Endometriosis warriors

• Endometriosis affects roughly 10% (190 million) of reproductive age women and girls globally.

• It is a chronic disease associated with severe, life-impacting pain during periods, sexual intercourse, bowel movements and/or urination, chronic pelvic pain, abdominal bloating, nausea, fatigue, and sometimes depression, anxiety, and infertility.

• There is currently no known cure for endometriosis and treatment is usually aimed at controlling symptoms.

• Access to early diagnosis and effective treatment of endometriosis is important, but is limited in many settings, including in low- and middle-income countries. (World Health Organization)

What is endometriosis?

Let's start with basic anatomy. The endometrium is the innermost layer of the uterus and acts as the wall of the uterus or the womb where the baby develops.

Endometriosis is a disease in which tissue similar to the lining of the uterus grows outside the uterus. Thus, endometrial tissue can be found in places other than the uterus such as the fallopian tubes, ovaries etc. 

Endometriosis can start at a person’s first menstrual period and last until menopause.

Why does endometriosis cause so much pain?

Endometrial tissue is highly susceptible to hormone changes and the growth and shedding thereof is determined by hormonal cycles in a female.

 During the follicular phase of a female’s menstrual cycle, the estrogen levels rise which stimulates endometrial cell growth to prepare the uterus to receive the egg from the ovaries, the endometrium will reach peak growth just before ovulation and then decline prior to menstruation. (Menstruation is the shedding of the uterine lining, eg. The endometrium.)

Thus, during these stages where the endometrium grows rapidly it can become as thick as 12-16mm. 

Women with endometriosis experience the same process in their bodies, but the endometrial tissue that is found outside if the uterus undergoes the exact same process of growth as the tissue in the uterus.

Now imagine endometrial tissue in the fallopian tube (0.5-1.2cm in diameter) growing during the follicular phase to the size of 1.2-1.6 cm in a tube with an average size of 1cm.

This leads to inflammation and scar tissue forming in the pelvic region and (rarely) elsewhere in the body.

It causes a chronic inflammatory reaction that may result in the formation of scar tissue (adhesions, fibrosis) within the pelvis and other parts of the body. 

What is the cause of endometriosis?

Endometriosis is a complex disease that affects many women globally from the onset of their first period through menopause, regardless of ethnic origin or social status.

Many different factors are thought to contribute to its development, but the exact cause is still unknown. At present endometriosis is thought to arise due to: 

• Retrograde menstruation is when menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity at the time that blood is flowing out of the body through the cervix and vagina during periods. Retrograde menstruation can result in endometrial-like cells being deposited outside the uterus where they can implant and grow. 

• Cellular metaplasia is when cells change from one form to another. Cells outside the uterus change into endometrial-like cells and start to grow. 

• Stem cells can give rise to the disease, which then spreads through the body via blood and lymphatic vessels.

Other factors may also contribute to the growth or persistence of ectopic endometrial tissue. For example, endometriosis is known to be dependent on estrogen, which increases the inflammation, growth and pain associated with the disease.

However, the relationship between estrogen and endometriosis is complex since the absence of estrogen does not always mean the absence of endometriosis. 

Symptoms of endometriosis:

Endometriosis often causes severe pain in the pelvis, especially during menstrual periods.

Some people with endometriosis don’t have any symptoms. For those who do, a common symptom is pain in the lower part of the belly (pelvis). Pain may be most noticeable:  

• during a period

• during or after sex

• when urinating or defecating.

Some people also experience: 

• chronic pelvic pain

• heavy bleeding during periods or between periods

• trouble getting pregnant

• bloating or nausea

• fatigue

• depression or anxiety.

Symptoms often improve after menopause, but not always.

Endometriosis symptoms are variable and broad, meaning that healthcare workers may not easily diagnose it. Individuals with symptoms may not even be aware of the condition.

Treatment of endometriosis:

Endometriosis can not be cured, but treatment to reduce symptoms and pain can be provided. A range of medication is available to treat the symptoms of endometriosis based on the severity of the disease and desire to become pregnant.

Consult with your healthcare provider/doctor about the appropriate treatment plan according to your needs.

Endometriosis and pregnancy:

Having endometriosis does not automatically mean you can not become pregnant. Many women living with endometriosis fall pregnant naturally, however every 1 in 3 women with endometriosis might struggling falling pregnant naturally.

To become pregnant, an egg needs to be released from the ovary into the fallopian tube and be fertilized by sperm. The fertilized egg then attaches to the uterus lining where it will grow for the duration of the pregnancy.

Endometriosis may affect fertility when one of the above mentioned steps are inhibited such as:

• Endometrial tissue blocking the ovary from releasing an egg.

• Endometrial tissue blocking the fallopian tube.

• Endometrial tissue stopping the normal functioning of the fallopian tube.

• Endometrial tissue prevents the fertilized egg from attaching to the uterine lining.

Endometriosis is a complicated disease that affects women around the world of all races, ages, backgrounds and medical history. 

Due to the normalization of symptoms and lack of awareness by both men and women, there is a significant delay in the diagnosis and treatment of endometriosis in women. Thereby leading to many many women living with endometriosis and the excruciating painful result thereof for multiple years without proper pain management and treatment of the symptoms, remaining to suffer under the pretense of “just another painful period”.

It is time for us to take the menstrual, hormonal and reproductive health of women seriously, and stop the generalization of certain symptoms just because it is a woman complaining of the symptoms.

For the celebration of endometriosis awareness month, let's support our sisters, mothers, girl friends, partners and fellow women.