Understanding endometriosis

By Nicole Brzozowski, MD

 

Endometriosis is a medical condition that affects millions of women worldwide. Despite its prevalence, it remains a widely misunderstood and often underdiagnosed disorder. Let’s shed some light on what endometriosis is, its symptoms, causes, diagnosis and treatment options.

 

What is endometriosis?

Endometriosis is a chronic medical condition characterized by the abnormal growth of endometrial-like tissue outside the uterus. Normally, the endometrium lines the inside of the uterus and is shed each month during menstruation. However, in women with endometriosis, this tissue can implant and grow on the ovaries, fallopian tubes, and other pelvic organs. The inflammation associated with the growth of endometriosis implants can also lead to the formation of scar tissue in the pelvis.

 

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What are the symptoms of endometriosis?

• Pelvic pain: The most common and often debilitating symptom of endometriosis is pelvic pain. The seriousness of pain may not be a sign of the extent of endometriosis growths in your body. You could have a small amount of endometriosis with severe pain, or you could have lots of endometriosis with little or no pain. This pain is most common before and during your periods, but it can occur during daily activities as well.
• Menstrual abnormalities: Women with endometriosis may experience painful, heavy or irregular menstrual bleeding. The pain often leads women to miss school or work.
• Painful intercourse: Endometriosis can cause pain during or after sexual intercourse, known as dyspareunia.
• Painful bowel movements or urination: In severe cases, the abnormal tissue growth may affect the bowel or bladder, leading to pain during bowel movements or urination.
• Infertility: For some people, endometriosis is first found during evaluation for difficulty getting pregnant.
  
  

What Causes Endometriosis?

The exact cause of endometriosis remains unclear, but several theories exist:

• Retrograde menstruation: One theory suggests that during menstruation, some menstrual blood containing endometrial cells flows backward through the fallopian tubes and into the pelvic cavity, where these cells implant and grow.
• Hormonal and/or immune system dysfunction: Hormonal changes and issues with the immune system might help transform cells into endometriosis and allow them to survive and grow in areas outside the uterus.
• Endometrial cell transport: The blood vessels or lymphatic fluid system may move endometrial cells to other parts of the body.
• Genetic Factors: There is evidence suggesting a genetic predisposition to endometriosis, as the condition often runs in families.
  
  

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How do you diagnose endometriosis?

Diagnosing endometriosis can be challenging, as its symptoms can overlap with other conditions. Still, common diagnostic methods include:

• Clinical history and physical examination: A detailed medical history and pelvic examination can provide valuable information.
• Imaging studies: Ultrasound and MRI scans may help identify endometriotic implants.
• Laparoscopy: The most definitive method for diagnosing endometriosis involves a surgical procedure called laparoscopy, where a thin tube with a camera is inserted through small incisions on the abdomen to visually inspect the pelvic organs and suspicious lesions are biopsied.
  
  

What are the treatments for endometriosis?

While there is no cure for endometriosis, various treatment options aim to manage symptoms and improve the quality of life:

• Lifestyle modifications: It is especially important for women with endometriosis to focus on a healthy lifestyle. Prioritizing sleep, stress reduction, nutrition and regular exercise can reduce inflammation and improve symptoms.
• Pain medications: Over-the-counter nonsteroidal anti-inflammatory drugs or prescription pain relievers for muscle- or nerve-generated pain can help alleviate symptoms.
• Physical therapy: Many women with endometriosis also have pelvic floor dysfunction. In these cases, working with a pelvic floor physical therapist can improve symptoms.
  
  

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• Hormonal therapy: Hormonal treatments, such as birth control pills, may regulate menstrual bleeding and reduce the growth of endometriosis.
  
  

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• Surgery: In cases where medications fail, surgery may be recommended to remove endometrial implants and scar tissue. Removal of the uterus and/or ovaries is sometimes necessary for symptom control.
  
  

The bottom line: Endometriosis is a complex and often challenging condition that can significantly impact the lives of affected individuals. Increased awareness, early diagnosis and a multidisciplinary approach involving healthcare professionals, psychologists and support groups can contribute to better management and support for those living with endometriosis. Ongoing research and advocacy efforts are crucial to improve understanding, promote early intervention and enhance the overall well-being of individuals affected by this condition.

 

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Dr. Brzozowski is an obstetrician-gynecologist at Nuvance Health and fellowship-trained at the Minimally Invasive Gynecologic Fellowship Program at Nuvance Health.  She works at Danbury and Norwalk hospitals.