Endometriosis: What you need to know

By: Adebowale Bello (Freelance Health Writer and DLHA Volunteer)

With Editorial contribution by The DLHA Team

 

Every human needs to have an idea of how to take care of their bodies and potential health conditions. As a female, endometriosis is one of a number of conditions that are abnormalities related to the female reproductive system. 

 

Take the case of Blessing, a 32-year-old Nigerian business woman who lives in the bustling city of Lagos, Nigeria. She presents to her  doctor with concerns of infertility. She has been trying to get pregnant over the past  two years with  no success and offered that her 30-year-old sister also struggles with infertility. She reports that several times she thought she could be pregnant due to absent menses with accompanying abdominal pain that is sharp and stabbing”. The pain is more intense during menstruation. The pain usually extends from her lower abdominal area into her sides (flanks), and she rates it as 6 on a scale of 1-10. The use of over the counter pain killers like acateminophen does not relieve her pain. She reports that her cycle can be irregular, with the length ranging up to 25-38 days or occasionally no period at all. She is concerned that she may have cancer as her grandmother died at age 63 of colon cancer. She is also concerned that she and her husband have not had enough intercourse for a pregnancy to occur due to distressful pain associated with the act.

Blessing’s story is a typical story for patients with endometriosis as the most common symptoms of the condition are pelvic pain and infertility. Additional symptoms include irregular or absence of menstruation, pain during urination, defecation, and intercourse. Constipation and abnormal vaginal bleeding may also be present. A family history of infertility and cancer in a pelvic organ are also typical in these patients.

 

DID YOU KNOW?

According to the World Health Organization, 1 1 in 10 women and girls of reproductive age globally suffer from endometriosis. But reports from limited studies of the disorder suggest that it is relatively rare in African indigenous women 2, 3. The reason for this may include low awareness, under-diagnosis, under-reporting and under-resourced. Notwithstanding, endometriosis can lead to infertility among other life-impacting effects.

 

In this article, we’ll discuss

  • What endometriosis is
  • Types of endometriosis
  • Adverse effects of endometriosis
  • How does endometriosis cause infertility
  • What causes endometriosis
  • How do I know if I have endometriosis?
  • Diagnosis of Endometriosis
  • Can I prevent Endometriosis?
  • How is Endometriosis treated?

 

What is Endometriosis?

As a female, inside of your uterus (womb) is lined with an exclusive tissue known as endometrium and this tissue is found only in the uterus.

Endometriosis is the growth of a lookalike endometrial tissue outside the uterus and this similar tissue can grow on other organs such as the ovaries, fallopian tube and the outer part of the uterus (rather than the inside.), (See figure 1)

The presence of this tissue growth in the wrong place brings about pain and the formation of scar tissue on other organs.

Interestingly, the lookalike endometrial tissue bleeds at the end of the monthly menstrual cycle (just like the normal endometrium in the uterus) but unlike the normal endometrium, there’s nowhere for the blood to flow.

Let’s discuss the types of endometriosis,

 

Types of Endometriosis

1. Endometrioma: According to the Journal of Ovarian Research, this is the most common form of endometriosis as it is found in 17-44% of endometriosis patients. It forms dark fluid filled cysts in the ovary which vary in size and lead to a decrease in fertility.

2. Peritoneal endometriosis: The peritoneum is a membrane that lines the abdominal cavity and is also responsible for constant secretion of vital fluids. Endometriosis lesions could develop on the surface of the peritoneum.

3. Deeply Infiltrating Endometriosis: This type of endometriosis is found deep in the organ or tissue and this type of endometriosis can create a “frozen pelvis”. It is also quite rare as it doesn’t affect many women.

 

Adverse Effects of Endometriosis

Due to the growth of a similar endometrial tissue outside the womb, other organs within the abdomen and pelvis suffer adverse effects such as

  • Chronic pelvic inflammation
  • Scarring of the fallopian tubes
  • Distorted pelvis shape
  • Bladder and Bowel dysfunctions
  • Sexual intercourse issues
  • Nausea and Vomiting
  • Depression & Anxiety
  • Infertility

 

How does Endometriosis cause Infertility?

The adverse effects that the reproductive system suffers from, decreases the chances of fertility and prevents implantation of an egg.

 

What causes Endometriosis?

The cause of endometriosis is not known though research has shown that endometriosis is hereditary, that is your risk of endometriosis increases if a close family member like your mother or sister has the disease.

Another possible hypothesis of the cause of endometriosis is known as retrograde menstruation which is when instead of blood flowing out of the cervix and vagina during periods, it flows back into the body via the fallopian tube and some lookalike endometrial cells might be deposited outside the uterus and into the pelvis where they can attach to other tissues/organs and grow.

 

How do I know if I have endometriosis?

Endometriosis is often misdiagnosed as its symptoms are common. These symptoms vary and may include a combination of any of the following:

  • Painful urination
  • Painful intercourse
  • Painful periods
  • Recurring pelvic pain
  • Constant fatigue
  • Depression and anxiety
  • Infertility

These symptoms are also associated with some other disease conditions like cystitis and pelvic inflammatory disease. For this reason, the diagnosis of endometriosis isn’t as simple as it should be and it usually takes multiple doctor appointments which could span several years before a correct diagnosis can be made.

 

How is Endometriosis diagnosed?

To make a diagnosis of endometriosis, your doctor will take a comprehensive history from you, followed by a complete or focused examination of your body including your reproductive organs. Then s/he may employ a variety of medical procedures to support the clinical diagnosis.

Let’s have a look at three of these medical procedures.

1. Ultrasound

This is a medical procedure that uses high frequency sound waves to take live images of the ovaries, uterus and surrounding organs. It can reveal growth of cysts or other unusual tumor growth in the lower abdomen and pelvis. 

2. Laparoscopy

This is also another medical procedure used to examine internal body organs. A tube known as a laparoscope which has a camera and lighting is inserted into the body while images are shown on a screen. As live body images are shown on the screen, your doctor would watch out for the presence of lesions around your pelvis. These lesions could vary in size and colour that may indicate possible signs of endometriosis.

3. Magnetic Resonance Imaging. ( MRI )

This is a non-invasive medical procedure which creates detailed 3D images of the internal body organs and tissues with a specialized imaging tool that uses high frequency radio waves under magnetic fields. It is very effective in detecting endometrioma which is the most frequent form of endometriosis.

 

Click on image below to watch a nurse with endometriosis recount her painful journey to diagnosis.

 

Can I prevent Endometriosis?

No, you can’t

Unlike some other health conditions it is not possible for you to prevent endometriosis but that doesn’t mean that you’re without hope.

Regular medical checkup can help detect this disease condition early so that progressive measures can be put in place to minimize the possible ill effects of endometriosis.

But if you’ve been diagnosed with endometriosis, what treatment measures are available to ensure you live a reasonably normal life?

 

How is Endometriosis treated?

Endometriosis cannot be prevented neither can it be cured but its symptoms can be managed.

Your doctor might decide to use any of the following treatment methods or a combination of such methods.

1. Hormone treatment

Endometriosis thrives in the presence of the vital female hormone oestrogen and this treatment method aims to reduce the oestrogen level present in the body.

2. Surgery

Surgery is a medical option used to remove lesions and unwanted scar tissues, it can be considered as a last resort if other options do not work.

3. Pain relief Medications

Pain relief medication which mostly belong to the class of “Non-Steroidal Anti-Inflammatory Drugs” are prescribed to relieve patients who suffer from endometriosis of their pain and inflammation. Examples of these pain relief medications include ibuprofen and naproxen.

 

Take Away

Endometriosis is a disease condition that has the potential to affect females globally though you’re more at risk if you have a family history of endometriosis.

Though it can neither be prevented nor cured, treatment can help in managing symptoms of the disease so as to have a better quality of life.

There is need for more studies and community awareness raising especially in African countries to ensure early detection and diagnosis, as well as improve management of the disease.

 

REFERENCES

1, Endometriosis. World Health Organization. Accessed October 4, 2022.

2. Kyama, C.M. et al., Endometriosis in African women. Women’s Health (Lond.). 2007 Sep; 3 (5): 629-35.

3. Ohayi. S., Onyishi, N and Mbah, S.: Endometriosis in an indigenous African women population. Afr. Health Sci. 2022 Mar. 22 (1):133-138.

 

Published: October 8. 2022

 

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