endometriosis: signs, causes and getting help

the endometrium is the lining of the uterus. during the monthly menstrual cycle, the endometrium becomes thick with tissue and blood vessels to support a potential pregnancy. if you get pregnant during this time, the fertilized egg attaches to the endometrium, which will continue to support the baby for the duration of the pregnancy. if a pregnancy does not happen, the body sheds the extra tissue and blood (menstruation) in preparation for a new cycle.

in endometriosis , endometrium-like tissue is also present outside of the uterus (called endometrium implants) in places like the fallopian tubes, outside wall of the uterus, bladder, and rectum. in some very rare instances, endometrium has been found in the lungs and skin .

the presence of this tissue outside of the uterus can cause inflammation, cysts, and scarring – all of which can be very painful. there are four stages of endometriosis, with stage 4 having the most severe presence of endometrium implants, scarring and cysts. the four stages are not an indicator of pain, however – stage one can also be very painful depending on the physiology of the implants.

in some cases, implants may interact with nerves in the abdomen (like the sciatic nerve ), causing pain and weakness in various other area of the body.

it is thought that 10 per cent of women – or 1 in 10 – have endometriosis. however, because laparoscopic surgery is the standard for diagnosing endometriosis, this rate may be higher as surgery is often seen as a last resort.

there is no known cause of endometriosis. one theory suggests that it may occur as a result of “ retrograde menstruation ,” where endometrial tissue actually flows up and out the fallopian tubes and into the pelvic area during the natural progression of a menstrual cycle. retrograde menstruation is fairly common , however, in those without endo the immune system typically clears the rogue tissue. for this reason, it is also possible that endometriosis is connected to abnormal functioning of the immune system.

a second theory, called coelomic metaplasia , suggests that cells in the pelvis might actually morph into endometrial cells.

• pain although not present in every case of endo, individuals with endometriosis may feel moderate or severe pain wherever the endometrium deposits are located, including the lower abdomen, stomach area, and back. pain may also occur during sex and/or while going to the bathroom.
• infertility
• heavy or abnormal periods also, excessive pain during periods and bleeding between periods.
• inflammation
• nausea, vomiting

• medication: medication may be prescribed to help manage symptoms. ibuprofen can help with pain and inflammation, while other forms of hormonal medication (including birth control) may be prescribed to help manage the growth of the endometrium.
• surgery: to remove endometrium implants, cysts or scar tissue. the most common surgery recommended is laparoscopy. a viewing device called a laparoscope is inserted into the abdomen through this incision, allowing surgeons to see signs of endometria. other small incisions may be made to allow for other surgical instruments to help with removing the implants. laparoscopy is also the standard to diagnose endometriosis.
• complementary and alternative medicine: some patients may choose to pursue other treatments that might help relieve symptoms, including osteopathy, acupuncture, chiropractic, naturopathy and alterations to diet.

historically, women reporting pain have had a hard time being taken seriously.

a large-scale study on canadian endometriosis patients published in 2020 reported an average of more than five years for endo patients to be diagnosed, with three years between onset of symptoms and patients consulting with a doctor and more than two years from the first consultation to being diagnosed.

when working with a doctor to come to a diagnosis and treatment plan, asking why is a powerful tool to understand the reasons behind a diagnosis (or if one is not given) and to ensure the physician understands what you are experiencing. other questions you can ask include “what should i do if the symptoms get worse?” and “what else can explain these symptoms?” symptom trackers (including apps and websites) may help patients report everything they are experiencing to their doctors.

when in doubt, seek out a second opinion or ask for a referral to a specialist (like a gynecologist). serious abdominal pain is not normal and should be taken seriously by your healthcare team.

emjones@postmedia.com |  @jonesyjourn

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endometriosis: signs, causes and getting help

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