Endometriosis is a common medical problem affecting many women, with some not having symptoms at all. It can affect any woman of reproductive age, although it is more common in those in their 30s and 40s. It involves growths that are not cancerous, but they are still problematic. It is a big causal factor of infertility in women, especially if it has not been diagnosed.

According to Dr Boniface Musila, a gynecologist, endometriosis is a condition that is difficult to diagnose because the procedure used for diagnosis, called laparoscopy, is very expensive. In addition, the doctor has to rule out other related medical problems before diagnosing endometriosis as it can mimic conditions such as severe dysmenorhea (painful menstrual periods).

The cause of endometriosis is not known, but there are some theories that try to explain the endometrium grows outside the uterus — for example, genetics, hormones, or cuts made during C-sections. However, women who have not had surgeries can also have endometriosis. 

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Is endometriosis the same as dysmenorhoea?

Both conditions are associated with reproductive health and share some similarities, but they are not the same. Dysmenorrhea refers to painful menstrual periods, with pain occurring a few days to menstrual bleeding. Dysmenorrhea can be primary (not caused by other diseases); or secondary (where the pain is as a result of a disorder in the reproductive organs, like pelvic inflammatory disease, or uterine fibroids).

On the other hand, endometriosis usually occurs when endometrium (a tissue that normally lines the uterus) grows in other places other than in the uterus. During menstrual periods, as the uterus sheds the endometrium, the endometrium in these places is also being shed, hence resulting into pain.

Common places where endometrium can grow include the ovaries, bladder, on the space behind the womb, the umbilical area, or any other place where there is an incision — for example, after caesarean section. These growths can swell and cause pain because they grow in places where it is difficult for the body to get rid of them. As they continue to expand, they can block fallopian tubes, cause inflammation or form scar tissue. 

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I usually have painful periods. Could I be having endometriosis?

Pain is a common characteristic of endometriosis. Typically for endometriosis, onset of pain precedes flow by a few days and begins to resolve one to two days into the menses.

Pain may also occur during intercourse, and some patients may have chronic pain in the pelvis and lower back, or pain during bowel movements. Also, other symptoms may occur, like heavy and prolonged menstrual flow through the cycles, which tend to be regular.

Women who have not been able to conceive should be investigated for endometriosis because the inflammation caused by the condition can cause adhesions that can affect fertility. A third of women with endometriosis remain asymptomatic, and the best way to identify what is causing you to have painful periods is to have a gynaecologist examine you.

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My doctor diagnosed me with endometriosis recently after complaining of painful periods for long. I was given different treatment options, including surgery.

What should I opt for?

If the symptoms are mild, the doctor may advise use of over-the-counter, non-steroid pain relievers, such as brufen. Hormonal treatment, such as use of birth control pills which work by extending the cycle so that you can have fewer menstrual periods in a year or stop the cycle altogether, are also regularly prescribed.

The hormones in these birth control pills can change the tissue, hence easing the pain. Birth control injections like Depo Provera may help ease the pain as they cause the menstrual period to disappear.

The doctor may also prescribe a gonadotropin-releasing hormonal medicine that stops the body from secreting hormones that are responsible for menstrual cycle, ovulation and development of endometriosis. This medicine induces a medical artificial menopause, but at the same time controls development of endometriosis. Menopause helps improve symptoms of pain because it causes the body to stop producing the hormones estrogen and progesterone, hence the tissue shrinks gradually. The menstrual cycle resumes once the medicine is stopped.

Another medication that can be used is Danazol, which influences the cycles by interfering with ovarian function through different mechanisms. For severe symptoms, surgery may be an option when hormonal treatment fails to provide pain relief. During surgery, the doctor locates the areas of endometriosis and removes the culprit tissue, though sometimes radical surgery like that of removing the uterus, ovaries and fallopian tubes may be necessary for those who have completed their family. Hormonal treatment may be resumed after surgery.

In order to be make the right treatment choice, please discuss with your gynaecologist and get the treatment that is best suited for your case.

KNOW YOUR BODY:

A biological engineering marvel

The female reproductive system carries out several functions out of its design. It produces the female egg cell, called an ovum, needed for reproduction; and is designed to carry the ova to the fertilisation site. The fertilisation of an egg by sperm, which is known as conception, takes place in the fallopian tubes. Once the egg is fertilised, it implants into the walls of the uterus, which is the onset of pregnancy. If there is no fertilisation or implantation, the system is designed to shed the uterine lining every month, usually called menstruation. Here, the complexities of the system: 

Ovaries: A pair of tiny glands, like almonds in shape and size, which are situated on the left and right sides of the pelvic body cavity. Ovaries produce female sex hormones, including estrogen and progesterone, and the female egg, called an ovum. Ova are developed gradually throughout a woman’s early life and mature by puberty. Every month during ovulation, a mature egg is released. 

Fallopian tubes: These are a pair of muscular tubes which extend from the left and right main corners of the uterus to the edge of the ovaries. The tubes end in funnel-shaped structure which is surrounded by tiny finger-like projections known as fimbriae. The fimbriae are responsible for picking up the released egg and carrying it into the fallopian tubes for transportation to the uterus. 

Uterus: This is a hollow, muscular, pear-shaped structure. The uterus is commonly known as the womb since it surrounds and supports the growing faetus during pregnancy. The inner lining of the uterus, called endometrium, gives support to the embryo during early development. The muscles of the uterus contract during childbirth, pushing the faetus through the birth canal. 

Reproductive cycle: This is the process of producing an egg and preparing the uterus to receive the fertilised egg to start pregnancy. If an egg is produced and no fertilisation occurs, the system is reset through menstruation. The whole reproductive cycle takes about 28 days but it may take as short shorter as 21 days, or as long as 35 days, for some women. 

Ovulation: Through the influence of luteinizing hormone (LH) and follicle stimulating hormone (FSH), ovaries release a mature egg in a process referred to as ovulation. At around 14 days into the reproductive cycle, an oocyte (a cell in an ovary that may undergo division to form an ovum) matures and is released as an egg. 

Fertilisation: Once the egg is released from the ovary, it is picked by the fimbriae and swept down the fallopian tube to the uterus. The egg takes about a week to travel to the uterus. If sperm is able to penetrate the egg during this period, the egg is fertilised and a zygote is formed. After two weeks of cell division, the zygote develops into an embryo which attaches itself into the walls of the uterus for development during pregnancy.  

Menstruation: While the egg matures and moves through the fallopian tube, the endometrium grows and develops to prepare for the embryo. If the egg is unfertilised in time or fails to implant on the uterine walls, the arteries supplying blood to the uterus constrict, cutting off blood flow to the endometrium. Lack of blood flow leads to death of cells in the endometrium and shedding of tissues (menstruation).