Endometriosis Symptoms, Causes, Treatment & Risk Factors | Diseases List A-Z

Endometriosis Definition

Endometriosis is a disease of the female reproductive system. Also known as chocolate cysts, this condition causes tissue from the inner lining of the uterus to grow outside the uterine cavity.

The tissue also undergoes a process of thickening and shedding, just as when women experience their menstrual cycle.

However, the blood becomes stagnant and cannot come out because it is located outside the uterus. As a result, this can irritate the surrounding tissue.

Is endometriosis dangerous? This problem can cause blood that should have fallen and come out of the uterus to settle.

This can potentially trigger dangerous complications. For example, ovarian cancer or pelvic inflammatory disease.

Symptoms of Endometriosis

The main symptom of endometriosis is quite severe pain around the hips and lower abdomen.

This pain is worst before and during the menstrual cycle.

However, there are also those who feel pain all the time. So, what do endometriosis sufferers feel? Here are some of the symptoms:

• Pain also occurs during sex or after.
• Pain when urinating and defecating.
• Blood appears in the stool or urine.
• Stomach feels bloated.
• Excessive blood volume during menstruation.
• Experiencing bleeding outside the menstrual cycle.
• Constipation.
• Diarrhea.
• Fatigue.
• Nausea during menstrual periods.
• Pain during bowel movements and urination.

The effects of this disease vary. In fact, sufferers may not feel any pain at all.

The thing you need to pay attention to is the extreme pain during menstruation. If there is unusual pain, you should contact a doctor immediately.

Difference Between Cysts and Endometriosis

What is the difference between ovarian cysts and endometriosis? . Cysts related to endometriosis are ovarian cysts. There are two types, namely functional and pathological. This pathological type is caused by endometriosis.

An ovarian cyst itself is a fluid-filled sac located in the ovary or on its surface.

Every woman has two sacs on each side of the uterus that are about the size and shape of almonds.

Endometriosis is a disorder that occurs when the endometrium (the lining of a woman’s uterus) grows outside of its proper area. This tissue acts like uterine tissue during menstruation.

The endometrium can rupture and bleed at the end of the menstrual cycle. However, the blood cannot flow out of the body. The blood settles and causes inflammation and swelling.

Causes of Endometriosis

There are several conditions that experts suspect cause endometriosis, namely:

1. Retrograde menstruation

This condition causes menstrual blood not to flow out but to flow back through the fallopian tubes and into the pelvic cavity. Endometrial cells will stick to the pelvic wall and continue to thicken.

2. Transformation of embryonic cells

Hormones such as estrogen can change embryonic cells into endometrial-like cell implants.

This process normally occurs during prenatal development and is the initial step in the formation of complete human body organs.

3. Surgical procedures

Surgical procedures such as hysterectomy or cesarean section increase the risk of disease.

The reason is that endometrial cells can stick to the surgical incision area.

4. Disorders of the body’s immune system

A disturbance in the immune system makes the body unable to recognize and destroy endometrial-like tissue that grows outside the uterus.

5. Environmental factors

Exposure to certain chemicals in the environment increases the risk of endometriosis. One of these is dioxin, a substance found in environmental pollutants and certain chemicals.

6. Changes in immature cells

Immature or embryonic cells will grow as the cells develop.

In endometriosis sufferers, these cells can develop into the endometrium due to changes in the hormone estrogen.

7. Changes in peritoneal cells

The final cause is changes in the peritoneal cells. This is the membrane that lines the inside of the abdomen.

These cells can develop into endometrium when affected by hormones or immune problems.

Important Facts About Endometriosis

1. Because chronic symptoms can affect fertility, many women with endometriosis experience emotional stress, anxiety, and depression. Psychological support can be a step to help with this condition.
2. Endometriosis can also occur in women who have gone through menopause, although it is more common in women of childbearing age.
3. Around 30-50% of women with endometriosis have difficulty getting pregnant.
4. An estimated 10-15% of women of childbearing age in Indonesia have endometriosis. However, most cases are not properly diagnosed due to lack of knowledge about this condition.

Endometriosis Risk Factors

There are several risk factors for endometriosis, namely:

• There are family members who suffer from the same disease.
• Never given birth.
• Having a medical condition that prevents menstrual blood from leaving the body.
• Have a disorder of the immune system.
• There is an abnormality in the uterus.
• Having your first period before the age of 12.
• The vagina, cervix, or uterus has an abnormal shape that can cause menstruation to be obstructed.
• An unhealthy lifestyle, such as consuming alcohol and an unhealthy diet.
• Insufficient intake of omega-3 fatty acids.
• Having a short menstrual cycle, namely less than 27 days.
• Have or have had a pelvic infection.
• Have high levels of the hormone estrogen.

Myths and Facts About Endometriosis

Endometriosis is a condition in which endometrial-like tissue grows outside the uterus, causing pain and reproductive problems.

There are many myths about endometriosis, so it is important to understand the facts to avoid misunderstandings.

1. Only Women with Irregular Menstruation Can Experience Endometriosis

In fact, endometriosis can occur in women with regular or irregular menstrual cycles.

This condition is not only related to the menstrual cycle, but more to the growth of abnormal tissue outside the uterus.

2. Endometriosis Always Causes Infertility

It is true that endometriosis can make it difficult to get pregnant, but not all women with this condition experience infertility.

With proper treatment, many women with endometriosis can still get pregnant naturally or with medical assistance.

3. Severe Menstrual Pain Is Normal

Excessive menstrual pain is not normal. If the pain interferes with your daily activities, it could be a sign of endometriosis or another medical condition that needs to be evaluated by a doctor.

4. Endometriosis Can Be Cured with Pregnancy

Pregnancy may ease some symptoms due to hormonal changes, but it does not cure endometriosis. After delivery and hormones return to normal, symptoms may return.

5. Hysterectomy (Removal of the Uterus) is the Only Treatment

Hysterectomy may be a last option, but it is not the only way to treat endometriosis.

Many other methods such as hormonal therapy and laparoscopic surgery, can control symptoms without the need to remove the uterus.

What Do Studies Say About Endometriosis? 

A study entitled Endometriosis: Epidemiology, Diagnosis, and Clinical Management (2017) states that late diagnosis can increase the risk of someone with endometriosis experiencing decreased reproductive potential and fertility.

It is stated in this study that early diagnosis with medical equipment such as MRI or CT scans is very helpful in identifying patients early, so that endometriosis can be detected quickly and prevent pain experienced by sufferers and the potential for decreased fertility.

Endometriosis Diagnosis

In addition to knowing the patient’s medical history, there are several examinations that doctors can perform to diagnose endometriosis :

• Pelvic exam. This exam can be done manually by a doctor to determine whether or not there are abnormalities in the reproductive organs.
• Ultrasound. The doctor can perform a transvaginal ultrasound by inserting a device through the vagina to see the condition inside the body. This test is to check for health problems related to endometriosis.
• Magnetic Resonance Imaging (MRI). MRI examinations can be performed by doctors using magnetic fields and radio waves to create detailed images of organs and tissues inside the body.
• Laparoscopy. This examination can provide information about the location, extent, and size of endometriosis implants.
• Biopsy. This method is done by the doctor by taking a sample of tissue in the uterus, then taking it to the laboratory for examination.

Endometriosis Stages

There are several levels or stages of endometriosis which are measured by the location, number, size, and depth of endometrial implants.

Here are the four levels:

1. Minimal endometriosis (Grade 1)

This stage is characterized by small, shallow lesions or sores in the ovarian area. Inflammation may have occurred in or around the pelvic cavity.

2. Mild endometriosis (Grade 2)

The pain is still relatively mild. Endometriosis at this stage is characterized by the appearance of mild lesions and shallow implants on the ovaries and pelvic lining.

3. Moderate endometriosis (Grade 3)

At this stage, the sufferer will experience more intense pain. Because there will be more lesions and implants on the ovaries in the pelvic lining.

4. Severe endometriosis (Grade 4)

At this stage, the implants and lesions in the pelvic lining and ovaries are already very numerous. It is not impossible that these lesions will appear in the intestines and fallopian tubes.

Endometriosis Treatment

Can endometriosis be cured? Treatment for endometriosis will depend on how severe the condition is.

However, the doctor will initially try conservative treatment first.

If these treatments fail, your doctor may need to perform surgery. Here are the steps to treat endometriosis :

1. Giving painkillers

Doctors usually recommend taking an over-the-counter pain reliever, such as ibuprofen first to help relieve menstrual cramps.

Then, doctors can combine it with hormone therapy for women who are not planning to get pregnant.

2. Hormone therapy

Supplemental hormones are sometimes effective in reducing or eliminating pain from endometriosis.

Hormonal fluctuations during the menstrual cycle are often the main cause of endometrial implants thickening, rupturing and bleeding.

Well, hormonal drugs can slow the growth of endometrial tissue and prevent new implants. This therapy can be:

• Hormonal contraception. Giving birth control devices such as birth control pills, patches and vaginal rings to control the hormones that trigger the buildup of endometrial tissue each month.
• Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists. These drugs block the production of ovarian-stimulating hormone, lowering estrogen levels and preventing menstruation. This can shrink the endometrial tissue.
• Progestin therapy. Various progestin therapies, including the levonorgestrel-only contraceptive device, the contraceptive implant, the contraceptive injection or the progestin-only pill, can stop menstrual periods and the growth of endometrial implants.
• Aromatase inhibitors. These are a class of drugs that reduce the amount of estrogen in the body. Your doctor may recommend them along with progestin or hormonal birth control to treat endometriosis.
• Intrauterine device (IUD) placement. This procedure can help relieve pain by controlling the growth of endometrial tissue. It involves inserting a small, flexible device into the uterus.
• Androgen therapy. This method can suppress the production of the hormone estrogen, which can help reduce the growth of endometrial tissue outside the uterus.

3. Hormonal therapy with Dienogest

One of the main methods for controlling endometriosis symptoms is long-term hormonal therapy, such as the use of dienogest.

Dienogest is a synthetic progestin that works by suppressing estrogen production, thereby inhibiting the growth of abnormal endometrial tissue.

This medication can reduce chronic pelvic pain, slow the progression of endometriosis lesions, and prevent recurrence after surgery.

However, like other hormonal therapies, dienogest can have side effects, such as changes in menstrual cycles, breast tenderness, or mood changes, so its use should be based on a doctor’s recommendation.

4. Conservative operations

For those with endometriosis who are trying to get pregnant, surgery may be a solution to remove endometriosis implants.

This procedure preserves the uterus and ovaries so that there is still a chance of getting pregnant.

Doctors may perform laparoscopic procedures or abdominal surgery for more extensive cases.

• Laparoscopy. This procedure allows the doctor to remove the endometriosis tissue and remove it with a laser or electric current. Patients have a faster recovery process than other methods.
• Laparotomy. This involves making a wide incision in the abdomen to access organs and remove tissue. This procedure can also repair the structure of organs affected by endometriosis.
• Hysterectomy. This is a procedure to remove the uterus, cervix, and both ovaries. This method helps reduce or eliminate pelvic pain and endometriosis symptoms associated with the menstrual cycle.

4. Fertility treatment

Endometriosis can make it difficult for women to get pregnant, which is why doctors may also recommend fertility treatments.

Fertility treatments range from stimulating the ovaries to produce more eggs to in vitro fertilization (IVF).

Complications of Endometriosis

Endometriosis that does not receive proper treatment can increase the risk of complications in sufferers.

Some of these conditions include:

1. Fertility disorders

The main complication of this disease is infertility. One-third to one-half of women with this disease have difficulty getting pregnant.

Endometriosis can block the fallopian tubes, preventing the egg and sperm from meeting.

2. Ovarian cancer

People with this condition are at higher risk of developing ovarian cancer compared to those who do not have this disease.

For this reason, undergoing treatment and undergoing care are important things that you need to do to reduce the risk of complications.

3. Adhesion

Adhesions, or adhesions, are conditions in which tissues in the body stick together after a healing process or surgery. The impact can cause disruption of the normal function of the organs and structures involved.

4. Ovarian cysts

Ovarian cysts are fluid-filled lumps that can develop on a woman’s ovaries. They can be asymptomatic and cause discomfort and affect reproductive health.

5. Subfertility

Subfertility is a condition where a couple has difficulty getting pregnant.

This means that there is potential for pregnancy, but the couple’s fertility may be reduced or there may be factors that make it more difficult to conceive.

6. Infertility

This disorder is a problem of infertility in one or both partners.

Where a woman does not get pregnant after one year of regular intercourse without contraception.

7. Organ adhesions

Adhesions are a chronic inflammatory reaction to endometriosis. This problem develops when scar tissue attaches to organs or other tissues in the uterus.

How to Prevent Endometriosis

Some effective steps to prevent endometriosis include:

1. Routine examination of female organs

Having regular check-ups does not directly prevent endometriosis.

However, this method can help detect and treat reproductive health problems early that can lead to endometriosis.

A scientific study entitled Endometriosis: Epidemiology, diagnosis and clinical management published in Current Obstetrics and Gynecology Reports, reveals several methods.

Studies have suggested several appropriate diagnostic procedures, such as urinalysis, pap smear, pregnancy test, vaginal swab, and endocervical swab. Pelvic ultrasound scans may also be needed to facilitate diagnosis.

2. Exercise regularly

Exercising regularly can help maintain a balanced weight.

This may help reduce the risk of endometriosis, as excess weight can increase estrogen production, which can worsen endometriosis.

3. Avoid alcohol

Alcohol consumption can affect hormone levels in the body, including estrogen.

High estrogen levels can trigger the growth of endometriosis tissue outside the uterus. By reducing your alcohol consumption, you can help maintain your body’s hormonal balance.

4. Losing weight becomes more ideal

Although the exact cause of endometriosis is not fully understood, several steps can be taken to reduce the risk of developing it.

One prevention that can be applied is maintaining ideal body weight. Being overweight can increase estrogen production, which can worsen endometriosis symptoms.

By implementing a healthy diet and regular exercise, hormone levels in the body can be more balanced and reduce the risk of inflammation that triggers the growth of endometriosis tissue.

5. Limit caffeine and alcohol

Additionally, reducing caffeine and alcohol consumption can also help. Caffeinated beverages, such as coffee and tea in excess, can increase estrogen levels in the body.

Likewise, alcohol can affect hormone metabolism and increase the risk of inflammation.

Therefore, limiting caffeine and alcohol consumption, as well as adopting a healthy lifestyle, can help reduce the risk of developing endometriosis or worsening symptoms in sufferers.

6. Other prevention

Some other steps to prevent endometriosis include:

• Reduce red meat consumption.
• Avoid sugary and carbonated drinks.
• Wear a mask when traveling to avoid exposure to harmful chemicals.
• Consume foods containing omega-3 fatty acids.

Diet plays an important role in preventing endometriosis.

What Do Studies Say About Endometriosis? 

A study published in the Journal of Minimally Invasive Gynecology notes the importance of a multidisciplinary approach in treating endometriosis.

This study emphasizes that delayed diagnosis may increase the risk of decreased reproductive potential and fertility.

Researchers also underline the important role of medical imaging, such as MRI and transvaginal ultrasound, in the early diagnosis of endometriosis.

Early detection allows for quicker intervention, reduces the risk of complications, and improves the patient’s quality of life.

In addition, this study reviews the effectiveness of various treatment options, including medical and surgical therapies, and emphasizes the importance of an individualized approach in selecting the most appropriate therapy for each patient.

The Right Time to See a Doctor

You can chat directly with a specialist doctor if you experience symptoms such as:

• Feeling pain during menstruation.
• The pain begins to interfere with daily activities.
• Feeling pain during sex.
• Feeling pain when urinating.
• There is blood in the urine or difficulty controlling the flow of urine.
• Not getting pregnant after trying for 12 months.

That’s the complete information about endometriosis. You can also consult a doctor if you experience symptoms like endometriosis to get an early diagnosis and further treatment.