HORMONAL DISORDERS
ENDOMETRIOSIS
Endometriosis is the abnormal growth of endometrial tissues in locations outside of the uterus. The endometrium, the inner lining of the uterus, consists of epithelial cells that grow and shed with each menstrual cycle and are transported outside of the body with each menstrual bleeding, if no pregnancy occurs. In endometriosis, endometrial cells implant in locations other than the uterus, most often the fallopian tubes, ovaries, or other areas in the pelvic cavity, where they continue building up and shedding with each menstrual cycle. (Endometriosis in more remote parts of the body, such as the extremities, is extremely rare.) Because - outside of the uterus - there is no way for the shedded endometrial cells and bloody byproducts to exit the body, they often cause inflammation, adhesions, or cysts, which can lead to severe pain and other chronic symptoms, including digestive issues and - in more severe cases - infertility. With about 10% prevalence, endometriosis is a relatively common disorder amongst women of reproductive age. It can be diagnosed via pelvic exam, or imaging, such as ultrasound, MRI, or laparoscopic biopsy. Diagnosis may be difficult and/or delayed, as symptoms of endometriosis are non-specific. Although it is a chronic disease, treatments today resolve most symptoms and in many cases allow for future pregnancies.
Risk Factors
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Lack of pregnancy
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Late onset of menopause
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Early onset of menarche (menstrual cycle)
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Heavier, longer or more frequent menstrual periods
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Family history (relatives with endometriosis)
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Elevated estrogen levels/exposure
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Lower BMI (body weight)
Causes
The causes of endometriosis are not conclusively understood. There are several different hypotheses, alternative explanations and possible etiologies of endometriosis. One common theory is that endometriosis is caused by retrograde menstruation, i.e. the back flow of menstrual blood through the Fallopian tubes into the pelvic cavity, where endometrial cells then implant and grow. Although all women experience some amount of retrograde menstruation, endometriosis may be caused as a result of some form of immunodeficiency, if the immune system is unable to recognize and eliminate the endometrial cells outside of the uterus. Cellular metaplasia, the hormone-induced transformation of peritoneal cells into endometrial cells, is another possible explanation of endometriosis. Endometrial tissue can further reach extra-uterine areas through surgical tissue transfection, i.e. the unintentional translocation of endometrial cells during uterine surgery. In the rare cases in which endometriosis occurs in remote parts of the body, the endometrial may travel to these locations via vascular or lymphatic cell transport.
Symptoms
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Strong menstrual bleeding
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Menstrual pain (dysmenorrhea)
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Painful intercourse (dyspareunia)
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Painful bowel movements or urination (dyschezia)
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Infertility
Treatments
In most cases, endometriosis can be successfully treated with hormone therapy. This includes hormonal contraceptives, such as intrauterine devices (IUDs), contraceptive implants or oral contraceptives, consisting of progesterone and/or estrogen agonists. Other hormone therapies function with GnRH (gonadotropin-releasing hormone) antagonists, which reduce the levels of estrogen and progesterone in the body. In either case of hormone therapy, the hormonal levels are held steady throughout the month, thereby preventing build up and break down of endometrial tissue and reducing symptoms of endometriosis.
In more severe cases, or when conservative (medical) treatments are not sufficient, surgical removal of the endometrial tissue outside the uterus may be necessary. Most often, this can be done with minimally invasive (laparoscopic) procedures, where a light microscope and tools are inserted into the pelvic cavity via small holes in or to the sides of the naval. In rare cases, an open laparotomy or hysterectomy may be required, for instance if endometrial tissue build up in the pelvic cavity is excessive. As endometriosis is chronic, a repeat surgery may be necessary if endometrial tissue build up continues after the initial removal.