Endometriosis

Endometriosis is a chronic and often painful condition that affects 6.5 million women in the United States alone. It can lead to a significant loss of productivity, averaging over six hours per week, and deeply impacts both professional and emotional aspects of life.

Despite its prevalence, around 90% of people with endometriosis report being disbelieved or dismissed by loved ones and healthcare professionals. This guide aims to provide accurate information about endometriosis and explore treatment options available through NextPain Care.

Thanks to advances in research, we now have a better understanding of endometriosis and its symptoms. In addition to medications, hormonal therapies, and surgeries, patients now have access to alternative treatment options, such as electroanalgesia.

What Is Endometriosis?

To understand endometriosis, it’s important to have an overview of the female reproductive system. The uterus, a pear-shaped organ in a woman’s pelvis also known as the womb, is essential for functions such as menstruation, gestation, and labor. It is lined with endometrial tissue, known as the endometrium.

During the luteal phase of the menstrual cycle, the endometrium thickens to prepare the uterus for a fertilized egg. If pregnancy occurs, the endometrium supports fetal growth by supplying oxygen and nutrients and protecting the embryo from microbial invasions. If pregnancy does not occur, the body sheds the endometrium during menstruation, and new endometrial tissue is created in each cycle.

Endometriosis occurs when endometrial tissue begins to grow outside the uterus. These abnormal growths, known as endometrial implants, can affect various organs and tissues around the uterus, including:

• Ovaries
• Fallopian tubes
• Ligaments around the uterus
• Pelvic cavity
• Exterior walls of the uterus
• Bladder
• Rectum
• Cervix
• Intestines
• Vagina

In severe cases, endometrial tissue can also be found in the diaphragm and chest.

The build-up of abnormal endometrial tissue outside of the uterus can lead to a cascade of complications, including inflammation, scarring, and cysts. The tissue may also bind organs in the pelvis together, causing adhesions and preventing the organs from functioning as they should.

The endometrial tissue that grows outside of the uterus behaves in the same way as the tissue inside the uterus. This means that it responds to the hormonal changes that occur during the menstrual cycle and other events such as menopause.

During your cycle’s luteal phase, the endometrial implants will also grow, swell, and thicken. However, unlike the lining within the uterus, abnormal tissue that grows on other organs cannot easily leave your body during menstruation. This can cause significant pain and other symptoms associated with endometriosis.

Over time, the accumulation of endometrial implants can expand and cause severe problems such as:

• Inflammation and swelling
• Blockages in the fallopian tubes
• Trapped blood in the ovaries, which may lead to cysts
• Adhesions between organs
• Scar tissue in the reproductive organs, which can lead to infertility
• Problems with digestion and difficult bowel movements

The Stages of Endometriosis Development

Endometriosis is generally classified into stages to describe the extent and location of the abnormal growth of endometrial tissue. It is important to note that the correlation between the spread of endometrial tissue and the severity of symptoms isn’t always straightforward. For instance, some women may experience excruciating pain and severe symptoms even if they have a mild form of endometriosis or are in the early stages of the condition. Conversely, some patients have a severe form of endometriosis and only experience mild discomfort.

Here is a closer look at the stages of endometriosis:

• Stage 1: Minimal

Stage 1 endometriosis is characterized by minimal lesions and small wounds. During this stage, endometrial implants may affect your ovaries and cause inflammation in and around the pelvic cavity.

• Stage 2: Mild

As the abnormal endometrial growths continue to build up, you may experience stage 2 endometriosis. In this phase, the endometrial implants are still shallow and mostly affect the ovaries and pelvic lining.

• Stage 3: Moderate

Moderate endometriosis causes more and deeper implants, which are usually localized within the ovaries and pelvic linings but may extend to other organs. During this stage, you may also have small adhesions between organs, ovarian cysts, and lesions.

• Stage 4: Severe

Stage 4 endometriosis is the most severe form of this condition. It involves many deep implants that have spread through the ovaries, pelvic lining, fallopian tubes, and bowels. You may also have large cysts on one or both of your ovaries, as well as severe adhesions between organs.

Risk Factors for Endometriosis

Endometriosis can occur at any point during a woman’s reproductive years, but it is more likely to develop after the first menstrual cycle (menarche). Symptoms may take years to become noticeable, and in asymptomatic patients, a diagnosis is often only achieved when investigating unexplained infertility.

While the idiopathic nature of endometriosis makes it challenging to diagnose and treat, certain risk factors may increase your likelihood of developing this condition. Let’s explore these risk factors in detail.

Pregnancy History

If you have never given birth, you may be at a greater risk of developing endometriosis. Pregnancy temporarily halts the menstrual cycle and lowers estrogen levels, reducing the growth of endometrial cells both inside and outside the uterus. For those with existing endometriosis, pregnancy may temporarily alleviate symptoms.

However, endometriosis can still develop post-pregnancy, often due to the transfer of endometrial cells to other organs during a cesarean section. Postpartum endometriosis may also occur in women who experienced long labor, as the prolonged period between the rupture of the fetal membrane and delivery increases the risk of contamination and infections.

Menstrual History

Certain aspects of your menstrual history may increase the likelihood of developing endometriosis, including:

• Early Menarche: Starting your period before age 11.
• Late Menopause: Experiencing menopause at an older age.
• Short Menstrual Cycles: Having cycles shorter than 27 days on average.
• Heavy Periods: Having menstrual periods that last longer than seven days.

Early menarche and late menopause increase exposure to retrograde menstruation, while heavy or long periods indicate an abundance of endometrial tissue, both of which can contribute to the development of endometriosis.

Age

Endometriosis often begins during puberty, but women in their 20s, 30s, and 40s are more likely to be diagnosed. This increased diagnosis rate may be attributed to attempts to conceive, leading to the discovery of infertility issues.

Genetics

Genetics may play a role in the prevalence of endometriosis in certain demographics, though no direct correlation has been established. You are at greater risk if one or more of your first-degree relatives (mother, aunts, or sisters) have endometriosis. A family history of infertility may also be a genetic risk factor for developing this condition.

Higher Levels of Estrogen

Excessively high levels of estrogen or prolonged exposure to this hormone can increase your risk of endometriosis. Estrogen supports the growth and thickening of the endometrium during the menstrual cycle, which can lead to the buildup of endometrial tissue both inside and outside the uterus.

Low Body Mass Index

Women with a slight, smaller frame or low Body Mass Index (BMI) are more likely to develop endometriosis. However, the connection between low BMI and endometriosis is not entirely clear. Interestingly, recent studies have shown that nearly 40% of participants with endometriosis were overweight or obese, suggesting that a high BMI can also be a risk factor.

Medical Conditions That Block Menstrual Blood

Certain medical conditions can prevent menstrual blood from flowing out of the body as expected, leading to retrograde menstruation. Conditions that may contribute to this include abnormalities or obstructions in the uterus, vagina, or cervix.

Reproductive Tract Disorders

Disorders of the reproductive tract can increase the risk of endometriosis. These include:

• Uterine Growths Like Polyps: Uterine growths may cause uterine bleeding, which can lead to endometrial growths being transported outside the uterus. Both uterine growths and polyps are estrogen-dependent, which means these conditions often coexist with endometriosis.
• Asynchronous Uterine Contractions: Normal uterine contractions help expel menstrual blood. Irregular contractions, or asynchronous uterine contractions, can cause retrograde menstruation, increasing the likelihood of developing endometriosis.

How Endometriosis Is Diagnosed

Although endometriosis affects up to 11% of women of reproductive age, obtaining an accurate diagnosis can often take nearly seven years. Recent improvements in diagnostic protocols aim to shorten this delay and ensure that women with endometriosis receive timely and appropriate treatment.

Here are some of the tools used to diagnose endometriosis:

• Medical History: A healthcare provider, usually an obstetrician-gynecologist (Ob-Gyn), will assess your symptoms, review your medical history, and inquire about any previous pregnancies to determine whether you are at risk of endometriosis.
• Physical Exam: During a physical exam, the healthcare provider will palpate, or manually feel, your pelvic area to identify abnormalities such as cysts and scars that may indicate the presence of endometrial tissue outside the uterus.
• Ultrasound: Ultrasound tests use high-frequency sound waves to create images of the inner pelvic area. These tests can help detect the presence of endometrial implants outside the uterus, particularly if these have not yet caused abnormalities that can be felt during a physical examination.
• Imaging Tests: Imaging tests, such as Magnetic Resonance Imaging (MRI), use magnetic fields and radio waves to create detailed images of the pelvic organs. These tests provide accurate insights into the severity and location of endometrial implants.
• Laparoscopy: Laparoscopy is a minimally invasive surgical procedure in which a surgeon uses a thin viewing instrument called a laparoscope to examine the inside of the abdomen. This procedure can help determine the areas affected by endometriosis, collect tissue samples for testing, and remove parts of abnormal endometrial growth.

Consequences of Leaving Endometriosis Untreated

Although there is no permanent cure for endometriosis, it is important to address this condition with adequate treatment. Without treatment, endometrial implants outside the uterus will continue to grow with each menstrual cycle, potentially leading to severe complications such as:

• Infertility: Scar tissue and blockages in the fallopian tubes can prevent egg cells from leaving the ovaries and implanting in the uterus, leading to temporary or permanent infertility.
• Chronic Pain: Endometrial growth can clog the fallopian tubes, trapping blood in the ovaries and leading to cysts, scar tissue, and adhesions. This can cause severe chronic pain, which can affect mental health, cause missed workdays, and lead to depression, anxiety, and social withdrawal.
• Cancer: Abnormal endometrial growth can develop into a tumor, slightly increasing the risk of epithelial ovarian cancer. More research is needed to determine the exact correlation between endometriosis and cancer.

Prevalence of Endometriosis

The World Health Organization estimates that around 10% of women of reproductive age worldwide have endometriosis, accounting for approximately 190 million people globally. The condition is present in nearly 40% of infertile women and is most prevalent among women aged 15 to 44.

While these statistics highlight how common endometriosis is, the actual number of women with the condition may be higher due to underdiagnosis or misdiagnosis. The prevalence of endometriosis can also vary by race and ethnicity.

A 2019 study indicates that Black women are less likely to receive an accurate diagnosis compared to White women, while Asian women are more likely to be diagnosed. Research on the prevalence of endometriosis among other ethnic groups, including American Indian patients, is still limited. On average, women wait between 8 and 12 years from the onset of symptoms to be diagnosed with endometriosis.

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