What you need to know (and how to deal with it!)
Are you experiencing menstrual cramps during your period? This slight discomfort is usually common in most women. However, when you feel that the menstrual pain hurts more than the usual and becomes intolerable, it may be a signal to take your situation seriously.
Extreme menstrual and pelvic pain are indicative symptoms of endometriosis which affects a lot of women worldwide.
What is endometriosis
Endometriosis is a gynaecological condition where the tissues lining the uterus, the endometrium (hence the name), begin to grow outside and reach the other reproductive organs and even up to the parts of your abdomen and most of the time cause severe pain during menstrual period.
Why is endometriosis considered as a gynaecological condition?
Since the outgrowths are endometrial in nature, they also respond to hormonal changes during menstrual cycle and continue to thicken and shed every time you have your period.
Doesn’t sound too alarming right?
But remember, these endometrial tissues grow outside of your uterus, thus, the bleeding cannot exit your body!
Overtime, this result to irritations, swelling and scarring on the normal tissues of affected neighbouring organs. In some cases, it may even result to some organs and pelvic tissues to attach to each other.
The common parts where endometriosis can develop are:
- Fallopian tubes
- Exterior part of the uterus
- The linings of the pelvic
I heard that endometriosis can also cause chocolate cysts. What are these?
Typically, when the condition reaches the ovaries, fluid-filled cysts called ovarian endometriomas are formed within the ovarian tissues. These are also commonly known as chocolate cysts. The name is derived from the characteristic brown and tar-like appearance of the cysts that is very similar to chocolate.
This chocolate-like appearance is caused by old menstrual blood and tissues that are trapped inside the cavity of the cysts in the ovary. These cysts can grow from 2cm to 20 cm in size and can develop in one or both ovaries. This condition can be found in 20-40% of women with endometriosis, although mostly linked with more severe stages.
What are the symptoms of endometriosis?
In addition to extreme menstrual and pelvic pain, some of the most common symptoms also include:
- Extreme menstrual pain spreading to your lower back and abdomen
- Prolonged menstrual pain throughout your period
- Pain during and after sexual intercourse
- Pain during urination and bowel movements (during period)
- Abnormal heavy flow
- Gastrointestinal issues including diarrhea, constipation and bloating
- Nausea and fatigue
- Difficulty in getting pregnant
- Chocolate cysts also exhibit similar symptoms with endometriosis since it is a subgroup of this condition, usually in the more severe stages.
When a cyst ruptures, severe pain is usually experienced on the location of the cyst in the body.
What causes this condition?
There are no proven causes as of now; researches have speculated these following reasons on how and why endometriosis develops:
Retrograde menstruation where menstrual blood with endometrial cells flows in a backward manner into the fallopian tubes and into the pelvic cavity instead of exiting the body
Abnormal transformation and transporting of different cells such as:
- Peritoneal cells in the lining of your abdomen
- Embryonic cells into endometrial cells as influenced by hormones or immune factors
Transporting of endometrial cells into other parts of the body by the blood vessels or by the lymphatic system
Issues with immune system where the body cannot recognize and fight the endometrial outgrowths
Surgical incisions where endometrial tissues can attach to, after surgery
Genetics and family history
Am I at risk of developing endometriosis?
Any woman in their reproductive age can be affected by this condition but it has reported to be most common in women between 30 and 40 years old.
If you are a woman in your 30s and have yet given birth, the risk might be higher for you.
In addition, the following also increases your chances of having endometriosis:
Abnormal uterus and menstrual pattern (period cycle is not the same as normal)
Period at an early age and menopause at an older age
Higher levels of hormones, i.e. estrogen
Family members (mother, sister or aunt) have endometriosis
Unhealthy lifestyle habits like excessive consumption of alcohol
How will I know if I have endometriosis?
If you recognize these symptoms in your body, the best thing you must do is to write them down and see your doctor as soon as you can.
Based on your list, your doctor will be able to recommend any of the following diagnostic test that may include examining your abdomen and pelvic area:
- Pelvic examination
- Advanced imaging technology such as CT scan and MRI
- Blood tests
- Laparoscopy (gold standard for diagnosis)
Depending on the severity of the condition, your gynaecologist may recommend you for laparoscopy, a procedure where a surgeon looks at the inside of your abdomen.
What are my treatment options?
For endometriosis, the following treatments are available depending on the severity of the condition:
Practical remedies for pain:
- Home remedies such as warm baths and heating pads to relive discomfort and pain from menstrual cramps
- Painkillers and anti-inflammatory medications for milder symptoms and less severe stages
- Regular exercises and healthy lifestyle
Hormonal therapy such as:
- Birth control pills
- Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists
- Progestin therapy and other hormone therapy
Usually, for milder and less severe stages, your doctor will only recommend watchful waiting to observe the response to medication before recommending further treatment procedures.
Your doctor may advise you to undergo surgery if he/she finds it necessary.
These surgical treatments may include:
- Laparoscopy – a minimally invasive procedure, which is also a diagnostic tool, using a device called laparoscope through an incision to view endometrial tissue growths. Your doctor can remove endometrial outgrowths using this procedure.
- Laparotomy – a major open surgery procedure where out-of-place endometrial tissues are removed. Doctors only opt for this procedure when endometriosis is severe, and laparoscopy is not enough to remove the endometrial tissues.
- Hysterectomy – complete removal of uterus (talk to your doctor if you still want to have children because this procedure zeroes your chance of childbearing).
- Fertility treatment directed by a fertility specialist, recommended by your doctor.