Endometriosis: Facts, Symptoms and Treatment

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Endometriosis Awareness Month is observed in March. This month aims to raise awareness about endometriosis, its symptoms, and promote early diagnosis and treatment. Our guest blogger, Dr. Joanna Palmieri, wrote a piece to help readers better understand Endometriosis and the importance of early detection and treatment.

Endometriosis is a condition that affects approximately 10% of reproductive age females, with symptoms that can continue all the way to menopause.  In order to better understand endometriosis, let’s take a little anatomy/physiology refresher course.

The uterus is an organ consisting predominantly of muscular tissue, and the endometrium (uterine lining) changes throughout the menstrual cycle. Beginning with menstruation, when pregnancy has not occurred and hormone levels decrease, the thickened endometrium sloughs off and bleeding occurs.  That menstrual cycle can be accompanied by pain and cramping, expelled clots of blood, and of course mood changes.

The next phases are hormonally controlled as the endometrium thickens and blood vessels proliferate. The lining develops to support a potential pregnancy and when pregnancy does not occur, the cycle repeats itself starting with menstruation. The reason for explaining hormonal cycles is to help us understand endometriosis and how far-reaching symptoms can be.

Endometriosis is simply defined as a condition in which tissue similar to the lining of the uterus can grow outside of the uterus, anywhere in the pelvis, and rarely reaching outside the pelvic cavity. So, another way to think of it is imagining all that tissue contracting and bleeding each month, almost like a chain of string lights (although not technically connected), each light or area of endometriosis working under that same hormonal control causing symptoms that result in pain, cramping and bleeding.

There are different possible causes of endometriosis: including retrograde menstruation describing when menstrual blood can flow back into the pelvis at the same time it is flowing out of the cervix and vagina. The back flow can cause endometrial cells to be seeded in the pelvis where they can implant and proliferate. Other theories include possible genetic components; lymphatic transport where cells move through the body to the pelvis; metaplasia, when cells outside the uterus change into those similar to endometrial cells and begin to grow; and also a possible immune system dysfunction where endometrial cells outside the uterus are not recognized and destroyed by the immune system.

Endometriosis can have effects that range from mild to severe and can negatively affect the lives of so many females. Some describe significant pain during menses leading to the loss of school or work, heavy cycles and/or bleeding between cycles, pain upon urination and/or defecation, abdominal discomfort causing bloating or nausea, painful intercourse and difficulty with fertility due to scar tissue presence in the pelvis along with numerous emotional effects, including but not limited to anxiety and depression.

The diagnosis of endometriosis can be challenging and requires a careful evaluation of symptoms. It can be difficult to diagnose given there are no specific markers for the condition itself. Endometriosis can be visualized in image studies, including transvaginal ultrasound and MRI, while diagnostic laparoscopy can lead to a histological diagnosis as samples are taken and sent to pathology for evaluation. Laparoscopic (a minimally invasive surgical procedure) and open surgical procedures can lead to the incidental finding of endometriosis as well.

It is important to note the severity of the condition is not directly related to the level of symptoms a patient has. A mild condition can result in severe symptoms and conversely severe conditions can have minimal symptomology.  

Endometriosis is classified into five stages:

  • Stage I-Minimal

  • Stage II-Mild

  • Stage III-Moderate

  • Stage IV-Severe

  • Stage V-Severe involving lesions/implants/adhesions outside the pelvis

Endometriosis is considered a benign chronic condition that can be treatable but not curable and is not fatal. The goal for patients is to manage the symptoms with non-steroidal anti-inflammatory medications, hormonal intervention including contraceptive options and GnRH analogues. Treatments can temporarily reduce the progression of the condition and surgical intervention can lead to increased scar tissue along with possible recurrence.

Unfortunately, the delay in diagnosis or inability for those suffering with symptoms to have access to health care is a great challenge worldwide. If you or anyone you know is struggling with symptoms that seem consistent with the diagnosis of endometriosis, I always recommend keeping a “symptom journal or log” which your healthcare provider can review and hopefully assist in the diagnosis and implementation of an adequate treatment regimen.