Endometriosis is a common gynaecological condition affecting around 2 to 10% of women of childbearing age. The tissue that lines the uterus is called the endometrium. The endometrium builds up to support pregnancy and sheds if conception does not happen during a woman’s regular menstrual cycle. The condition of endometriosis derives its name from the development of tissue that looks and acts like endometrial tissue and gets implanted outside of the uterus. These abnormal endometrial tissues are usually on other reproductive organs inside the pelvis or in the abdominal cavity.
Just like the endometrium, the misplaced endometrial tissue also responds to the hormonal changes of the menstrual cycle by building up and breaking down every month, leading to mild bleeding within the pelvis causing associated symptoms. Watchful waiting with the help of the best gynaecologist doctor in Chennai is to be observed during the course of the condition.
Symptoms of endometriosis
The ovaries, fallopian tubes and the tissue lining the pelvis are commonly involved in endometriosis. The endometrial-like tissues thicken, break down and bleed with each menstrual cycle, but unlike the endometrium, they don’t have a way to exit the body and thus get trapped. Endometriosis involving the ovaries may form cysts called endometrioses causing other neighbouring tissues to get irritated. This eventually leads to development of scar tissue and adhesions, which are bands of fibrous tissue that make pelvic tissues and organs to stick to each other and cause the primary symptoms of endometriosis.
Pain – Endometriosis can cause pain that can become severe, especially during menstrual periods. Pelvic pain that may include lower back/abdominal pain and cramping may begin before and extend several days into a menstrual period. Endometriosis can affect nerves that connect to the groin, hips and legs, making it hard to walk, causing a limp or requiring to rest often. Pain can be felt as sharp and stabbing that does not ease with medication. Pain is also described as being severely gnawing and throbbing which gives the feeling of the insides being pulled down.
Although cramping during their menstrual periods is experienced by many women with endometriosis, menstrual pain is typically described as being far worse than usual that may also increase over time. Hence, pelvic pain that is more often associated with menstrual periods is identified as the primary symptom of endometriosis.
However, the severity of pain may not be a reliable indicator to know the severity of the condition. Mild endometriosis with severe pain or advanced endometriosis with little or no pain are equally possible. Pain during sex can be experienced as an ache or stabbing pain that may extend up to 2 days after having sex. Painful bowel movements and painful urination are also commonly reported especially during menstrual periods. Pelvic inflammatory disease (PID), irritable bowel syndrome (IBS) or ovarian cysts with pelvic pain could be commonly mistaken for endometriosis.
Abnormal or heavy menstrual flow – Endometriosis can also impact the length of someone’s menstrual cycles, as well as how long their bleeding lasts. Unusual or heavy bleeding during periods that commonly last for longer happens because their body has more tissue to shed. Menstrual cycles may become shorter, with every menstruation beginning earlier than the normal 28 days. Vaginal bleeding between periods or blood in urine or stools may be seen.
Infertility – Endometriosis can make it difficult to get pregnant because the tissue growing outside the uterus causes scarring in the fallopian tubes preventing the fertilization of the egg by the sperm. This can also interfere with the fertilized egg from implanting in the lining of the uterus requiring endometriosis pregnancy treatment.
Other symptoms of endometriosis include fatigue that does not get better, nausea, vomiting, constipation and diarrhoea.
Treatment for endometriosis
Treatment for endometriosis is determined based on overall health and medical history, symptoms, severity of the condition, tolerance and preference for pregnancy. There is no cure for endometriosis but can be effectively treated through lifestyle changes, medications, hormonal therapy or surgery.
Diet – High amount of fat in red meat can make the body produce chemicals called prostaglandins, which may lead to excess oestrogen production that can in turn cause extra endometrial tissue to grow. Adding more fresh fruits and vegetables as the main portion of every meal can be helpful. Stocking your refrigerator with pre-washed and cut fruit and vegetables can help you eat more of both. Foods rich in omega-3 fatty acids, like salmon and walnuts, can prevent or control endometriosis. Alcohol and caffeine are associated with a higher risk of endometriosis.
Exercise – Exercise can help reduce oestrogen levels and prevent heavy periods to improve symptoms of endometriosis. Studies have shown that high-intensity exercises like running or biking can help overcome endometriosis. Physical activity even for a few minutes releases brain chemicals called endorphins that can actually relieve pain and reduce stress. Lower-intensity workouts like yoga can also be beneficial in relieving pain and reducing stress by stretching the tissues and muscles in the pelvis.
Selfcare –Stress is known to make endometriosis worse and vice versa. Ways to manage stress through meditation or developing hobbies can help you ease symptoms. A therapist who can offer tips for dealing with stress may also be helpful.
Pain management – Warm baths, hot water bottles and heating pads can give quick relief from endometriosis pain. Pain relievers and non-steroidal anti-inflammatory drugs may be prescribed.
Hormonal therapy – Hormonal replacements are suggested to lower oestrogen levels in the body to create and stop periods that also helps lesions to bleed less and thus reduce inflammation, scarring, and cyst formation. Hormones are commonly administered through birth control pills, patches and vaginal rings. Hormones may include Gonadotropin-releasing hormone agonists and antagonists, progestin or testosterone derivatives.
Surgery – Excision of as much of the affected tissue as possible helps ease symptoms and can increase the chances of getting pregnant. Laparoscopy, a minor surgical procedure at the best gynaecologist hospital in Chennai or standard surgery that uses larger cuts may be advised to remove endometrial growth. A hysterectomy to remove ovaries, uterus, and cervix may be needed if further pregnancy is not desired.