Endometriosis is a chronic gynecological disease that affects up to 10% of women of child-bearing age. It’s characterized by the abnormal growth of endometrial tissue outside the uterine cavity, mainly in the pelvic cavity. This tissue growth can cause pelvic pain, painful menstruation, and infertility. Basically, the endometrium grows outside the uterus, causing inflammation and sometimes adhesions in the pelvic cavity.
It’s important to stress that endometriosis is a complex condition that can have significant consequences on sufferers’ quality of life and fertility. Early diagnosis, appropriate treatment, and regular medical follow-up are essential for people living with this condition so that they can find the best solutions for their well-being.
Let’s take a look at the disease’s symptoms, diagnosis, treatment, and prevention.
Symptoms
The symptoms of endometriosis vary considerably from person to person but often include chronic pelvic pain, painful menstruation, pain during intercourse (also known as dyspareunia), chronic fatigue, and bowel and bladder problems, such as pain during bowel movements, bloating, diarrhea, constipation, pain during urination, and frequent urination.
Other less frequent symptoms include heavy bleeding during menstruation, nausea, vomiting, and chest pain.
Pelvic pain is often described as intense menstrual cramps that can radiate to the lower back and legs. The pain may worsen during menstruation, but it can also occur outside the cycle.
Infertility
Endometriosis is a complex and sometimes insidious disease that can have a profound impact on fertility. When the endometrium develops outside the uterus, the consequences can disrupt normal reproductive physiology and create obstacles to conception.
People with endometriosis may find it difficult to conceive naturally. Adhesions and cysts can cause anatomical alterations and disrupt the function of the fallopian tubes, which are the ducts that transport eggs from the ovaries to the uterus. This can lead to tubal obstruction, making it difficult for the eggs to pass to the uterus, where they can be fertilized by a sperm.
In addition, endometriosis can cause chronic inflammation in the pelvic cavity, which can impair the quality of eggs and interfere with their ability to be fertilized. Embryo implantation in the uterus may also be compromised due to inflammation and changes in the uterine environment.
The disease can also affect sufferers’ ovarian reserve (i.e., the number and quality of eggs available for fertilization). People with endometriosis may have a reduced ovarian reserve, which can reduce their chances of conceiving.
However, it’s essential to remember that infertility is not a guarantee for everyone with endometriosis. Many sufferers are able to conceive either naturally or with the help of fertility treatments such as in vitro fertilization or intrauterine insemination.
Endometriomas
Endometriomas, also known as chocolate cysts or endometriotic cysts, are fluid-filled masses that form in the ovaries. They are caused by the abnormal growth of tissue similar to the lining of the uterus, called the endometrium, outside the uterus itself. This condition is mostly linked to endometriosis.
The endometrium, which normally develops inside the uterus each month in preparation for a possible pregnancy, can also develop in other parts of the body when expelled from the uterus. When it attaches itself to the ovaries, it can form cysts that vary in size, from small to large masses.
Symptoms of endometriomas can vary according to size and location, and they typically include chronic pelvic pain, pain during intercourse (dyspareunia), and severe pain during menstruation (dysmenorrhea). People with endometriomas may also experience pain during defecation or urination as well as back pain and infertility.
The diagnosis of endometriomas is usually made using pelvic ultrasound, which visualizes the cysts and assesses their size and location. In some cases, magnetic resonance imaging (MRI) may also be used to obtain more detailed information.
The treatment of endometriomas depends on a number of factors, such as the severity of symptoms, the sizes and locations of the cysts, and the affected person’s plans for pregnancy. Treatment options may include medication to relieve pain and inflammation, hormonal contraceptives to suppress endometrial growth, and surgery to remove cysts or endometriotic tissue.
More on the different treatment options below.
Often ignored and downplayed as part of so-called “normal” menstrual pain, the pain caused by endometriomas is much more severe. Emotionally, these little cysts can also be triggers for stress, anxiety, and even distress. They can be a reminder that our bodies are struggling, fighting against themselves, and this can be difficult to accept.
Deep endometriosis
Deep endometriosis is a particular form of endometriosis disease, characterized by extensive infiltration of endometrial tissue outside the uterus. Unlike superficial endometriosis, where lesions are mainly localized on the surface of the pelvic organs, deep endometriosis involves deeper penetration of endometrial tissue into the surrounding tissues.
In deep endometriosis, endometrial implants can invade organs such as the ovaries, fallopian tubes, rectum, colon, bladder, and utero-sacral ligaments. These lesions can also develop in tissues farther away from the uterus, such as the diaphragm, the lungs, or even the abdominal wall.
The symptoms of deep endometriosis are often more severe than those of superficial endometriosis. People with deep endometriosis may experience the same symptoms and chronic pain but with increased severity and intensity, which can significantly impair their quality of life.
The diagnosis of deep endometriosis can be more complex than that of superficial endometriosis, as lesions may be more difficult to visualize using a standard ultrasound. In some cases, MRI or laparoscopy, a minimally invasive surgical procedure, may be required to assess the extent and locations of lesions.
It’s important to stress that deep endometriosis is a complex condition that requires individualized management and a multidisciplinary approach involving specialists in fertility, surgery, and pain management. Early and appropriate management can significantly improve the quality of life of those affected by this more severe form of endometriosis.
Diagnosis
Diagnosing endometriosis can be difficult, as symptoms may be similar to other gynaecological conditions. A gynecological examination may reveal a mass or nodules in the pelvis, but this is not always the case. Ultrasounds can help visualize abnormal endometrial tissue but are not always accurate. MRIs can also be useful in visualizing endometrial tissue and associated lesions. However, the only definitive way to diagnose the disease is by laparoscopy, a surgical procedure that allows direct observation of lesions in the pelvis.
Treatment
While there is no cure for endometriosis, there are effective treatments, both medical and surgical, to help relieve symptoms, prevent the disease’s progression, and improve fertility. The form of treatment depends on the severity of the disease.
Drug treatment
Drug treatment can be used to relieve symptoms.
Analgesics, such as non-steroidal anti-inflammatory drugs, can be used to relieve pelvic pain.
Hormonal contraceptives, such as birth control pills, patches, vaginal rings, or injections, can help control menstruation and reduce the growth of endometrial tissue.
Progestins, such as progestin-only medication or a hormonal intrauterine device, can also be used to reduce endometrial tissue growth.
Surgical treatment
Surgery may be necessary if endometriosis is severe or if symptoms can’t be controlled with medication.
Laparoscopy is often used to remove endometrial lesions, while hysterectomy, which removes the uterus, may be necessary in the most severe cases.
In some cases, an oophorectomy (removal of the ovaries) may also be necessary to control the growth of endometrial tissue.
Infertility treatment
Endometriosis can cause infertility due to the presence of abnormal endometrial tissue in the pelvis.
Infertility treatments associated with the disease can include ovulation-stimulating drugs, in vitro fertilization, or surgery to remove affected tissue.
Prevention
While there’s no way to completely prevent endometriosis, there are steps you can take to reduce your risk of developing the disease, including healthy lifestyle habits such as a balanced diet, regular exercise, and abstinence from tobacco and alcohol.
As previously mentioned, research also suggests that taking hormonal contraceptives can reduce the risk of developing endometriosis.
EndoCARES, Quebec’s reference centre for endometriosis
The opening of Quebec’s first specialized endometriosis treatment center aims to provide faster, more effective diagnosis and treatment for sufferers.
The McGill University Health Centre is proud to launch Quebec’s first multidisciplinary referral centre for multisystem endometriosis. Named EndoCARES, or Endometriosis − Centre for the Advancement of Research and Surgical Care, the centre aims to offer patients suffering from endometriosis-related pain and infertility accelerated access to specialized diagnostic imaging services followed by personalized, multidisciplinary care.
The creation of this centre is an important step toward improving care for endometriosis sufferers in Quebec.
Finally...
Once the diagnosis and medical treatments have been established, the best advice for managing the disease is to take time to listen to yourself and surround yourself with support.
Don’t hesitate to ask for the help you need. You have the right to seek out health-care professionals who listen to you, understand your pain and fears, and work with you to find the best solutions for your condition.
You’re the expert on your own body, and no one should make you doubt the way you feel.
FAQ
Is there a link between a retroverted uterus and endometriosis?
A retroverted uterus and endometriosis are two different conditions that can affect some people independently. Although some people may have both a retroverted uterus and endometriosis, there is no direct cause-and-effect relationship between the two.
A retroverted uterus simply means that the uterus is tilted backward rather than standing upright. This can be a normal anatomical feature and does not usually cause any particular symptoms. Some people may have a retroverted uterus without even knowing, as it often causes no discomfort or pain.
Can endometriosis be fatal?
Endometriosis itself is not generally considered a life-threatening condition. However, it can cause severe symptoms and considerably alter sufferers’ quality of life. Endometriosis-related pain can be extremely disabling, affecting daily activities, work, relationships, and mental health.
Some rare and serious complications can occur in association with endometriosis. For example, in very rare cases, the disease can cause severe urinary or intestinal complications that require urgent surgical intervention to avoid potentially fatal complications.
It’s also important to remember that every uterus is different and that the impact of endometriosis can vary considerably from one person to another. Some may live with relatively mild symptoms, while others may be more severely affected.
Can endometriosis cause odour?
There are generally no odours specifically associated with endometriosis as a disease in itself. However, it can be associated with other gynecological health problems that can lead to unusual odours. For example, some people with endometriosis may also suffer from vaginal infections, such as yeast or bacterial infections, which can cause unpleasant odours and unusual vaginal discharge.
It’s therefore essential to distinguish between the symptoms of endometriosis itself and other health problems that may coexist. If you notice unusual odours, pelvic pain, abnormal vaginal discharge, or any other worrisome symptoms, it’s important to consult a health-care professional for an accurate examination and diagnosis.
Can endometriosis cause digestive symptoms?
Yes, endometriosis can sometimes cause digestive symptoms. When endometrial tissue grows outside the uterus, it can affect surrounding organs and tissues, including the organs of the digestive system. This can lead to a variety of digestive symptoms that may be confused with other gastrointestinal problems.
Here are some of the digestive symptoms that can be associated with endometriosis:
Abdominal pain: Some people with endometriosis may experience abdominal pain, particularly during menstruation. This pain may be confused with abdominal pain of gastrointestinal origin.
Pain during bowel movements: Endometriosis can affect the intestine and colon, causing pain during bowel movements, particularly during menstruation.
Diarrhea or constipation: Some people with endometriosis may experience episodes of diarrhea or constipation, particularly during menstruation.
Bloating: Bloating and feelings of abdominal swelling may also be present in some people with endometriosis.
It’s important to note that these digestive symptoms can be caused by other gastrointestinal problems, independent of endometriosis. It’s therefore essential to consult a health-care professional for a thorough examination and accurate diagnosis.
Is there an age limit for developing endometriosis?
Endometriosis can develop in people as soon as they start menstruating (i.e., as early as puberty). However, symptoms may vary in intensity and frequency in adolescents.
In general, endometriosis is more common in people of child-bearing age (i.e., between puberty and menopause). Symptoms can worsen over time if the condition is not diagnosed and managed.
However, it’s important to note that age isn’t the only risk factor for developing endometriosis. Other causes, such as heredity, family history of the disease, hormonal imbalances, and environmental factors, can also play roles in the disease’s development.
