Some conditions are easy to deal with – out of sight, out of mind. Others, however, take every opportunity they can get to remind the individual of its existence. These types of conditions are not easy to deal with, and more often than not, will haunt one for the rest of their life.
Unfortunately, endometriosis lands in the latter category. On top of the debilitating symptoms which can significantly impact one’s quality of life, this condition is also difficult to diagnose and treat. If you have been having a hard time managing your endometriosis, find comfort that there are ways to cope.
Discover in detail about endometriosis and the few ways that can alleviate its symptoms.
Endometriosis: An Introduction
In normal circumstances, the tissue that lines the uterus, otherwise known as endometrium, is found only within the uterine cavity. However, when one develops endometriosis, the endometrium will develop and grow outside the uterine cavity or myometrium (muscular outer layer of the uterus). These microscopic bits of tissue, also known as an endometriotic implant, may grow in the ovaries, fallopian tubes, the space between the uterus and the rectum or the bladder. In rare cases, they can even spread to organs outside of the reproductive system, like the lungs.
Since these tissues make up the lining of the womb, they too respond to the hormones estrogen and progesterone by thickening, and they may bleed intermittently. Unfortunately, since they are not within the uterine cavity, the blood cannot leave the body. As a result, inflammations and scars often develop.
Endometriosis: How It Came to Be
The reason behind how the endometrium attains an abnormal placement is inconclusive and controversial, but the predominant theory is that retrograde menstruation is the cause. This happens when menstrual blood flows back through the fallopian tubes into the pelvic cavity instead of leaving through the body via the vagina. However, this theory is still heavily disputed as not all of those with retrograde menstruation experience endometriosis.
Another plausible cause includes immunologic abnormalities. Those with immune dysfunction that interferes with the clearing of the lesions may experience endometriosis. Somatic mutations with resulting poor growth regulation can be difficult to stop, especially if one has a faulty immune system.
Symptoms and Risks
Endometriosis manifests in two ways: pelvic pain and infertility. The extent of the pain is influenced primarily by the location and depth of the endometriotic implant, with the worst case being in areas that supply nerves to other parts of the body. Infertility, on the other hand, can result from the distortion of the anatomical relations between the various parts of the reproductive system, which can be due to the increase in fibrosis and the formation of adhesion. Moreover, these implants or the surrounding tissue can also produce a variety of substances, such as prostaglandins, cytokines and growth factors, which may impede overall infertility.
Aside from the symptoms of endometriosis itself, this condition also carries multiple risks. These risks can culminate into obstruction of menstrual flow (e.g. Mullerian anomalies), exposure to diethylstilbestrol (a synthetic form of hormone estrogen) in utero, prolonged exposure to endogenous estrogen, exposure to endocrine-disrupting chemicals and the like. All of these factors can further contribute to fertility complications, miscarriages, and infertility.
Note that these symptoms and risks are heavily dependent on the stage of the disorder.
Stage I (Minimal): Has few superficial implants, and there may be inflammation in or around your pelvic.
Stage II (Mild): Light lesions and shallow implants are observed.
Stage III (Moderate): Multiple deep implants are observed. There may be small cysts on one or both ovaries, as well as the presence of filmy adhesions.
Stage IV (Severe): There are multiple deep implants as well as large cysts that sit on one or both ovaries. There are many dense adhesions as well.
Managing Endometriosis
Unfortunately, there is no cure for endometriosis at the moment. However, there are available treatments that serve to alleviate the pain and symptoms of endometriosis. Medical treatments for endometriosis have focused primarily on the hormonal alteration of the menstrual cycle, with the aim to prompt a pseudo-pregnancy, pseudo-menopause, or chronic anovulation. If this conservative approach does not work, your doctor may suggest considering surgery.
The treatment options include:
Danazol
Danazol is a medication used to prompt anovulation (inhibiting the release of an ovum) by way of hormone manipulation. Whilst it does help to assuage the pain, it does not mean that the progression of the condition has stopped. Moreover, danazol also comes with substantial androgenic side effects, including hair growth, mood changes, deepening of the voice, adverse effects on serum lipids, and, rarely, liver damage.
Progestational Drugs
Progestational drugs are frequently used in the treatment of endometriosis. They cause significant morphological and functional changes to the cells of the endometrium, with eventual atrophy. If you are considering progestational drugs, be sure to consult your doctor as its side effects include abnormal uterine bleeding, nausea, breast tenderness, fluid retention and depression in some cases.
Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists
Gonadotropin-releasing hormone (GnRH) agonists and antagonists work by blocking the secretion of follicle-stimulating and luteinising hormones, which results in little or no production of sex hormones. This state will result in eventual endometrial atrophy and irregular menstrual cycles. The side effects include transient vaginal bleeding, hot flashes, vaginal dryness, decreased libido, breast tenderness, irritability and fatigue, insomnia and depression. Taking small doses of estrogen and progesterone simultaneously can help limit or prevent these symptoms.
Hysterectomy
Rarely, your doctor may suggest a total hysterectomy as a last resort should your condition not improve even with other treatments. This treatment involves the removal of the uterus and cervix. They may also remove the ovaries as these organs are involved in estrogen production, the hormone that triggers the growth of endometrial tissue. Additionally, the surgeon may remove visible implant lesions as well.
Hysterectomy is typically not recommended for endometriosis, especially if you desire to conceive after the surgery. As such, be sure to get a second opinion before agreeing to the surgery if you are thinking about starting a family.
Engage in Our Gynaecology Services
Unfortunately, the female body is extremely biologically complex and it undergoes multiple changes throughout its lifetime. There is no way to predict or avoid endometriosis from developing, and the only course of action left is to manage the condition.
At The O&G Specialist Clinic, we place your female reproductive health as our priority. Our fertility clinic boasts a team of experienced gynaecologist specialists dedicated to providing holistic gynecologic care that supports and enhances the health and well-being of women at any age. If you are suffering from endometriosis, we will look into the various treatments available and tailor them to fit your needs and wants.
Book a virtual consultation and let us help you take charge of your health today.
References:
Olive, D. L., & Pritts, E. A. (2001). Treatment of endometriosis. New England Journal of Medicine, 345(4), 266-275.
Parasar, P., Ozcan, P., & Terry, K. L. (2017). Endometriosis: epidemiology, diagnosis and clinical management. Current obstetrics and gynecology reports, 6(1), 34-41.
