What is Endometriosis?
The lining of the uterus is called the endometrium. Endometriosis occurs when the tissue similar to the lining of the uterus (known as endometrial tissue) grows outside the uterine cavity on the ovaries, fallopian tubes, bowel, and the surrounding pelvic tissue. Whilst it is rare for endometrial tissue to spread beyond the pelvic region, it is not unheard of.
With each menstrual cycle, the endometrial tissue thickens, disintegrates and sheds (bleeds). Normal endometrial tissue passes through the vagina after shedding, but this is not possible for the endometrial-like tissue that is outside the uterus. It has nowhere to go and becomes a source of pain and irritation. This irritation eventually leads to scarring. Adhesions of abnormal fibrous tissue bind pelvic tissues and organs together. Issues with fertility are also a result.
What causes endometriosis?
Whilst numerous theories have been proposed and we will explore some of these later, the truth is the exact cause of endometriosis is not known. Many females may not be diagnosed for several years due to the invasive nature of testing.
So, let’s explore some of these theories. Remembering these theories are not proven and may not be true. They are a best guess to explain what is happening and there may be more than one contributing factor.
Embryonic cell transformation.
Embryonic cells (These are cells in the earliest stages of development.) may metamorphose into endometrial-like cell implants during puberty by hormones.
Endometrial cell transport.
Endometrial cells may be transported to other parts of the body by blood vessels or the lymphatic system.
Inflammation and Immune System Disorders
There are increased inflammatory markers in the peritoneal fluid of women who have endometriosis. The immune system may not recognise and destroy endometrial-like tissue that's growing outside the uterus or the immune system may be overzealous and cause inflammation.
Surgical scar implantation
Endometrial cells may attach to an incision after surgery for a C-section or hysterectomy.
Menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These endometrial cells may attach a blood source (pelvic walls and pelvic organs) and continue to grow.
Transformation of peritoneal cells
Peritoneal cells that line the inside of the abdomen are transformed into endometrial-like cells by hormones and/or the immune system.
Do you have any of the symptoms?
Endometriosis effects approximately 10% of women and has varying symptoms. Although pelvic pain is often an indicator of endometriosis, some women may have no symptoms. So, what are the common symptoms of endometriosis?
- Dysmenorrhea (Painful periods)
- Individuals may experience cramping, pelvic pain, abdominal and lower pain before and during their period. This may last for days.
- Excessive bleeding both during your period and sometimes between cycles.
- Pain during or after intercourse
- Painful bowel movements
- Pain when urinating
- You may not discover this until trying to conceive.
- Severe teenage acne
- Long term research has revealed a link between severe teenage acne and endometriosis.
Other signs and symptoms include fatigue, diarrhoea, constipation, bloating and nausea during period.
A friend’s story
Unfortunately, the endometrial-like tissue spread outside the pelvic region in my friend. It was extremely painful and become increasingly debilitating as it spread and attached to the bowel. The mass formed was the size of an orange! I remember my friend being so scared that she would need a colostomy bag after the surgery. Thankfully, the surgeons were able to remove it all and leave the bowel intact. It was a life changing moment for her.
If you think you may have endometriosis, please book an appointment to see your doctor.