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What to know about endometriosis? | BY HEIDI


 

Endometriosis is a condition that can affect females. It happens when tissue that is similar to that of endometrial tissue grows outside the uterus.


The tissue responds toTrusted Source hormones that affect the menstrual cycle in the same way that endometrial tissue does. It swells and bleeds like endometrial tissue, but there is nowhere for the waste tissue and blood to go.


The tissue is not cancerous, but it can lead to scarring and adhesions. It can block the fallopian tubes, and cysts can form due to trapped blood. Tissues can fuse, leading to changes in the reproductive organs.


Symptoms include pain and unusual bleeding. It may affect a person’s chances of becoming pregnant.


Experts believe endometriosis affects around 11%Trusted Source of females in the United States aged 15–44 years. It is most common among those in their 30s and 40s.


Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.


What is endometriosis?


Endometrosis occurs when tissue, similar to the lining of the endometrium, grows outside the uterus. The tissue that grows outside the uterus in endometriosis is not the same as endometrial tissue, but they have some features in common.


The tissue can develop anywhere in the body, but it usually affects the pelvic area, including:


the ovaries

the fallopian tubes

tissues that support the uterus

the outside of the uterus

Endometrial tissue can also develop in other areasTrusted Source, including the digestive tract, the lungs, and around the heart.


The body usually expels this type of tissue during menstruation, but the tissue that forms in endometriosis may remain in the body, which can lead to inflammation. As tissue decomposes, scar tissue can form.


Endometriosis can significantly affect a person’s quality of life. In addition to the pain, they may experience pressuresTrusted Source relating to:


chronic pain

employment

the cost of medical care

relationships

difficulty maintaining a social life

concerns about not being able to become pregnant

stress, anxiety, and depression

A 2013 report notes that it can take an average of 6.7 yearsTrusted Source to get an accurate diagnosis. During this time, people lose an average of 10.8 hours of work a week due to the debilitating impact of the condition.


Symptoms

Symptoms of endometriosis include:


painful cramping, similar to menstrual cramps

long-term lower back and pelvic pain

periods lasting longer than 7 days

heavy menstrual bleeding

bowel and urinary problems, including pain, diarrhea, constipation, and bloating

blood in the stool or urine

nausea and vomiting

fatigue

pain during sex

spotting or bleeding between periods

difficulty becoming pregnant

Pain is the most common indication of endometriosis, but the severity of the pain does not always correlate with the extent of the disease.


Pain often disappears after menopause, when the body stops producing estrogen. However, if a person uses hormone therapy during menopause, symptoms may persist.


Pregnancy may provide temporary relief from symptoms.


What are endometriosis adhesions?


Diseases with similar symptoms

Endometriosis can be difficult to diagnose. One reason for this is that other medical conditions have similar symptoms. These include:


pelvic inflammatory disease

ovarian cysts

irritable bowel syndrome

Complications of endometriosis include:


infertility, which can affect up to 50%Trusted Source of those with the condition

a higher risk of ovarian cancer or endometriosis-linked adenocarcinoma

ovarian cysts

inflammation

scar tissue and adhesion development

intestinal and bladder complications

Monitoring symptoms and seeking help may help prevent long-term complications. People should let their doctor know if they experience severe pain or unexpected bleeding.



Treatment

There is currently no cure for endometriosis, but various treatment options may help manage symptoms. They include:


Pain relief

Medications can help manage pain. They include nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin IB, others) and drugs to relieve painful menstruation.


If over-the-counter options do not help, a doctor may prescribe stronger drugs.


Hormonal treatment

A doctor may recommend birth control pills or other hormonal methods of birth control, such as the Mirena device. In some cases, they may recommend gonadotrophin-releasing hormone.


These may reduce estrogen levels and help limit the development of unwanted tissue. However, they cannot repair adhesions or improve fertility.


Surgery

If other treatments do not work, a doctor may recommend surgery to remove unwanted tissue. In some cases, a hysterectomy with removal of both ovaries may be necessary.


Fertility treatment

If endometriosis affects fertility, in-vitro fertilization may be an option.


What is the latest research on endometriosis treatment?


Natural remedies

Some complementary and alternative treatments and lifestyle choices may help manage endometriosis symptoms. They includeTrusted Source:


acupuncture

herbal medicine

avoiding caffeine

hypnosis

biofeedback

counseling

regular exercise, such as walking

Some people may find these methods help, but there is little scientific evidence to show that they are effective. They will not cure endometriosis or reverse any damage that has occurred.


Click here for some tips on living with endometriosis.


Diagnosis

It can be difficult for a medical professional to diagnose endometriosis because no specific test can confirm it, and the symptoms may be hard to see. The symptoms can also resemble the symptoms of other conditions.



a pelvic exam

imaging tests, such as an ultrasound or MRI scan

laparoscopy

a biopsy

Surgical laparoscopy is the only way to confirm a diagnosis of endometriosis. This is a minimally invasive procedure in which a doctor inserts a laparoscope through a small incision in the pelvic area. This provides images of tissue changes.


Stages

There are different ways of staging endometriosis. In 1996, the American Society of Reproductive Medicine (ASRM) set out four stages to describe the severity of endometriosis, ranging from minimal to severe.


Stage Category Features

1 Minimal Isolated implants and no significant adhesions

2 Mild Superficial implants on the peritoneum and ovaries; no significant adhesions.

3 Moderate Multiple implants, both superficial and deeply invasive. Adhesions may be present about the tubs and ovaries.

4 Severe Multiple superficial and deep implants and large ovarian endometriomas; dense, filmy adhesions in most cases.

The stages of endometriosis are not specifically linked to levels of pain, the impact on mental health, and other factors. However, the risk of infertility appears to increaseTrusted Source as the stages progress.


There is controversy regarding the stages. Some expertsTrusted Source say they do not help doctors decide which treatment to offer, as they do not adequately reflect how the disease affects an individual.



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Diet

Various dietary factors may affect the risk of developing endometriosis, the way a person experiences symptoms, and their overall sense of well-being.


A 2020 interview studyTrusted Source involving 12 people concluded that focusing on dietary factors helped relieve pain and fatigue. This may be partly due to an enhanced awareness of endometriosis and an increased focus on diet and well-being overall.


Dietary factors that may be beneficial include:


removing gluten and dairy products from the diet

increasing the consumption of fruits and vegetables

avoiding junk food

preparing meals using fresh ingredients

avoiding caffeine and alcohol

following a low-FODMAP diet

consuming a type of seaweedTrusted Source known as bladderwrack

However, the studies that produced these suggestions were small, and there is no information regarding the race or ethnicity of participants. Researchers have not yet found enough evidenceTrusted Source to confirm that any dietary steps will affect the risk or impact of endometriosis.



Causes and risk factors

Experts do not know exactly why endometriosis happens.


Two known risk factorsTrusted Source are starting menstruation before the age of 11 years and heavy and prolonged menstruation, but other factors may play a role.


These includeTrusted Source:


genetic factors, as it appears to run in families

problems with menstrual flow, resulting in blood and tissue not leaving the body

immune system problems, in which the immune system does not eliminate unwanted tissue

high levels of the hormone estrogen in the body

surgery to the abdominal area, such as a cesarean delivery or hysterectomy

shorterTrusted Source menstrual cycle

alcohol and caffeine consumption

ExpertsTrusted Source have linked some health conditions with endometriosis. These include:


allergies

asthma

sensitivity to some chemicals

some autoimmune diseases

chronic fatigue syndrome

ovarian cancer and breast cancer

Researchers also have found linksTrusted Source between endometriosis and exposure to certain chemicals, including phthalates.

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