Endometriosis is a condition where similar tissue which normally lines the uterus (the endometrium) grows or implants outside the uterus on pelvic tissue lining and pelvic organs such as the ovaries, fallopian tubes, bowel, rectum and the bladder. Occasionally, but rarely, this tissue can stray even further and can be implanted outside the pelvic region in other areas of the body. This misplaced endometrial tissue behaves just like the uterine lining itself in that it responds to the interplay of hormones during the menstrual cycle. This means that tissue and blood sheds in these areas, just as the uterine lining sheds every month. The problem is that the tissue in the pelvic cavity has no means of being cleared, so over time it builds up in the body, which can form masses and lesions. The cyst-like masses are called pseudocysts, and usually appear dark blue to brown, the latter being called “chocolate cysts”.
Even though it is classified as an inflammatory disease, I personally do not disregard the role of the endocrine system when working with this condition, as it affects women and their menstrual cycle so deeply. The condition almost exclusively occurs in menstruating females. It is also still believed to be driven by oestrogen but now not actually believed to be caused by oestrogen or oestrogen dominance. Research suggests rather that endometriosis is an oestrogen-dependent disease, meaning it thrives off oestrogen, however the most recent research is now also indicating that low levels of prenatal testosterone could be having a major impact on women with endometriosis.
During a laparoscopy, a doctor makes a small incision in the abdomen and inserts a thin tube with a light and camera to view the pelvic region. Being able to see the endometriosis implants and scarring is what enables doctors to classify the disease into four different stages. To determine the stage of endometriosis, doctors assign points to what they see as they perform the laparoscopy. However, these stages do not reflect the levels of pain or discomfort or potential problems with fertility the patient may be having. The point system is looking at how ‘wide spread’ the legions are, but someone with mild endometriosis can potentially be in more pain then a woman with severe endometriosis or a woman in stage 1 might have more fertility struggles then a woman in stage 4.
Different forms of endometriosis are currently recognised and they may develop in different ways. These are typical or peritoneal endometriosis, cystic or ovarian endometriosis and deep infiltrating endometriosis, where nodules infiltrate other pelvic organs, most commonly the bowels, bladder and pelvic ligaments.
Often taking years to diagnose due to the painful symptoms possibly being caused by other health conditions. If your doctor suspects you have endometriosis they may do a pelvic exam and order an ultrasound but the only way they can be absolutely sure (At this stage) is to do a minor surgical procedure called laparoscopy. During a laparoscopy, if your Doctor sees signs of endometriosis, like implanted endometrial tissue or scar tissue, they can both diagnose the condition and remove things like cysts and scar tissue.
Signs of Endometriosis
The primary symptom of endometriosis is pelvic pain often worse during menstruation. Pain during or after sex is also common, as is pain associated with a bowel movement or urination. Other common symptoms are heavy bleeding during the period or uterine bleeding between periods. Occasionally endometriosis can also cause nausea, bowel movement changes, and fatigue (which can often be cause by low Iron levels due to heavy menstruation).
- Heavy menstrual bleeding
- Pain in the abdomen, legs or lower back during your periods
- Pain during sexual intercourse
- Chronic thrush due to constant changing tissue
- Pain while trying to pass a stool
- Sore breasts
- IBS related symptoms – alternating diarrhoea and constipation, bloating, gas and nausea