Endometriosis is a potentially painful disorder affecting more than a million women in India. The pain associated with the condition often causes dysfunction. It is chronic in nature, but there are effective treatments available to manage the pain and prevent the complications that are commonly associated with it.
What is endometriosis?
Endometriosis is a disorder when the tissue that usually lines the endometrium (inside the uterus) grows out of the uterus. The usual places where this misplaced tissue grows are the fallopian tubes, ovaries, and the pelvis tissue lining. In rare cases, the endometrial tissue grows beyond the pelvic region. Although the endometrial tissue is outside the uterus, it thickens and breaks down during the menstrual cycle, which causes bleeding. However, the tissue does not have an exit like in normal menstruation, and hence gets trapped. Over a period, this tissue causes cysts, inflammation and scarring.
What are the different endometriosis symptoms?
Not all individuals with endometriosis will experience the symptoms or with the same intensity. However, here are the common symptoms associated with endometriosis:
- Intense pelvic pain before, during, and after menstrual days. May include abdominal and lower back pain, too.
- Pain during or after intercourse
- Painful bowel movements or during urination, especially during menstruation
- Excessive menstrual bleeding and intermenstrual bleeding, i.e. bleeding between menstrual cycles
What Are the Types of Endometriosis?
There are four types of endometriosis categorised based on the location of tissue growth. The types include:
- Superficial peritoneal endometriosis
The least severe type, here the tissue attaches to the peritoneum which is a thin membrane lining the pelvis and abdomen.
Also known as ‘chocolate cysts,’ endometriomas are dark and filled with fluid. They most commonly occur in the ovaries but can be found in parts of the abdomen or pelvis, too.
iii. Deeply infiltrating endometriosis
Occurring in about 1-5% of individuals with endometriosis, this type affects the organs outside or within the pelvic cavity, including the bladder, bowels, rectum, and ovaries. The scar tissue bonds the organs making them stuck in one place. This condition is also known as the frozen pelvis.
- Abdominal wall endometriosis
As the name suggests, this type of tissue grows along the abdominal wall.
What are the causes of endometriosis?
The exact cause of endometriosis is yet unknown. However, researchers have identified certain factors that increase the risk of developing endometriosis. These risk factors include:
- Early onset of the period
- Reproductive tract abnormalities
- Developing menopause at an older age
- High oestrogen level or higher lifetime exposure to oestrogen in the body
- Low BMI (Body Mass Index)
- Family history of endometriosis
- A medical condition, which restricts the normal passage of menstrual blood out of the body
- Short menstrual cycles- less than 25-27 days
- Heavy menstrual periods- last longer than seven days
Treatment for endometriosis
There is no cure for endometriosis, but there are multiple effective treatment options for patients. The treatment is based on the severity and dysfunction caused by endometriosis. It also depends on whether the individual wishes to become conceive anytime in the future. Doctors recommend conservative therapies, to begin with, but may recommend aggressive options like surgery if there are serious complications or dysfunction.
The following are the treatment options for endometriosis:
A doctor will recommend OTC pain relievers such as ibuprofen, nonsteroidal anti-inflammatory drugs (NSAIDs), or naproxen sodium to manage the menstrual cramps.
- Hormone therapy
From oral contraceptive pills to aromatase inhibitors, there are many hormone therapies that an individual can undertake. The pain from endometriosis can be reduced or eliminated using supplemental hormones. Hormonal treatment can slow down the growth of endometrial tissue, and consequently, reduce the amount of endometrial tissue break down and bleeding.
Let’s take a look at four effective hormone therapies:
- Hormonal contraception
Birth control pills such as Mankind’s Unwanted -21, vaginal rings or patches reduce the endometrial tissue build-up by controlling the hormones responsible for it. Using a continuous cycle contraceptive like Mankind’s Unwanted-72 is most effective in reducing and even eliminating pain in some individuals. Being India’s No. 1 Contraceptive Tablet, it is readily available and convenient to use.
2. Gonadotropin-releasing hormone agonists and antagonists
Gn-RH prevents menstruation by blocking or reducing the production of oestrogen by the ovaries. Since the endometrial tissue shrinks, the pain is reduced. However, artificial menopause is caused by these drugs. To mitigate the side effects of menopause, taking a low dose of oestrogen or progestin along with Gn-RH agonists and antagonists is recommended.
If you are looking to get pregnant, stop the medication to resume the menstruation cycle.
- Progestin therapy
Intrauterine devices, implant, injection or pill containing progestin can prevent menstruation and thus, prevent the growth of endometrial tissue. This will relieve the individual of the symptoms of endometriosis.
These restrict the amount of oestrogen in the body, preventing menstruation. A doctor may combine this inhibitor with progestin or a combination contraceptive pill to treat the symptoms of endometriosis.
- Conservative surgery
Conducted laparoscopically or through traditional abdominal surgery, this surgery for treating severe cases of endometriosis, and if the individual wishes to get pregnant in the future. The surgery removes the endometrial implants while preserving the ovaries and uterus.
The individual may be prescribed hormonal therapy to deal with the after-surgery pain. It is important to note that there is a possibility of pain and endometriosis returning.
- Hysterectomy and/or oophorectomy
Surgery to remove the uterus and the ovaries is another treatment option. Hysterectomy is an option for those experiencing intense pain brought on by endometriosis. However, you should consult a doctor before opting for this alternative as there are risks attached to these surgeries.
- Fertility treatment
One of the possible complications of endometriosis is the difficulty in getting pregnant. Fertility treatment in the form of in vitro fertilisation or stimulation of the ovaries or other specialised fertility treatments can be considered to become pregnant.
Having endometriosis can have psychological implications, too. Talking to someone with endometriosis, joining a support group can help the individual to deal with the pain and uncertainty often associated with the condition.