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Endometriosis : All you need to know

Every once in a while, things can go wrong. Here’s another step towards awareness and education.


What is endometriosis?

By Khyati Patkar

During your regular cycle, your body sheds the lining of your uterus, called the endometrium. This allows your blood to flow out of the system in sync with the cervix. For someone who has endometriosis, these tissues implant themselves outside of the uterus, and grow on your ovaries, fallopian tubes, and the pelvic cavity.

These misplaced tissues develop just like the normal ones, except that they are not connected to your vaginal canal. This leaves the tissues and the blood with no other place to go, thus facing a dead-end. This may cause pain and swelling of surrounding tissues due to inflammation.


Who can have it?

You’re not alone if you have endometriosis, as it’s a common gynecological disorder, affecting more than 10% of menstruators. It’s especially seen among those in their 30s and 40s, making it harder to conceive.


Signs and symptoms:

To sum them up in one word-pain. Occasional cramping is okay, but severe pain isn’t. As the tissue remains trapped over time, it can cause:

· Irritation and scar formation

· Binding your pelvic organs together

· Fertility issues

· Severe pain in the lower abdomen, pelvis, or lower back

· Heavy and usually long periods

· Abnormal pain during or after sex

· Pain with bowel movements


Most of the times, endometriosis is benign, i.e. non cancer causing. But make sure to get regularly checked to analyze increased risk of reproductive cancers. From mild to agonizing pain, and severe to less discomfort, symptoms can vary from body to body.

Note: The severity of pain does not indicate the degree or stage of your condition.


Why it happens?

The exact cause remains a mystery, but one of the oldest theories has been ‘retrograde menstruation’. This is when the blood flows back through your fallopian tubes into the pelvic cavity instead of the right way.

Another theory focuses on hormonal changes mirroring the cells inside the uterus to those outside, called endometrial cells. They continue to grow, thicken, and bleed over the course of your menstrual cycle in response to the hormones of your cycle.

The development of endometriosis also links to genetics, puberty, or even environmental toxins.


Stages:

If you are someone who has endometriosis, this might help you figure out which stage you’re at. Different factors determine the stage of the disorder. These factors can include the location, number, size, and depth of endometrial implants.


There are four main stages-

1. Minimal: There are small lesions or wounds and shallow endometrial implants on your ovary. There may also be inflammation in or around your pelvic cavity.


2. Mild: Involves light lesions and shallow implants on an ovary and the pelvic lining.


3. Moderate: Deep implants on your ovary and pelvic lining. There can also be more lesions.


4. Severe: The most severe stage of endometriosis involves deep implants on your pelvic lining and ovaries. There may also be lesions on your fallopian tubes and bowels.


Diagnosis:

Treating pain requires accurate diagnosis. Similar to that of ovarian cysts and pelvic inflammation, you can base your observations on the following, as per your doctor:

1. Detailed history- symptoms, family history, signs of long term disorder

2. Physical exam- manually feel your abdomen for cysts or scars

3. Ultrasound- Transvaginal or abdominal ultrasound to identify cysts

4. Laparoscopy- viewing and removing the tissue directly through a minor surgical procedure


Treatment:

Quick relief from the pain is all you want, which is understandable. Even though endometriosis has no cure yet, its symptoms can be managed and controlled. Consult your gynecologist or a health professional to find the treatment that suits you best. Owing to the multitude of issues that endometriosis brings along, it can get difficult to handle mentally. Keep educating yourself and engage with support groups to get through it and keep yourself inspired.


Some treatment options are:

1. Pain medications- over-the-counter meds like ibuprofen. But these do not prove to be effective in all cases


2. Hormone therapy- supplemental hormones can relieve pain and stop progression of symptoms. This regulates the hormones that promote endometrial tissue growth


3. Hormonal contraceptives- birth control pills, patches, and vaginal rings can reduce or eliminate pain. The medroxyprogesterone (Depo-Provera) stops growth of these misplaced cells. But, it goes without saying that they further reduce your chances of conception and decrease fertility. These should be your last resort, owing to the risk of decreased bone density, weight gain, and increased depression.


4. GnRH agonists and antagonists: These block the production of estrogen to induce an artificial menopause. The side effects include vaginal dryness and hot flashes.


5. Danazol: These meds also stop periods and reduce symptoms, while the disorder continues to progress. Side effects include acne and facial hair growth.


6. Surgery: Includes laparoscopy to destroy endometrial growth and hysterectomy to remove the uterus and cervix.

It’s best to get an expert’s opinion before going ahead with any decision.

A few myths: All of these are a big NO. Make sure you stay away from and correct them whenever you come across one.

  • Severe period pain is normal

  • You’re too young to have endometriosis

  • Pregnancy cures it

  • Endometriosis equals fertility

  • Endometriosis is ‘emotional’

  • Abortion causes it


If you have endometriosis, don’t let it impact your everyday life. Develop and maintain healthy practices and do all that’s best for your body. You’re going to be okay!


Written by Nibha Patil

Cover by Khyati Patkar

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