Instead of growing inside the uterus, the endometrium will grow around the ovaries, fallopian tubes, and even around abdominal organs not related to the reproductive symptoms. During normal menstruation, the uterine lining, including the endometrium, sheds and flows out of the vagina; when a person struggles with endometriosis, the endometrium will still shed, but because it has no easy way to exit because it grows in abnormal places, the result can be extremely painful.
About 5 million people in the US deal with painful menstruation, trouble becoming pregnant, and heavy bleeding, along with other symptoms of endometriosis. This means two out of every 10 women in the US, between the ages of 25 and 40, have mild to severe endometriosis.
Although endometriosis can affect women at any age, most people receive a diagnosis of this condition in their 30s or 40s. One estimate suggests that 11 percent of women between 15 and 44 years old struggle with endometriosis. Like any chronic condition, there are several factors that influence whether a woman could develop endometriosis.
Some of these risk factors include:
- Trouble with menstrual flow: Retrograde menstrual flow may go up into the fallopian tubes, pelvis, and other parts of the reproductive system or abdominal organs.
- Genetic factors: While no specific genetic mutation has been linked to endometriosis, there is likely a genetic component since family history is associated with a higher risk of endometriosis.
- Immune system issues: Autoimmune issues, an overactive immune system, and even some kinds of cancer can attack the endometrium and lead to growths outside the uterus.
- Hormones: Estrogen appears to increase the risk of endometriosis; women with higher levels of estrogen or extreme fluctuations in this hormone are more likely to struggle with endometriosis.
- Surgery: Women who have had abdominal surgeries may develop endometriosis. A Cesarean section or partial hysterectomy can pick up uterine tissue and accidentally move it to other areas of the body.
Other factors associated with a risk of endometriosis include:
- Never having children
- Periods that last more than seven days
- Short menstrual cycles lasting less than a month
- Close relatives with endometriosis
- Another health problem that prevents blood from flowing out of the uterus during menstruation
- Some environmental or chemical toxins that mimic estrogen
Signs of endometriosis include:
- Intense menstrual cramps before and during menstruation
- Chronic lower belly and back pain
- Uncomfortable vaginal sex
- Heavy periods
- Bleeding or spotting between periods
- Bloating, nausea, or diarrhea
- Difficulty with urination or bowel movements
- Intestinal pain
- Other stomach or digestive problems
Endometriosis leads to benign growths. These can block fallopian tubes, grow over the ovaries, or even grow inside ovaries. Trapped blood inside the ovaries and fallopian tubes can form cysts. This and other growths may lead to inflammation and swelling. The growths may also form scar tissue, which can bind organs together, causing pelvic pain, problems in the intestine, and bladder trouble.
- There are four stages of endometriosis:
- Minimal: Small lesions or wounds lead to the endometrium growing outside the uterus, causing inflammation in or around the pelvic cavity.
- Mild: Light lesions lead to shallow implants on the pelvic lining, ovaries, fallopian tubes, or other areas.
- Moderate: Deep implants of uterine tissue occur on the ovaries and pelvic lining.
- Severe: Deep implants of endometrial tissue appear on the ovaries, pelvic lining, fallopian tubes, and even the bowels.
- There are several conditions associated with endometriosis, although the exact reasons are unknown. Some of these conditions include:
- Allergies and asthma
- Autoimmune diseases like lupus, hypothyroidism, or multiple sclerosis
- Chronic fatigue syndrome
- Some forms of cancer, including non-Hodgkin lymphoma, breast cancer, and ovarian cancer
Ovarian cysts and cancer may have symptoms similar to endometriosis, so a woman may be misdiagnosed with endometriosis before receiving a cancer diagnosis.
The Association between Endometriosis and Ovarian Cancer
For over 100 years, medical professionals have theorized about a link between endometriosis and ovarian cancer. Only recently, though, medical studies have clarified the correlation between these two conditions. One study of ovarian cancer patients who have had operations for this cancer found that 10 percent had co-occurring ovarian endometriosis. When the study narrowed ovarian cancer to clear cell ovarian cancer, that percentage went up to 36.8 percent. Because of studies like these, a type of ovarian cancer called endometriosis-associated ovarian carcinoma (EAOC) has been identified.
Another potential link involves hormone therapy. Women with intense endometriosis symptoms may take hormonal therapies to manage their levels of estrogen; however, these artificial changes in estrogen levels may increase the risk of ovarian cancer.
Doctors are clear that endometriosis is actually much more common than ovarian cancer, but screening for endometriosis is still fairly difficult. Complications from screening for endometriosis may just lead to a misdiagnosis of potentially malignant cysts, which are cancerous or precancerous rather than benign. The current methods for diagnosing endometriosis include a pelvic exam, transvaginal ultrasound, and using hormone therapies to manage symptoms; less painful, more regular menstrual cycles indicate that endometriosis is successfully treated by estrogen therapy.
Treatment of Endometriosis
While there is no cure for endometriosis, there are several approaches to treatment, depending on how serious symptoms are.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to manage pain and inflammation.
- Some forms of hormonal birth control can lower estrogen levels or manage estrogen cycles to reduce endometriosis symptoms.
- Exercising more than four hours per week, to keep a low percentage of body fat, is recommended.
- Avoid excessive alcohol consumption, which raises estrogen levels; stick to one serving of alcohol per day.
- Avoid drinking too much caffeine; limit intake to one caffeinated beverage per day.
- Medications like gonadotropin-releasing hormone (GnRH) agonists can lower the amount of estrogen during menstruation.
- Laparoscopic surgery may be used to remove pockets of uterine tissue or fibroids.
- If no other treatments work, a hysterectomy may be the best option.
Healing from Endometriosis and Related Mental Struggles
- Because endometriosis is a chronic health condition, the cost of long-term treatment could be extensive. Monthly medications or therapies may be hard to manage financially, especially if work days are consistently missed due to pain. One study estimated that annual medical costs and loss of productivity can lead to $2,801 and $1,023 lost per patient. In the US, the annual costs of endometriosis treatment in 2002 was around $22 million. In addition, a one-time surgery can be a large upfront expense.
- Getting treatment to manage anything associated with endometriosis is extremely important. Aside from directly related symptoms like pain or exhaustion, women may develop depression or anxiety as they lose their ability to do things they once loved or they struggle with pain all the time. Some women may develop a substance abuse disorder to self-medicate their mood or pain. Working with mental and behavioral health professionals to overcome substance abuse, mood disorders, and other problems associated with endometriosis can help to manage symptoms directly caused by the underlying condition.