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Synopsis

How Does Endometriosis Occur? Mechanism of endometriosis is still a topic of debate but the most acceptable explanation is retrograde menstruation.

What is Endometriosis?

Endometriosis is a long term and recurrent disorder affecting women mainly in their childbearing age (30-40 Yrs).
In this disorder tissue from endometrial lining of the uterus gets implanted outside of the uterus i.e. other sites in the abdomen, grows there and creates problems like lower abdominal pain, pain during periods, and intercourse, heavy menstrual bleeding and difficulty in having pregnancy.

How it occurs?

Mechanism of endometriosis is still a topic of debate but the most acceptable explanation is retrograde menstruation.

Uterus is a pear-shaped organ in lower abdomen which has a triangular cavity and this cavity is connected through fallopian tubes to inner side of abdomen.

Normally uterus has three layers, outermost is serosa, the middle layer is myometrium which is a muscular layer and innermost is endometrium. This innermost or endometrial layer which lines the uterine cavity is sensitive to hormones (estrogen and progesterone). In the first half of the menstrual cycle Endometrium get thickens in presence of estrogen and in the second half, it prepares itself for pregnancy in the presence of progesterone hormone. In absence of pregnancy, it sheds off along with menstrual blood and this is how a woman get her periods every month.

In some women, some amount of this menstrual blood with endometrial cells goes in retrograde or reverse manner to fallopian tubes, gets deposited in the abdominal cavity & surrounding tissues, and starts to grow there. During periods, these endometrial cells also tend to shed off but since there is no way to exit they grow in surrounding tissues & organs and release some substances which cause irritation, inflammation, adhesions of surrounding organs, damage to ovarian tissues, blockage of fallopian tubes and formation of scars which leads to pain in the lower abdomen and various other symptoms.

Other possibilities of endometriosis are –

• Direct transfer of endometrial tissues at the time of surgery is responsible for scar endometriosis
• Transfer of endometrial cells via the bloodstream and lymphatic system

Organs which can be involved in endometriosis: These all are the sites where endometrial tissue can get implanted

  • Ovaries
  • Inner lining of abdominal cavity
  • Intestines
  • Bladder
  • Ureter
  • Ligaments (Uterosacral ligament etc.)
  • Cervix
  • Vagina
  • Lungs and brain (Rare occurrence)

Who all are at risk?

Endometriosis a hormone-dependent disorder starts with periods and mostly ends with menopause.

It affects 2-10% of women in the general population,20-50% of women having difficulty in getting pregnant and 40-50% of women with pelvic or lower abdominal pain.

  • Women with history of endometriosis in mother/sister
  • Shorter gap between two periods(<25 days)
  • Longer duration of bleeding (More or = 7 Days)
  • Women who got their first period at early age ( <11yrs)
  • Lifestyle, Obesity, Smoking
  • Delayed marriageand delayed conception
  • Women who have never given birth

Symptoms: ESHRE (European Society for Human Reproduction and Embryology) has classified the endometriosis into four categories (Minimal/Grade I, Mild/Grade II, Moderate/Grade III, Severe/Grade-IV) according to location, depth, area and size of endometriosis implant

Common symptoms are:

Scar endometriosis – some women who had undergone cesarean section In previous pregnancy may suffer from scar endometriosis. It is a very rare condition in which there is pain, swelling, and bleeding from incision scar during periods.

Endometrioma – It is presence of endometriosis in ovaries. Sometimes women can have sudden and severe abdominal pain due to rupture of endometrioma.

Endometriosis is major problem for women, health system and society. It is a socio-economical burden because of greater medical expenses. It decreases the quality of life significantly because of physical and emotional stress. There is no definite cure for endometriosis but health awareness among women and early recognition of symptoms may help to detect the disease in early stages. Early diagnosis is very helpful as endometriosis can be easily treated with medicines and most of the time surgery can be avoided and help a woman to live a better and fulfilling life.

  • Endometriosis has terrible triad – Dysmenorrhea, Dyspareunia and Infertility. But not all women have all three complains together
  • Chronic Pelvic pain – Pain in lower abdomen and upper thighs is most common complaint in 40-60% of women which means 40-60% of women who visit hospital because of lower abdominal pain have endometriosis
  • Dysmenorrhea – Intense pain during periods. Pain starts before periods and remain even after bleeding had stopped
  • Menorrhagia – Heavy bleeding during periods
  • Dyspareunia – Severe pain during intercourse
  • Infertility – 20-50% of women have inability to conceive or encounter difficulty in getting pregnant because of
    1. Fallopian tubes get sticked to ovaries and intestines and form a mass and lose it’s normal functions
    2. Decreased tubal motility due to adhesions
    3. Decreased sperm motility
    4. Defective maturation of egg and inhibition of egg release
    5. Inhibition of embryo implantation
  • Other Symptoms – Depends on organ involved
    1. Dysuria – Pain while urinating
    2. Hematuria – Presence of blood in urine
    3. Painful defecation
    4. Headache, irritability, frequent stools and constipation.

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