Dr. Sonali Gupta, Principal Consultant and IVF Specialist, Yatharth Superspeciality Hospital, Greater Noida
Endometriosis is an often painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes, and the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond pelvic organs.
What are the common causes of Endometriosis?
Although the exact cause of endometriosis is not known, possible explanations include:
In retrograde menstruation, 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 stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
Transformation of peritoneal cells
In what’s known as the “induction theory,” experts propose that hormones or immune factors promote the transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial-like cells.
Embryonic cell transformation
Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial-like cell implants during puberty.
Surgical scar implantation
After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
Endometrial cell transport
The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
Immune system disorder
A problem with the immune system may make the body unable to recognize and destroy endometrial-like tissue that’s growing outside the uterus.
What are the Risk Factors?
Several factors place you at greater risk of developing endometriosis, such as:
- Never giving birth
- Starting your period at an early age
- Going through menopause at an older age
- Short menstrual cycles — for instance, less than 27 days
- Heavy menstrual periods that last longer than seven days
- Having higher levels of estrogen in your body or greater lifetime exposure to estrogen your body produces
- Low body mass index
- One or more relatives (mother, aunt, or sister) with endometriosis
- Any medical condition that prevents the normal passage of menstrual flow out of the body
- Reproductive tract abnormalities
Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis may temporarily improve with pregnancy and may go away completely with menopause unless you’re taking estrogen.
With endometriosis, the endometrial-like tissue acts as endometrial tissue would — it thickens, breaks down, and bleeds with each menstrual cycle. But because this tissue has no way to exit your body, it becomes trapped.
When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other.
Endometriosis can cause pain — sometimes severe — especially during menstrual periods. Fertility problems also may develop. Fortunately, effective treatments are available.
What happens if endometriosis is left treated?
Endometriosis does not resolve on its own. If you experience pain and other symptoms, these symptoms will remain unless you receive treatment. In some cases, your symptoms may get worse.
In addition to pelvic pain, infertility is another common complication of endometriosis. About half of all women with endometriosis have problems getting pregnant. Fortunately, there are many treatment options to resolve infertility and other symptoms.
Furthermore, those with endometriosis have a higher risk than those without it for developing ovarian cancer.
Treatment options for endometriosis depend on the symptoms and the severity of the condition, as well as whether you would like to get pregnant.
What Are the Stages of Endometriosis?
There are different ways to measure endometriosis. The most widely used scale is from the American Society of Reproductive Medicine. Doctors assign points according to the spread of the endometrial tissue, its depth, and the areas of your body that are affected.
Based on the results, the condition is ranked in one of four stages:
Stage 1 or minimal: There a few small implants or small wounds or lesions. They may be found on your organs or the tissue lining your pelvis or abdomen. There’s little to no scar tissue.
Stage 2 or mild: There are more implants than in stage 1. They’re also deeper in the tissue, and there may be some scar tissue.
Stage 3 or moderate: There are many deep implants.
Can endometriosis affect a pregnant woman?
During pregnancy, people with endometriosis may be more likely to experience complications or when giving birth, although this is very rare.
Most people with endometriosis are able to have a healthy, uncomplicated pregnancy.
There are no specific monitoring tests or treatments for people who are pregnant and have endometriosis.