It is a gynaecological condition that occurs when the endometrial tissue (the inner most lining of the uterus) is found deposited outside the uterus on various sites in the pelvis. The most common sites are the ovaries, uterine ligaments, pouch of Douglas and fallopian tubes as represented in the above diagram. Endometrial deposits can also occur on the bowel, urinary tract, vagina and cervix. Other locations outside of the pelvic cavity where endo has been found are the gastrointestinal tract, lungs, diaphragm, abdomen, liver and heart. Endometriosis affects 10–15% of all women of reproductive age and 70% of women with chronic pelvic pain. ⠀⠀⠀⠀⠀⠀⠀⠀⠀
This endometrial tissue responds to the hormonal changes that occur in the menstrual cycle (the pain associated with endometriosis will follow the same 28-day cycle) and undergoes growth and shedding. This means those endometrial deposits will bleed in the same manner in which your uterine lining would bleed when you are menstruating. Without a way to drain from the pelvic cavity, this causes an internal accumulation of blood. Patients often present with symptoms such as intermenstrual bleeding (bleeding at any time during the menstrual cycle other than during normal menstruation), painful periods (dysmenorrhea), painful intercourse (dyspareunia), painful defecation (dyschezia) and painful urination (dysuria). I have seen these painful episodes have serious negative effects on the quality of life of patients.⠀⠀⠀⠀⠀⠀⠀⠀⠀
In my #endoseries I will discuss how and why endometriosis occurs; the signs and symptoms; the risk factors; how endo is diagnosed and what my approach to essentially managing and treating endo is.
Part 2: Why and How does Endometriosis occur?
There is no definitive cause of endometriosis, however there are several hypotheses regarding how it develops. One possible mechanism is retrograde menstruation.
What is Retrograde Menstruation?⠀⠀⠀⠀⠀⠀⠀⠀⠀
The uterus is an ‘open ended’ organ – it has an opening at the bottom through the cervix and on the top on either side through the fallopian tubes. The fallopian tubes are not attached to the ovaries. So according to this hypothesis, during menstruation, when the blood is meant to exit the uterus through the cervix it can escape upward through the fallopian tubes as represented in the diagram above. This causes blood to spill over into the pelvic cavity which is where your bladder, ovaries and large intestine lie.
If there are other underlying issues such as estrogen dominance (these patients’ experience heavy menstrual bleeds or expel clots), the uterus may need to contract to push the blood and clots out. This action of contraction may cause some blood to escape from the uterus into the pelvic cavity through the fallopian tubes. With no drain in the pelvic cavity, the endometrial cells attach to various parts, bleed and grow on a monthly basis. Surrounding areas may become inflamed or swollen. Scar tissue and lesions may develop as a result.
Although a retrograde bleed might be part of the cause, treating the underlying issues such as estrogen dominance or heavy menstrual bleeding as well as dissolving existing endometriosis lesions and helping ease the pain patients go through is my aim in practice when treating this condition.
Another major factor that needs to be considered and treated is the chronic inflammation caused by endometriosis that occurs within the pelvic cavity. This inflammation, scar tissue and adhesions that form as a result are one of the reasons why women with endometriosis suffer with extreme pain and infertility.
Part 3: Signs and Symptoms of Endometriosis
Endometriosis often presents as infertility or continued pelvic pain and cramping.
Patients often present with:⠀⠀⠀⠀⠀⠀⠀⠀⠀
- intermenstrual bleeding (at any time during the menstrual cycle other than during normal menstruation)⠀⠀⠀⠀⠀⠀⠀⠀⠀
– painful periods (dysmenorrhea)⠀⠀⠀⠀⠀⠀⠀⠀⠀
– heavy and/or excessive bleeding⠀⠀⠀⠀⠀⠀⠀⠀⠀
– painful intercourse (dyspareunia)⠀⠀⠀⠀⠀⠀⠀⠀⠀
– painful bowel movements (dyschezia)⠀⠀⠀⠀⠀⠀⠀⠀⠀
– painful urination (dysuria)⠀⠀⠀⠀⠀⠀⠀⠀⠀
– pelvic pain around ovulation can be present⠀⠀⠀⠀⠀⠀⠀⠀⠀
– sacral and lower back pain before and/or during menses can also be present⠀⠀⠀⠀⠀⠀⠀⠀⠀
– difficulty falling pregnant
Severe pelvic pain and cramping may present before menstruation begins and continues throughout the bleed. However, endometriosis can also be asymptomatic, only coming to a clinician’s attention during an examination. I will discuss how endometriosis is diagnosed and treated conventionally in Part 4.⠀⠀⠀⠀⠀⠀⠀⠀⠀
One of the parameters I use when tracking healing is pain. At each visit, I will ask a patient to rate their pain on scale of 1 – 10. This method allows me to track how patients are improving with treatment. Another indicator that their pain is decreasing and healing is taking place is the reduction in the need of pain killers/analgesics or anti-inflammatories needed with each cycle. I have taken patients from using these every 6-7 hours to deal with pain to not having to take any form of pain medication. Remember your period should NOT be something you dread every month and suffer in silence with.