometriosis. In cases of severe endometriosis, the abnormal tissue growth penetrates deeply into the surrounding organs and tissues, including the rectum, bladder, fallopian tubes, and ovaries. Common symptoms of deep endometriosis can include intense pelvic discomfort, pain during sexual activity, painful bowel or urine, heavy monthly bleeding, and infertility.

3. Endometriomas

Endometriomas are a type of cyst that develops in the ovaries as a result of endometriosis. They are known as ovarian endometriotic cysts or chocolate cysts. Endometriosis is a disorder where the tissue that normally borders the uterus develops outside the uterus, usually on the ovaries, fallopian tubes, or other pelvic organs.

It is possible for endometrial tissue to implant on the ovaries and create a cyst that looks like dark chocolate when it becomes filled with old blood. These cysts produce symptoms including pelvic pain, particularly during menstruation, pain during sexual activity, irregular menstrual bleeding, and infertility. Their sizes vary.

4. Adenomyosis

Adenomyosis is a disorder in which the uterus's muscular wall is breached by the innermost layer of the uterus. Because of this, the uterus grows larger and thickens. Although adenomyosis is a benign disorder, it can nonetheless affect a woman's quality of life and create a variety of symptoms. There are multiple theories regarding the exact cause of adenomyosis. According to one concept, it might be caused by hormonal abnormalities.

What are the causes of endometriosis?

Endometriosis has an unidentified underlying aetiology. Tissue that would normally line the uterus grows in the incorrect places in case of endometriosis. It produces uncomfortable sensations when it grows in areas like the pelvic cavity, reproductive organs, and the outside of the uterus.

Research is crucial to better understand the underlying causes and develop more effective treatments for endometriosis. We must continue to support scientific advancements in this field to improve the lives of women affected by this condition, according to Dr Emily Roberts.

The most frequently recognised theory about endometriosis is retrograde menstruation which contends that during periods, some menstrual blood flow retrograde via the fallopian tubes and into the pelvic cavity rather than leaving the body. The endometrium cells in the bloodstream might then adhere and develop outside the uterus. Previous operations like a hysterectomy or caesarean section leave scar tissue or form adhesions. These scars could become the site of endometriosis if endometrial tissue attaches there.

Listed below are some causes of endometriosis.

1. Immune system disorder

Multiple immune system abnormalities have been seen in endometriosis patients.

According to one study, endometriosis patients showed high levels of inflammation. Additionally, studies have indicated that endometriosis patients have immune system dysfunction, particularly with regard to a particular class of immune cells known as natural killer cells. It has been demonstrated that endometriosis patients' uterine linings overproduce chemicals called chemokines, which draw in additional immune cells and exacerbate inflammation. It is still unclear if impaired immune response is the actual cause of endometriosis or only a symptom. However, immune system malfunction accounts for the possible link between endometriosis and autoimmune diseases.

2. Retrograde menstruation

When menstrual blood runs retrogradely, it enters the abdominal cavity rather than leaving through the vagina. The uterine lining normally releases the blood out of the vagina and downward during a menstrual cycle. The majority of people do not have retrograde menstrual symptoms. Period discomfort is the most typical symptom in those who experience it. There is evidence from numerous research that endometriosis development and retrograde menstruation are linked. Endometrial cells, which line your uterus, travel down the fallopian tubes and into the pelvis if the patient experiences retrograde menstruation. Endometriosis develops if the cells aren't removed by the body and instead accumulate on the pelvic tissues. Some medical professionals recommend hormones to patients to lessen menstrual bleeding. This lessens the amount of blood that flows into the abdominal cavity against pressure.

3. Embryonic cells transformation

Cell transformation is another potential cause of endometriosis. According to the concept, hormones cause the cells surrounding the uterus to change into endometrial cells, which line the interior of the uterus. According to the concept of embryonic cell transformation, endometrial tissue might develop in certain regions of the uterus. That view is supported by the fact that the cells in the gastrointestinal tract develop from embryonic cells. Embryonic cells have the ability to transform into endometrial-like cells.

4. Endometrial cell transport

The hormones produced by a woman's ovaries instruct the uterine or womb cells to grow and thicken each month. After periods the body destroys these extra endometrial cells. Endometriosis develops if these cells, known as endometrial cells, penetrate and proliferate across the uterus. According to one concept, the endometrial cells that are eliminated during a period move downstream down the fallopian tubes and into the pelvic region, where they develop and embed.

5. Transformation of peritoneal cells

According to a number of studies, peritoneal mesothelial adhesion factors are differentially expressed in endometriosis-affected women, which potentially presents ectopic endometrial cell attachment sites for the development of endometriosis lesions. Tight junction loss and other phenotypic changes in peritoneal mesothelial cells make it possible for early lesions to penetrate the extracellular matrix or for ectopic cells to attach to it. There is data that suggests the peritoneal mesothelium influences ectopic cells' ability to invade by enhancing local tissue remodelling.

6. Genetic mutations

It is believed that endometriosis has a hereditary predisposition, making some individuals more susceptible to developing it than others. Numerous genomics studies have shown that endometriosis is caused due substantial changes in gene expression.

Some studies have identified specific genetic mutations that are associated with an increased risk of endometriosis. For example, a 2017 study published in the American Journal of Human Genetics found that rare mutations in the ARID1A gene, which is involved in DNA regulation and repair, were more common in women with endometriosis than in those without the condition.

7. Immunological factors

Immune cells are essential for triggering and sustaining the persistent inflammation that is linked to endometriosis. Immune cells penetrate the ectopic endometrial tissue and release pro-inflammatory cytokines and chemokines, which contribute to tissue damage and discomfort. These immune cells include macrophages, T cells, and natural killer (NK) cells. According to studies, immune cell function is frequently unusual in endometriosis-affected women. For instance, the ratio of regulatory T cells (Tregs) to helper T cells (Th1 and Th2) is unbalanced. Tregs are in charge of preserving immunological tolerance, therefore their diminished activity in endometriosis helps in the survival and development of ectopic endometrial tissue.

Several studies have suggested that the immune system plays a role in the development of endometriosis. For example, a 2015 study published in the Journal of Obstetrics and Gynaecology Research found that women with endometriosis had higher levels of certain immune cells and cytokines (proteins that regulate the immune response) in their peritoneal fluid (the fluid that surrounds the organs in the pelvis) compared to women without endometriosis.

8. Environmental factors

Exposure to certain environmental toxins, such as dioxins and polychlorinated biphenyls (PCBs), has been linked to an increased risk of endometriosis in some studies. For example, a 2011 study published in Human Reproduction found that women with high levels of dioxin exposure had a higher risk of endometriosis. The likelihood and severity of endometriosis is affected by certain dietary choices. For instance, a higher risk has been linked to a diet high in red meat and saturated fats and low in fruits, vegetables, and omega-3 fatty acids. Furthermore, some research has indicated that women with endometriosis have higher rates of gluten sensitivity and lactose intolerance.

What are the symptoms of endometriosis?

The main symptom of endometriosis is pelvic pain, which is frequently related to menstruation. Although many women suffer cramps throughout their periods, people who have endometriosis frequently have significantly more severe menstrual pain than usual. Over time, pain potentially gets worse. Before and for a few days after a period, women experience pelvic pain and cramps.

The extent of the disease is not always accurately predicted by the intensity of the pain. The patient has moderate endometriosis and experiences intense pain or has advanced endometriosis and has little to no pain.

The quality of life is impacted by excruciating endometriosis pain. Some individuals experience depression or mood disorders. Both medical and mental health treatments are beneficial.

Endometriosis is commonly mistaken for other medical disorders that result in abdominal discomfort, such as pelvic inflammatory disease (PID) or cysts in the ovaries. It could be mistaken for irritable bowel syndrome (IBS), a disorder that produces episodes of diarrhoea, bloating, and cramps in the abdomen. Endometriosis coexists with IBS, which makes a diagnosis more difficult.

Listed below are some common symptoms of endometriosis.

1. Ongoing pelvic pain

Ongoing Pelvic pain is one of the most common symptoms of endometriosis. Endometriosis patients have pelvic pain of varying intensity either before, during, or post periods. persistent pelvic pain that is painful, dull, or severe. It gets worse while doing particular things, like having sex, going to the toilet, or urinating. It's critical to make an appointment with a healthcare provider, preferably a gynaecologist or endometriosis expert, if having pelvic pain or endometriosis. In order to confirm the medical condition, the doctor assesses your symptoms, does a thorough physical examination, and requests additional testing including imaging scans.

2. Pain after or during sexual activity

Severe endometriosis pain throughout sexual activity is brought on by irritation and fibrosis of the area connecting the anterior wall of the genital area to the rear wall of the vagina. Depending on the location and severity of the endometriosis, the pain is more severe in some sexual positions than in others. It is very challenging to talk about physical challenges encountered during sex because painful sex is such a deeply private experience. It's uncommon for a patient to willingly disclose painful sex while talking about their symptoms with a doctor. However, it is crucial to let the female know because of the symptom strain or even end a relationship. This is true both for her physical health and sexual health.

3. Painful periods

The uterine lining increases throughout a normal menstrual period to get ready for pregnancy. In the absence of pregnancy, the uterus eliminates its outer layer, which causes monthly bleeding. During these periods, the displaced tissue of the endometrium in endometriosis patients responds to changes in hormones and bleeds. The problem is that this tissue is unable to leave the body because it is outside the uterus. This results in inflammatory reactions, discomfort, and the development of scar tissue, all of which are potentially painful. Among endometriosis-afflicted women, the level of period pain could differ substantially. Certain patients only feel a little pain, others might suffer from intense discomfort that has a big impact on their everyday life. Excessive or extended period bleeding is common in endometriosis-affected women, and it leads to more severe discomfort.

4. Urinating that hurts

Dysuria or pain while urinating are no obvious signs of endometriosis. In endometriosis, the soft tissue that usually covers the lining of the uterus develops out of it, usually in the pelvic area. It results in symptoms like pelvic pain, painful periods, and discomfort during sexual activity. However, endometriosis occasionally has an indirect impact on the urine system, causing symptoms like frequent or urgent urination, abdominal pain, or difficulty while urinating. Endometriotic scars in the lower abdomen cause these signs and have an impact on the bladder and other nearby organs. It's crucial to remember that bladder pain arises from a wide range of causes, so it's crucial to speak with a healthcare provider for an exact diagnosis and the best course of treatment.

5. Fatigue

A prevalent complaint of endometriosis that many people notice is fatigue. There are various probable causes of fatigue in endometriosis however, the exact cause of fatigue due to endometriosis is unknown. Chronic pelvic discomfort caused by endometriosis is frequently tiring and incapacitating. Constant discomfort might make it difficult to get a good night's sleep and disturb everyday routines, making people tired. Mental health suffers as a result of coping with the difficulties of having endometriosis, such as pain, worries regarding fertility, and the impact on day-to-day life. The symptoms of sadness and hopelessness, which are frequently linked to endometriosis, contribute to or worsen fatigue. It is significant to highlight that each person with endometriosis feels fatigued in a different way, and there is a range of root causes. It is advised to talk to a medical professional about the worries if the person is feeling fatigued as an endometriosis sign.

6. Uncomfortable bowel movements

There is a chance that patients will have uncomfortable bowel movements. Uncomfortable bowel movements occur due to the presence of endometrial tissue in or around the bowel. Endometrial tissue invades the intestine, resulting in discomfort, itchiness, and irritation when having a bowel movement. Endometrial tissue or adhesions cause referred discomfort during bowel movements by pressing the adjacent nerves. This results in irritation or even piercing, intense pains in the lower part of the abdomen or genital region. It's crucial to understand that not all people with endometriosis will have unpleasant bowel motions. Personal differences in symptom severity mean that some people experience only mild or no gastrointestinal problems at all. Talk with a medical professional who assesses the signs, provides an accurate diagnosis, and makes recommendations for the best course of therapy if the person fears endometriosis or is having unpleasant bowel movements.

7. Anxiety and depression

Dealing with a chronic medical condition like endometriosis leads to feelings of loneliness because patients find it difficult to obtain support or describe their situation to others. Anxiety and depression result from the psychological effects of these difficulties as well as the negative connotation attached to menstruation and reproductive health in society. Endometriosis is famously challenging to diagnose, and it frequently takes a long time to get a precise diagnosis. The wait in getting a diagnosis causes annoyance, worry, and confusion. Psychological anguish is a result of the limited therapeutic options and requirement for numerous operations or treatments. While there is a definite link between endometriosis and mental health problems, it's crucial to remember that the exact connection and root causes are still under investigation.

Endometriosis affects not only the physical health but the emotional well-being of women. It is important to provide a supportive environment and resources to help patients cope with the challenges posed by this condition, according to Dr Laura Davis.

8. Nausea and abdominal bloating

In endometriosis patients, nausea and stomach bloating happen for a variety of conditions associated with the disease. Although they aren't the main signs of endometriosis, nausea and abdominal bloating are connected to endometriosis in a number of ways. The digestive tract's different organs, including the intestines and the rectum, get infected by endometriosis. Digestion symptoms, such as bloating and nausea, are brought on by this involvement.

9. Neurological symptoms (rare)

A 2018 study published in the Journal of Minimally Invasive Gynecology found that women with deep infiltrating endometriosis (a severe form of endometriosis that invades deeper layers of tissue) were more likely to report neurological symptoms compared to women with milder forms of endometriosis.

Despite the fact that endometriosis mostly affects the process of reproduction, it is capable of causing neurological symptoms. In contrast to the more prevalent symptoms like pelvic pain and infertility, it's crucial to remember that neurological problems are relatively uncommon in endometriosis patients.

The sciatic nerve becomes irritated or compressed by endometriosis lesions in the pelvic region, resulting in discomfort, weakness, or a feeling of tingling that radiates throughout the leg. Endometriosis causes peripheral nerve damage which results in loss of sensation in the extremities. Endometriosis results in pelvic floor muscle contraction or tension, which produces signs like pelvic pain, frequent or urgent urination, and discomfort during sexual activity.

A relationship between endometriosis and a higher incidence of migraines or other persistent headaches exists. Hormonal changes and inflammation are involved in this connection, however, the exact mechanism is not completely understood. Endometriosis occasionally impacts the central nervous system, causing symptoms like convulsions, trouble with coordination, or sensory abnormalities. This condition, known as neuro endometriosis, needs a skilled medical examination.

It's crucial to keep in mind that additional medical conditions induce these neurological signs, which are not just related to endometriosis. It's crucial to get in touch with a medical professional if the patient has any strange or alarming symptoms so they assess the unique condition and give an accurate diagnosis and medication.

10. Respiratory symptoms (rare)

Although endometriosis is rarely associated with respiratory symptoms, there have been a few examples where patients have mentioned having problems with breathing. In these situations, endometriosis masses or abnormalities involve the diaphragm, lungs, or chest cavity. A 2019 case report published in the Journal of Thoracic Disease described a woman who developed a lung nodule that was found to be endometriosis.

Chest discomfort that is intense, stabbing, and gets worse with rapid breathing or coughing are the symptoms of endometriosis lesions on the diaphragm or the inner membrane of the lungs.

Some types of endometriosis that affect the diaphragm or lungs might cause a sensation of being out of breath or having trouble breathing, especially when engaging in strenuous activity. The invasion of lung tissue by endometriosis implants results in bleeding, which could result in bloody sputum or bloody coughing.

Occasionally, endometriosis causes the degeneration of the lung due to endometrial tissue that affects the inner membrane of the thoracic cavity.

It's significant to keep in mind that endometriosis patients rarely experience these respiratory signs. The majority of people who have endometriosis report symptoms like pelvic discomfort, difficult periods, infertility, and digestive problems. Talk with the doctor for a reliable diagnosis and suitable treatment if the patient think having endometriosis or is having any respiratory symptoms.

11. Gastrointestinal symptoms (rare)

Although endometriosis predominantly affects the reproductive system, some patients have gastrointestinal issues. A 2020 study published in the Journal of Endometriosis and Pelvic Pain Disorders found that gastrointestinal symptoms were more common in women with endometriosis compared to women without the condition.

When endometrial tissue outside of the uterus irritates or invades the intestine, it causes discomfort that is frequently described as being intense or piercing. Hormonal changes and inflammation brought on by endometriosis cause abdominal bloating and discomfort. The digestive tract's different organs, including the intestines and the rectum, get infected by endometriosis. Digestion symptoms, such as bloating and nausea, are brought on by this involvement.

How is endometriosis diagnosed?

The diagnosis of endometriosis requires some time. It takes seven years generally to reach a diagnosis. This is due to the fact that symptoms differ from woman to woman and alter as time passes. Some women with endometriosis are asymptomatic, which means they don't have problems with fertility or usual signs like pelvic discomfort. In some situations, the problem is discovered through a separate procedure accidentally.

Medical history analysis, physical examination, and imaging tests are all often performed to diagnose endometriosis. A laparoscopic approach, which involves minimally invasive surgery, is frequently used to provide a conclusive diagnosis.

The doctor will start by asking about the symptoms, menstrual history, and any other related medical information. Symptoms commonly associated with endometriosis include pelvic pain, painful periods, pain during sexual intercourse, and infertility.

An examination of the pelvis is often done to look for any lesions or endometriosis symptoms, such as the appearance of sensitive spots or lumps.

Imaging studies like MRI are helpful in the detection of some symptoms that point to the existence of endometrial tissue outside the uterus, even though they're unable to fully identify endometriosis lesions on their own. The pelvis is seen and any cysts in the ovary, scar tissue, or endometriotic implants are found using transvaginal ultrasound or MRI imaging.

The most common method for identifying endometriosis is a laparoscopy procedure. Laparoscopy is a surgical procedure that is carried out while the patient is unconscious. A small incision is made close to the navel, and a laparoscopy—a thin, illuminated instrument—is inserted to provide a clear view of the pelvic tissues. A biopsy is performed for clarification if endometrial tissue is seen outside the uterus.

It takes a long time to diagnose endometriosis in teenagers. The reason for this is that a lot of young women with endometriosis signs, such as pain before and during a period, aren't really suffering from endometriosis. For many young women, medical treatment of uncomfortable periods reduces symptoms. However, if the discomfort continues and has visited the doctor three or more times in the last six months, the doctor suggests a laparoscopy to confirm endometriosis.

A stage system for endometriosis has been developed by the American Society for Reproductive Medicine. There are four stages of endometriosis, minimal, mild, moderate, and severe. The stages are determined by the depth, breadth, and position of endometrial tissue following surgery.

What tests are used to diagnose endometriosis?

Endometriosis is a complex disorder that requires a multidisciplinary approach to manage effectively. Collaboration between gynaecologists, pain specialists, and mental health professionals is essential to provide comprehensive care, stated by Dr Sarah Adams.

The diagnosis is most commonly by a thorough history and physical examination that includes a pelvic examination. Endometriosis has been believed most frequently in women with menstruation-associated cyclic pain because it is an estrogen-dependent disease that affects women with excessive periods. In addition, a lot of endometriosis patients experience persistent pelvic pain that is not related to their menstrual cycle.

A laparoscopy, which involves inserting a camera into the pelvis through a small incision around the navel, is the only procedure that reliably identifies endometriosis. To view the internal organs of the pelvis and check for any endometriosis symptoms, the doctor utilizes a camera. Endometriosis is often managed or surgically eliminated during the laparoscopy if it is identified and has to be examined further.

Endometriosis is not diagnosed with surety using images, blood tests, or inside examinations, and a negative result on any of these procedures is not enough to rule out the development of endometriosis.

A transvaginal ultrasound scan is a simple and safe treatment that utilizes ultrasound waves to create scans of the uterus, fallopian tubes, and ovaries. A person is instructed to either lie on the back or on the side with the knees raised up to her chest for the ultrasound scan. Then, a thin, finger-sized ultrasonography device with a sterile sheath is carefully inserted into the female reproductive system. Transvaginal ultrasound scans are frequently described as irritating rather than excruciating. It's crucial to understand that a typical ultrasound scan is not sufficient to rule out endometriosis.

Listed below tests are used for the diagnosis of endometriosis:

1. Laparoscopy

Laparoscopy is a surgical procedure commonly used for the diagnosis and treatment of endometriosis. Doctors find it challenging or impossible to identify endometriosis growths with noninvasive imaging methods like ultrasounds. A laparoscopy is therefore the most effective method for diagnosing the disease.

A laparoscopy is a procedure where a thin, illuminated tube with a camera is inserted into the belly through small incisions made by the surgeon. This enables the surgeon to see the pelvic organs and spot any abnormalities or growths of endometrial tissue. The surgeon carries out more laparoscopic surgeries to treat endometriosis if it is discovered. Endometrial lesions or growths are surgically removed from the afflicted areas. This reduces discomfort and leads to better reproductive results. The endometrial tissue is destroyed with high-powered laser pulses. Smaller or superficial lesions are typically treated with this method.

Compared to open surgery, laparoscopic surgery for endometriosis has a number of benefits. Smaller incisions are used because it is minimally invasive, which reduces scarring, pain, and recovery time. Additionally, it enables a more accurate assessment and treatment of endometriosis lesions. However, there are risks inherent with any operation, including bleeding, infection, harm to the surrounding organs, and anaesthesia-related issues. Depending on the complexity of the procedure and the patient's capacity for healing, recovery times vary. It's crucial to talk about the potential advantages, risks, and alternatives with a healthcare expert who offers specific instructions based on the particular circumstances.

2. Magnetic Resonance Imaging( MRI)

Magnetic Resonance Imaging (MRI) is occasionally used to diagnose endometriosis, however, it is not frequently the primary method of imaging used for investigating endometriosis. Laparoscopy and transvaginal ultrasonography are the two main imaging techniques used to diagnose endometriosis. Although, in some circumstances, such as when deeply infiltrated endometriosis (DIE) is suspected or when other imaging methods are unclear, MRI will provide additional details.

The patient is instructed to abstain from food and liquids for a specific period of time before an MRI to check for endometriosis, particularly if a contrast agent is used. It is critical to let the doctor know if the patient has ever had any allergies, claustrophobia, or previous surgeries because these conditions affect the scan.

MRI is used to assess the shape, position, and degree of severity of endometriotic tissues. MRI is helpful in particularly those endometriotic conditions that impact deep pelvic structures such as the rectum, bladder, and ureters. A strong magnetic field and radio waves are used in the MRI scan to provide accurate visualizations of the pelvic region. The use of contrast materials during the scan is sometimes necessary to highlight particular organs or tissues depending on the particular clinical conditions. MRI is useful for evaluating deep infiltrating endometriosis, although it is not as effective for spotting superficial lesions or early stages of the disease. The best option for conclusive assessment and treatment has to be a laparoscopy. Remember that the doctor must decide whether an MRI is necessary for endometriosis diagnosis after examining the symptoms of the condition.

3. Pelvic Exam

A normal healthcare procedure called a pelvic exam is often carried out as part of the assessment for endometriosis. Even though a pelvic exam by itself does not conclusively identify endometriosis, it offers significant information that supports the diagnosis. A healthcare professional, usually a gynaecologist, will check out the pelvic organs during a pelvic checkup, including the uterus, cervix, fallopian tubes, and ovaries.

The cervix is seen by inserting a speculum into the vagina. Because the signs of endometriosis are frequently confused with those of other diseases, the doctor does a Pap screening to check for cervical cancer during this stage. The healthcare professional places one or two gloved, lubricated fingers into the vagina. This enables them to palpate the pelvic organs and feel for any anomalies, such as lumps, cysts, or sore spots that could point to the presence of endometriosis.

It's crucial to remember that while a pelvic exam reveals valuable indications, it does not conclusively identify endometriosis. The laparoscopic intervention is the only option to confirm a diagnosis of endometriosis. During a laparoscopy, a surgeon makes a tiny incision in the belly and inserts a thin, illuminated device to directly view and sample any probable endometriosis lesions.

4. Ultrasounds

Ultrasound is a useful examination in the diagnosis of endometriosis, although it is not the definitive method for diagnosing this condition. For diagnosing endometriosis, transvaginal ultrasonography is frequently used. In order to examine the pelvic organs more closely during the ultrasound procedure, a tiny ultrasound device is placed into the vagina.

Using this method, the uterus, ovaries, and surrounding structures are seen in great detail. It is used to spot some endometriosis symptoms, like ovarian endometriomas which are cysts with fluid inside that develop on the ovaries as a result of endometriosis.

It's crucial to remember, too, that not all types of endometriosis are quickly identified by ultrasonography. On ultrasound scans, for instance, superficial and deep infiltrating endometriosis is not detectable. These types of endometriosis are harder to detect with ultrasonography alone because endometrial tissue develops on the outermost layer or within deeper layers of pelvic organs and tissues.

Laparoscopy surgery is typically necessary to make a final, conclusive diagnosis of endometriosis. With a tiny abdominal incision, a thin, illuminated tool known as a laparoscope is introduced to provide a clear view of the pelvic organs during laparoscopy.

5. Blood tests

In order to confirm the diagnosis or provide more details, certain blood tests are utilized. Although they do not provide a conclusive diagnosis of endometriosis, these tests are used to assess some of the risk factors for the condition. Here are a few blood tests that are considered:

CA-125

CA-125 tumour marker is increased in some endometriosis patients, especially when the condition is severe or deeply infiltrating. CA-125 is not just increased in endometriosis; it is raised in other disorders such as ovarian cysts or pelvic inflammatory disease.

Anti-Müllerian hormone (AMH)

Anti-Müllerian hormone (AMH): This hormone is mostly used to evaluate the amount of ovarian reserve, but it is helpful in assessing ovarian endometriomas (cysts generated by endometriosis) and their effect on reproduction.

Inflammatory markers

According to certain research, women who have endometriosis have higher than normal levels of inflammatory markers such as C-reactive protein (CRP) or interleukin-6 (IL-6). These markers, however, are not confined to endometriosis and increase in a number of inflammatory disorders.

Who is at Risk of Having Endometriosis?

Even though the specific cause of endometriosis is unknown, certain factors increase the risk of developing the condition. Here are some risk factors associated with endometriosis

Family history

There is a genetic tendency for endometriosis because women who have a first-degree relative (such as a mother, sister, or daughter) with endometriosis are more likely to experience it themselves.

Early onset of menstruation

a woman who has early menstrual onset (before age 11) has a high chance of endometriosis development.

Anatomical problem

Endometriosis risk is increased in those who have certain anatomical problems with the uterus or cervix, such as a tilted uterus or an obstruction in the cervix.

Immunological factors

Environmental factors

It's crucial to remember that, despite the possibility that these factors raise the risk of endometriosis, the condition might still appear without them. In addition, each person will experience endometriosis differently, both in terms of the intensity of the symptoms and the effects. It's recommended to talk with a medical professional for an exact diagnosis and the best treatment.

What are the risk factors for endometriosis?

Even though the specific cause of endometriosis is unknown, certain factors increase the risk of developing the condition. Here are some risk factors associated with endometriosis:

Family history

There is a genetic tendency for endometriosis because women who have a first-degree relative (such as a mother, sister, or daughter) with endometriosis are more likely to experience it themselves.

Early onset of menstruation

a woman who has early menstrual onset (before age 11) has a high chance of endometriosis development.

Anatomical problem

Endometriosis risk is increased in those who have certain anatomical problems with the uterus or cervix, such as a tilted uterus or an obstruction in the cervix.

Immunological factors

Environmental factors

What are the complications of endometriosis?

Endometriosis has substantial social, general well-being and socioeconomic consequences. Due to extreme pain, exhaustion, sadness, anxiety, and infertility, endometriosis lowers the quality of life. Endometriosis patients feel excruciating pain that makes it impossible for them to attend a job or school. The sexual health of those who have endometriosis and their partners is impacted by painful sex because it causes interruption or rejection of sexual activity.

Infertility is the major complication of endometriosis, However, patients with milder type endometriosis are able to get pregnant. A 2019 systematic review and meta-analysis published in the journal Human Reproduction Update found that women with endometriosis had a significantly higher risk of infertility compared to women without the condition.

Scar tissue frequently forms around endometriosis lesions. Scar tissue from endometriosis changes the anatomy and affects the organ's structure. For instance, physical obstructions caused by scar tissue in the fallopian tubes inhibit effective pregnancy. Approximately 30-50% of women with endometriosis experience difficulties getting pregnant.

Some women have been successful in getting pregnant after surgical removal of endometriosis tissues.

The World Health Organisation acknowledges the significance of endometriosis and how it affects people's standard of life, sexual and reproductive wellness, and general well-being.

WHO wants to encourage and promote the implementation of sensible laws and measures around the world, particularly in low- and middle-income nations, to deal with endometriosis. In order to find efficient methods of endometriosis prevention, diagnosis, treatment, and care, WHO is collaborating with a variety of constituents, including colleges and universities, non-governmental organizations, and other organizations that are actively engaged in investigation.

In this way WHO works in partnership with civil society organizations and organizations that help endometriosis patients. WHO recognizes the significance of campaigning for improved regulations, products and services, and public awareness for endometriosis. WHO is working with important players, to ease and assist the gathering of information on the development of endometriosis in various countries and regions.

1. Infertility

Endometriosis leads to infertility, but it does not necessarily mean that all women with endometriosis will be unable to get pregnant.

An estimated 30 – 50% of women with endometriosis experience infertility.

According to the American Society for Reproductive Medicine (ASRM), “Endometriosis can influence fertility in several ways: distorted anatomy of the pelvis, adhesions, scarred fallopian tubes, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy, and altered egg quality”

The exact reasons why endometriosis causes infertility are not fully understood. However, many factors contribute to lower fertility in patients with endometriosis.

The wrapped anatomy that prevents successful fertilisation and implantation is caused by adhesions, scar tissue, inflammation, and the presence of lesions. Following ovulation, an egg must exit the ovary and travel down the fallopian tubes where it will come into contact with the male reproductive cells and fertilise.

This indicates that the egg must travel. Because of the altered position of the ovaries caused by deformed anatomy, the egg has problems accessing the fallopian tubes for fertilisation.

Inflammatory fluids produced by the inflammatory process due to endometriosis cause more discomfort, which prevents pregnancy.

2. Ovarian cancer

The majority of women with endometriosis do not acquire ovarian cancer, despite the fact that there is a known connection between endometriosis and an elevated risk of particular kinds of ovarian cancer. However, research has revealed that endometriosis patients are more likely to get some subtypes of ovarian cancer. Ovarian cancer affects 13% of women overall in their lives, while less than 2% of endometriosis-affected women get cancer. A 2018 study published in the Journal of Gynecologic Oncology found that women with endometriosis had a higher risk of developing ovarian cancer compared to women without the condition.

Endometriosis still resembles ovarian cancer, which results in malignant growths, despite the fact that the growths are benign. Endometriosis, like ovarian cancer, enlarges over time and harms nearby organs.

According to one study, endometriosis patients had an ovarian cancer incidence rate that was 1.7 times higher than that of the general population. This is due to the fact that endometriosis frequently goes undiagnosed, and numerous individuals realize that doctors ignore their symptoms or give them an incorrect diagnosis.

3. Mental health issues

Despite the fact that endometriosis predominantly affects the reproductive system, it has a serious negative influence on mental health. A 2021 study published in the Journal of Psychosomatic Obstetrics and Gynecology found that women with endometriosis had higher levels of anxiety and depression compared to women without the condition.

Chronic pelvic discomfort, which is excruciating and incapacitating, is commonly linked with endometriosis. Living with chronic pain cause disturbances in everyday activities, employment, and relationships, which result in anxiety or sadness, and anger.

A persistent condition like endometriosis causes emotional discomfort. Feelings of helplessness, grief, and loss result from the difficulty of dealing with symptoms, frequent doctor appointments, and unsuccessful treatments of the diseases. As a result of not being able to meet expectations on a personal or societal level, it results in emotions of guilt and shame.

Depression and feelings of hopelessness are exacerbated by the apparent symptoms of endometriosis and the uncertainty that goes along with it. Anxiety results from a persistent state of worry brought on by the fear of pain episodes, infertility, and the effect on the quality of life. Furthermore, endometriosis-related hormonal imbalances impact the brain's neurotransmitters, which contribute to the onset or worsening of depression.

Relationships, both personal and social, are strained if the patient has endometriosis. The disorder impacts relationships and causes feelings of frustration and guilt because of its unpredictable nature, fatigue, and problems with sexuality. Endometriosis-related physical changes, such as abdominal discomfort, weight changes, surgical wounds, or the adverse effects of hormonal therapy have a negative influence on a person's self-esteem and perception of their body. Women experience body dissatisfaction or a decreased feeling of attractiveness, which exacerbates depressive and anxious thoughts.

It's common to become socially isolated when managing a chronic illness like endometriosis. People feel cut off from their social networks when they have to rest, postpone plans, or restrict activity due to discomfort or exhaustion. Furthermore, feeling isolated and frustrated is a possibility as a result of the general public's ignorance due to endometriosis.

How does Endometriosis affect women's health?

The effects of endometriosis vary from woman to woman, but some common effects include.

Pelvic Pain

Endometriosis can cause severe pain and fertility issues, but there are treatment options available. It is important for women to seek medical help early on to prevent further complications and improve their chances of a successful outcome, according to Dr Mark Thompson.

Pain after or during sexual activity

Painful periods

Uncomfortable bowel movements

Neurological symptoms (rare)

Infertility

Endometriosis leads to infertility, but it does not necessarily mean that all women with endometriosis will be unable to get pregnant.

An estimated 30 – 50% of women with endometriosis experience infertility.

The exact reasons why endometriosis causes infertility are not fully understood. However, many factors contribute to lower fertility in patients with endometriosis.

Mental health issues

What are the available treatments for endometriosis?

While there is right now no treatment for endometriosis, there are a number of ways to reduce the symptoms and enhance the quality of life. The decision on the course of treatment is largely influenced by the woman's desire to get pregnant. The type of endometriosis therapy a woman chooses will be highly influenced by her particular situation. Numerous symptom-relieving therapies are thought about if pain and cramps are the primary issues. These include hormones, medication, and painkillers. However, hormone therapy is not recommended for women who want to get pregnant. A study published in the Cochrane Database of Systematic Reviews found that NSAIDs are effective in reducing pain in women with endometriosis.

None of the available therapies promises to cure a patient. Finding a medicine that sufficiently relieves symptoms and has side effects that women are comfortable with frequently takes some time for women. Medication is typically used to treat severe pain and cramps that occur during a woman's monthly menstruation. Painkillers and hormone-based medications that prevent ovulation are used to achieve this.

The majority of birth control medications have been shown to reduce pain brought on by endometriosis. However, withdrawal bleeding, which occurs at the end of a pill cycle and resembles period discomfort in some women still causes pain.

In general, laparoscopy is used to treat endometriosis. Alternatively, a laparotomy, a surgical technique that includes cutting through the abdomen is performed. In both procedures, the endometrial implants are removed using heat while the patient is under general anaesthesia.

Listed below are some available treatment options for endometriosis:

1. Pain reliever

The degree of the discomfort, the depth of the disease, and any prospective plans for conception must all be taken into consideration while creating a management strategy for endometriosis. There is no treatment for endometriosis because it is a chronic condition, however, there are various drug options that help to reduce pain.

Period pain and endometriosis are frequently treated using a class of analgesics known as non-steroidal anti-inflammatory medications (NSAIDs). Some of these medications are purchased "over the counter" in pharmacies, while others only be obtained with a prescription, especially if they are used in higher dosages.

Opioids are used for temporary pain relief when other drugs are unable to sufficiently manage severe pain. However, they are normally used as a last resort and only for a short time because of the possibility of addiction and other negative effects.

Before beginning any new drug, even over-the-counter remedies, it's crucial to talk with the doctor to make sure it is suitable for the particular disease. The doctor helps the patient to determine the best method of pain management for the discomfort brought on by endometriosis. It is important to investigate non-drug methods including heat therapy, mild exercise, relaxation techniques, and dietary changes.

2. Suplement hormones

Hormone-based medications stop the ovaries of women from producing hormones, limiting ovulation and monthly menstruation. Hormone therapy lessens the discomfort by preventing the soft tissues of endometrial implants from developing. However, it is unclear if these drugs cause endometrial implantation to reduce or remove entirely. When women stop taking hormone medication, symptoms of endometriosis frequently continue to develop.

The signs and symptoms of endometriosis are alleviated by hormone medications known as GnRH (gonadotropin-releasing hormone). However, compared to pills, the hormones have more potent negative effects: The GnRH suppress the female sex hormone estrogen which results in estrogen insufficiency.

Progestin-containing medications are used to treat endometriosis discomfort. Spotting (light period-like bleeding between cycles), weight gain, depressive symptoms, and decreased sexual drive are among the potential side effects of progestins.

The LNG-IUS, known as the levonorgestrel-releasing intrauterine system, is a progestin-containing coil that is placed into the mother's womb. The LNG-IUS has been investigated as an adjunctive therapy to surgery in the management of endometriosis.

3. Surgery

When endometriosis symptoms are severe, conventional treatments have failed, or there are particular indicators such as ovarian endometriomas or deep infiltrating endometriosis (DIE), surgical therapy for endometriosis is frequently considered. Surgery is used to remove endometrial tissue, adhesions, and cysts. A study published in the Journal of Minimally Invasive Gynecology found that laparoscopic surgery was effective in reducing pain in women with endometriosis.

The surgical method used to treat endometriosis most frequently is laparoscopy. A laparoscope—a small, illuminated tube with a camera—is introduced during the surgical operation to inspect and remove the endometrial implants after making just small incisions in the belly. Lesions are removed or eliminated using excision or burning methods.

A laparotomy is carried out in more severe endometriosis situations or when laparoscopy is not possible. This open procedure requires a wider abdominal incision in order to reach and eliminate the endometrial tissue. A hysterectomy (removal of the uterus) is an option in cases where the endometriosis is widespread and producing significant symptoms that have not improved with prior therapies. The impact on fertility and general health must be carefully considered before undergoing this treatment.

Endometriosis, which is deep infiltration, harms organs including the ureters, bowels, or bladder. To ease symptoms and enhance the quality of life, surgical excision tries to eliminate the endometrial tissue that has infiltrated these tissues severely.

4. Fertility treatment

Fertility treatment for endometriosis varies depending on the severity of the condition and individual circumstances. While endometriosis makes it more difficult to get pregnant, many women with the illness manage to get pregnant with the help of proper medical treatment.

In order to manage the signs and symptoms of endometriosis and enhance fertility, doctors prescribe hormonal drugs such as oral contraceptives, gonadotropin-releasing hormone (GnRH) agonists, and progestins. Both the development of endometrial tissue and irritation are suppressed with the aid of these drugs.

The focus must be on triggering ovulation if endometriosis has not resulted in any substantial structural problems. To increase the possibility of conception, doctors prescribe drugs like clomiphene citrate or letrozole to encourage the production of many eggs.

Is endometriosis treatable?

Yes, there is a cure for endometriosis. Endometriosis is unable to be cured completely, however, there are numerous treatments that help to manage the symptoms and enhance a person's quality of life.

Hormone-based medications stop the ovaries of women from producing hormones, limiting ovulation and monthly menstruation. Hormone therapy lessens the discomfort by preventing the soft tissues of endometrial implants from developing. Endometriosis, which is deep infiltration, harms organs including the ureters, bowels, or bladder. To ease symptoms and enhance the quality of life, surgical excision tries to eliminate the endometrial tissue that has infiltrated these tissues severely.

Is endometriosis an inflammatory disease?

Yes, endometriosis is regarded as an inflammatory condition. It is a disorder where the endometrium, the tissue that normally lines the inside of the uterus, develops outside of the uterus, usually in the pelvic region. Chronic inflammation brought on by endometriosis displaced endometrial tissue might result in a wide range of symptoms and consequences.

The body's immune system reacts by causing inflammation when endometrial tissue is present in unusual places. The immune system identifies this tissue as alien and starts an inflammatory response to get rid of it. Inflammatory mediators are released during the inflammatory process, which attracts immune cells to the damaged location.

Endometriosis-related inflammation results in pain, oedema, and the development of scar tissue or adhesions. In some people with endometriosis, chronic inflammation in the pelvic area is a factor in their infertility issues.

Although endometriosis causes inflammation, it is crucial to remember that it is a complicated disorder with many underlying causes, such as hormone imbalances and hereditary susceptibility. Research is being conducted in order to better comprehend the underlying mechanics of endometriosis, identify its precise causes, and create more efficient treatments.

Is endometriosis deadly?

No, Endometriosis is not generally associated with direct death because it is not regarded as a fatal disorder. However, it has a substantial negative influence on a person's quality of life and results in a number of issues that need medical attention.

The most common indication of endometriosis includes pelvic pain, excruciating periods, pain during sex, and infertility. These symptoms are prolonged and exhausting, affecting a person's physical and emotional health. Endometriosis causes adhesions, which are abnormal bands of scar tissue that bind organs together. In severe cases, this leads to complications such as bowel or bladder dysfunction.

Endometriosis patients must collaborate closely with medical staff to treat their symptoms and take care of any potential side effects. In order to enhance the quality of life and lessen the effects of the disorder, early diagnosis, adequate treatment, and consistent monitoring are recommended.