It is important to have an understanding of the basics about endometriosis because it will help women who suffer from this condition know what and why they need to keep healthy and do as much as possible to establish hormone balance.
This condition is on the increase, and there are many thoughts about this. We suspect that the high oestrogen levels in western women are a contributing factor. It can be hereditory (runs in families) and can have immune dysfunction involvement. And of course, stress and emotional issues are often involved.
What is Endometriosis?
This is a common medical condition where the tissue of the lining of the uterus, called the ‘endometrium’, is found outside the uterus, affecting other organs in the pelvis such as the bowel or ovaries. Endometriosis usually develops in women of reproductive age.
Most endometrial tissue is found on structures in the pelvic cavity: ovaries, fallopian tubes, the front and back of the uterus, uterine ligaments, intestines and the bladder. It may spread to the cervix and vagina or to sites of a surgical abdominal incision. This condition can lead to serious health problems, primarily pain and infertility.
Endometriosis is the most common gynaecological problem after fibroids. The National Endometriosis Society estimates that 2 million women in Britain alone have endometriosis. In the US, that number is closer to 5 million. Up to 10% of Australian women suffer from this condition.
Facts and figures about endometriosis
- 3-10% of women of reproductive age are affected by this condition.
- Most patients are in their 20s and 30s.
- This condition is in the top three causes of infertility.
- 30-40% of women are infertile because of this condition.
- Some women have no symptoms and only become aware of having this condition when they start trying to conceive.
- Rarely, endometriosis persists after menopause; sometimes, hormones taken for menopausal symptoms may cause the symptoms to continue.
Causes of endometriosis
The womb lining (endometrial tissue) responds to the natural hormone cycle and bleeds every time a period occurs. When women bleed normally throughout menstruation, blood leaves the body through the vagina. However, in the case of endometriosis, the blood has no outlet and becomes trapped in the tissue, causing pain, inflammation, cysts and scar tissue. You may find blood in your stools or urine during your period, or experience pain in diverse areas of your body. More uncommon, but not unheard of, are women experiencing nosebleeds during their periods because they have endometrial patches in the nasal passages.
In summary, the following are key causes of endometriosis:
- Retrograde menstrual flow
- Genetic predisposition
- Oestrogen dominance/oestrogen displacement
- Microbes such as e.coli, mycobacteria and herpes viruses such as Epstein Barr virus (EBV) and Cyclomegalo virus (CMV) are associated with endometriosis.
While the exact cause of endometriosis remains unknown, many theories have been presented to explain its development. These concepts do not necessarily exclude each other. Endometriosis is an oestrogen-dependant condition, as it is seen during the reproductive years and generally disappears after menopause. Medical therapy is often aimed at lowering oestrogen levels to control the disease.
Key causes of Endometriosis
- ‘Retrograde menstruation’, is when some menstrual blood flows upwards into the pelvis and attaches to various organs in the abdomen. While most women may have some retrograde menstrual flow, typically their immune system is able to clear the debris and prevent implantation and growth of cells from this occurrence. However, in some patients, endometrial tissue transplanted by retrograde menstruation is able to implant and establish itself as endometriosis.
- Factors that might cause the tissue to grow in some women, but not in others, need to be explained, and some of the possible causes below may provide some explanation, i.e. hereditary factors, toxins or a compromised immune system.
- It can be argued that the uninterrupted occurrence of regular menstruation over decades, month after month, is a modern phenomenon, as in the past women had more frequent breaks from menstruation due to pregnancy or lactation.
- Hereditary factors may play a role. It is well recognised that daughters or sisters of patients with endometriosis are at a higher risk to develop endometriosis themselves. A specific gene, however, has not been identified.
- Endometriosis has been found in abdominal incision scars after surgery for endometriosis.
- On rare occasions endometriosis may be transplanted by blood or by the lymphatic system into peripheral organs (i.e. lungs, brain).
- Recent research is focusing on the immune system, which may not be able to cope with the cyclic onslaught of retrograde menstrual fluid.
- In this context there is interest to study the relationship of endometriosis to autoimmune disease, allergy reactions and the impact of toxins.
Symptoms of endometriosis
The symptoms of endometriosis can vary from woman to woman.
The amount of pain a woman feels is not necessarily related to the extent of endometriosis. On the other hand, some women may have severe pain even though they only have a few small areas of endometriosis.
You may be unfortunate to experience all of these symptoms or just a few. Symptoms of endometriosis include:
- Extremely painful menstrual cramps (dysmenorrhoea); pain may get worse over time
- Chronic pelvic pain (includes lower back pain and pelvic pain)
- Pain during or after sex
- Painful bowel movements and bloating
- Painful urination during menstrual periods
- Heavy periods
- Irregular periods
- Pre-menstrual spotting or bleeding between periods
- Pain in the pelvic region
- In addition, women who are diagnosed with endometriosis may have gastrointestinal symptoms that may mimic irritable bowel syndrome, as well as fatigue.
Symptoms often improve dramatically after pregnancy, and it is believed that having a break from the monthly cycle actually ‘quietens down’ the disease in some sufferers.
Women have talked about how the endometriosis takes over their lives. Holidays are planned to avoid periods and social arrangements are cancelled at the last minute when the pain becomes intense. Many women are forced to take days off work each month in order to cope with the condition and some women have had to give up work because their employers cannot cope with their frequent absences.
Why does endometriosis cause pain?
Endometrial lesions are active endometrial cells. These cells can grow outside the uterus, fallopian tubes, ovaries, the rectum and more uncommonly in the arm, lungs and thighs.
It is essentially normal tissue outside the uterus. Degeneration, inflammation and scar tissue may be present.
Complications of endometriosis
Sadly, the symptoms of endometriosis can lead to complications such as:
- Rupture of growths spreading lesion area
- Intestinal bleeding or bowel obstruction
- Poor bladder function
The good news is there is ample evidence supporting the role of healthy eating (gluten-free and vegan), alongside targeted nutritional supplements and herbs that can assist with the symptoms of endometriosis.