Endometriosis - causes, symptoms, stages, diagnosis and treatment

Medically Reviewed by Dr Sravya, MBBS, MS

Introduction

Endometriosis is one of the leading causes that has made many women long to experience the joy of motherhood only to meet disappointment. Endometriosis is a gynecological disorder, where the tissues that generally form inside the uterus in the uterine lining, called endometrium, form outside the uterus where it is not supposed to grow. It is a painful condition that may affect your day-to-day life and cause heavy, painful periods. It may also cause fertility issues.

In This Article

What is endometriosis?

It is a condition that causes uterine tissues to grow outside the uterus and makes you uncomfortable with its symptoms. It affects fertility in some, causing them problems in conception.

The endometrium is the lining of the uterus where the tissues grow, which shed away during menstrual periods and support the growth of the fetus in pregnancy by keeping intact the endometrium. In this condition, the tissues grow in the organs, including ovaries, fallopian tubes, and in the lining of your pelvic region. It is very uncommon to find endometrial tissues in the areas where your endometrial tissues grow.

Generally, the endometrial tissues thicken and shed away during each menstrual cycle. With endometriosis, the tissues grow outside the uterus, and they do not have a way to shed away. Hence, the tissues get trapped inside the body. Endometriosis, which involves organs like ovaries, may have a formation of cysts called endometriomas. The cysts irritate and lead to the development of scar tissue, i.e., bands of fibrous tissue that stick pelvis tissues and organs to each other.

Causes of endometriosis

Endometriosis does not have a clear cause but is thought to have caused due to the following reasons.

Retrograde menstruation: Here, the blood from the uterus flows back to the fallopian tubes and the pelvic cavity, but it should go outside the body. Endometrial cells adhere to the pelvic walls. They grow here and continue to thicken and shed away during each menstrual cycle.
Transformation of peritoneal cells to endometrial-like cells: Studies suggest that hormones or immune factors turn the peritoneal cells (inner cell lining of your abdomen) into endometrial-like cells.
Hormone estrogen transforms embryonic cells (the cells in their earliest developmental phase) into endometrial-like cells during puberty.
Surgeries like hysterectomy or C-section may have endometrial cells attached to the surgical cuts.
Sometimes, endometrial cells may be flown through blood vessels and the lymphatic system.
The immune system may recognize the endometrial-like tissues that grow outside the uterus as a foreign material.

Types of endometriosis

Endometriosis has different types based on the location of the pelvis it affects. It is divided into four main types:

Superficial peritoneal endometriosis: Peritoneum is the lining of your abdominal and pelvic cavity. The endometrial tissues attach to this lining.
Endometriomas: Also known as chocolate cysts, these dark fluid-filled cysts normally appear in the ovaries. They may vary in size and appear in different parts of the pelvis and abdomen.
Deeply infiltrating endometriosis: As the name suggests, the tissues deeply invade the organs inside or outside the pelvic cavity, which includes organs like ovaries, rectum, bladder, and bowels.
Surgical endometriosis: After having a cesarean, the endometrial-like tissues may grow on the abdominal wall.

Stages of endometriosis

There are four stages of endometriosis. Let us discuss them in detail.

Stage I - It is known as minimal endometriosis that involves small and superficial endometrial growths. They have growths on organs that line the pelvis and abdominal cavity.
Stage II - It is known as mild endometriosis. It involves deeper and more tissue growth with possible scar tissue. The growth can be located throughout the body but is mostly found near ovaries, fallopian tubes, and behind the uterus.
Stage III - This stage is known as moderate endometriosis and involves deeper tissue growth and ovarian endometriomas in at least one ovary. When the tissues lining the ovaries are shed, thick and brown blood is collected, which appears brown. Tissue implants activate the body’s response to fight the inflammation caused by tissue forming thin bands of scar tissue known as filmy adhesions. These filmy adhesions make the organs stick to one another and cause sharp, stabbing pain, etc.
Stage IV - This is the most severe form of endometriosis with many cysts and severe adhesions. The cysts grow to the size of grapefruit, which may go on their own or have to be surgically removed. The cysts may be present on the back of the uterus and rectum, causing painful bowel movements, constipation, or nausea. If the cysts block the fallopian tubes, the patient may have infertility problems.

Symptoms of endometriosis

Pelvic pain that is associated with menstrual periods may be a symptom of endometriosis. Period pains involve cramping, but the pain with endometriosis is worse than normal menstrual pain.

Symptoms of endometriosis include:

Dysmenorrhea: It is a medical condition that causes painful periods. The patient has pelvic pain and cramping, sometimes associated with lower back and abdominal pain.
Painful intercourse: Intercourse that leaves one in pain may be a sign of endometriosis.
Painful urination: Micturitions that feel painful during menstrual periods may be a symptom of endometriosis.
Heavy menstrual flow: Menstrual periods that are heavier than normal periods or bleeding that occurs between menses can be a sign of endometriosis.
Inability to reproduce: Endometriosis is one of the major reasons for infertility.
Some women experience diarrhea, bloating, and nausea, especially during menstruation. This may be due to endometriosis.

Diagnosis of endometriosis

Primary diagnosis of endometriosis involves assessment of symptoms. Primary symptoms include painful and heavy periods. A pelvic examination may be carried out. To collect more information, your OB-GYN may carry out imaging, and an MRI may be carried out. A laparoscopy may be performed to retrieve a tiny tissue sample that will be forwarded to the lab for endometriosis diagnosis.

Treatment of endometriosis

Based on the symptoms that you present, your healthcare provider may make a plan of treatment. Certain factors that are taken into consideration while making a treatment plan:

The primary focus of the treatment for endometriosis lies in managing and treating your pain along with improving reproductive functions if you are planning a baby. Treatment of endometriosis involves medications and surgery depending upon the severity of the symptoms.

Medicines, including hormonal pills and painkillers, are prescribed. Let us discuss the role of these medicines in the treatment of endometriosis.

Birth control pills: Birth control pills target gonadotropin-releasing hormone and estrogen. It is very common to have high levels of estrogen in endometriosis, and hence birth control pills are given to suppress estrogen and, in some cases, GnRH as it reduces the production of estrogen and hence reduces the growth of endometrial-like tissues outside the uterus.
Progestin therapy: This is similar to progesterone, which is a pregnancy hormone. It works by thinning the uterine lining and reducing the endometrial-like tissue growth. It is available in the form of pills, IUDs, skin patches, injections, and skin implants.
Danazol: This is an artificial steroid that is similar to testosterone, a male hormone that prevents the release of estrogen, eventually preventing endometrial-like tissue growth and pain. It is available in tablet form.

Conclusion

Endometriosis is a gynecologic disorder that causes the endometrial-like tissue to grow outside the uterus. It causes severe pain that affects your day-to-day life. It may cause infertility. An endometrium is an internal lining of tissues that is shed away every month during the menstrual period. However, in endometriosis, the tissues grow outside the uterus, and hence, the blood does not leave the body and remains there.

Retrograde menstruation is assumed to be the cause of endometriosis, transformation of peritoneal cells into endometrial-like cells, conversion of embryonic cells to endometrial-like cells during puberty, and surgical incisions that have this tissue growth.

Symptoms of endometriosis include painful periods, painful intercourse, and painful urination. Endometriosis is divided into four stages viz: minimal, mild, moderate, and severe. These stages have minimal to severe growth of tissues and affect fertility.

Diagnosis of endometriosis primarily involves a physical examination and imaging in a few cases if required. In a few cases, a laparoscopy may be done to diagnose endometriosis. Your gynecologist may check your family history for endometriosis and may make a treatment plan considering a few factors like your age, plans for a baby, and severity of the pain.

Treatment of endometriosis includes hormonal pills to suppress the excessive production of estrogen that causes the growth of endometrial-like tissues. Medicines used to treat this condition include progestin and danazol, a steroid similar to the male hormone testosterone, which reduces tissue growth and pain associated with endometriosis.