Endometriosis: The enemy in my belly

 

Endometriosis, a common and chronic condition, occurs when the tissue that normally lines the uterus unexpectedly grows outside this region. These abnormal developments can cause a range of symptoms and seriously affect the quality of life of affected women. Millions of women around the world suffer from this condition, which has both physical and psychological effects. This article aims to provide a deeper understanding of the causes, symptoms and treatment options of endometriosis.

Endometriosis: what is it all about?

Endometriosis comes into play when the tissue that typically lines the uterus grows in places outside of it. This tissue, called endometrium, can occur in different places in the body such as the ovaries, fallopian tubes, abdomen or other organs. The exact causes of this complex disease are not fully understood, but it is believed that hormonal, genetic and immunological factors may contribute to the development of endometriosis.

The unexpected development of endometrial tissue

Endometrial tissue that grows outside the uterus is also subject to cyclical changes during the menstrual cycle. Just like the normal endometrium, this abnormal tissue also thickens and bleeds during menstruation. However, because it is located outside the uterus, the rejected tissue cannot naturally exit the body. This can lead to inflammation, pain and the formation of scars and adhesions.

Where can endometriosis lesions be found?

The exact location of endometriosis lesions can vary greatly from woman to woman. They can be found on the ovaries, fallopian tubes, ligaments, peritoneum, intestines, bladder or other organs. In some cases, they may also occur in more distant parts of the body, such as the lungs or brain.

What are the causes of endometriosis

While the causes of endometriosis are not yet fully understood, there are several theories that suggest hormonal, genetic and immunological factors may play a role.

  • Hormonal factors
    During the menstrual cycle, the body undergoes complex hormonal regulation. It is thought that hormonal changes, particularly an imbalance between estrogen and progesterone, may promote the abnormal growth of endometrial tissue outside the uterus. This excess tissue can then colonize various sites in the body and cause inflammatory responses.
  • Genetic factors
    In addition to hormonal factors, genetic aspects also play a role in the development of endometriosis. There is evidence that certain genetic changes may increase the risk for endometriosis.
  • Immunological factors
    The immune system also plays an important role, as it should normally recognize and eliminate abnormal tissue. However, in women with endometriosis, there appears to be a malfunction of the immune system that results in the abnormal uterine tissue not being completely removed.

Although these factors point to a possible cause of endometriosis, the exact origin of the disease remains the subject of intense research.

Symptoms of endometriosis

Symptoms of endometriosis can vary from woman to woman and range from mild to severe. Here are some common symptoms:

Severe menstrual pain (dysmenorrhea).

Severe menstrual pain, medically called dysmenorrhea, often occurs as one of the main symptoms. This pain can be crampy and can severely interfere with a woman's normal daily life. It can occur during menstruation as well as before or after.

  • Pain during sexual intercourse (dyspareunia)
    Another common symptom of endometriosis is pain during sexual intercourse, medically called dyspareunia. This pain may occur during or after intercourse and may present as a dull, pulling or sharp pain in the lower abdomen. It can cause significant discomfort and interfere with sexual well-being.
  • Abdominal pain outside of menstruation
    In addition to period-related pain, women with endometriosis may also experience abdominal pain outside of menstruation. This pain can be chronic and occur over a long period of time. It may present as a pressing, stabbing or cramping pain in the lower abdomen and spread to the back or legs.
  • Spotting between periods
    Another possible symptom is the occurrence of bleeding between periods, medically called intermenstrual bleeding. These irregular bleeds can occur when abnormal endometrial tissue bleeds outside the uterus. They can be light or heavy and cause irregularities in the menstrual cycle.
  • Fertility problems
    ​Problems with fertility may also be a sign of endometriosis. Women with endometriosis may have difficulty getting pregnant or may experience repeated miscarriages. The presence of adhesions and scarring from the abnormal endometrial tissue may interfere with the normal function of the fallopian tubes and ovaries.

However, it is important to note that not all women with endometriosis have pronounced symptoms. Some women may have only mild symptoms or even no symptoms at all.

Diagnosis of endometriosis

Endometriosis is usually diagnosed through a combination of history, physical examination and imaging tests such as ultrasound. Here are some common diagnostic methods:

  • Medical history
    The history includes asking the patient in detail about her symptoms, medical history and possible risk factors. The doctor may also ask for information about family history, since endometriosis can be genetic in some cases.
  • Physical examination
    During the physical exam, the doctor may palpate the lower abdomen to look for any changes or painful areas. Other tests may also be performed, such as a rectal or vaginal exam, to accurately assess the condition.
  • Imaging procedures
    Imaging tests such as transvaginal ultrasound can help visualize changes in the pelvic area. Other imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) may also be used to make a more accurate assessment.
  • Laparoscopy
    Definitive detection of endometriosis is often confirmed by a laparoscopy, medically known as laparoscopy. This involves a minor surgical procedure in which a thin tube with a camera (laparoscope) is inserted through a small incision in the belly button. The doctor can view the inside of the abdomen and look for signs of endometriosis. If needed, tissue samples can also be taken during the laparoscopy to make an accurate diagnosis.

In many cases, diagnosing endometriosis requires close collaboration between the patient and the treating physician, as symptoms may vary and other conditions with similar symptoms must be ruled out.

Treatment options for endometriosis

Treatment for endometriosis is based on a woman's individual symptoms and plans to become pregnant. Several treatment options are available to relieve symptoms and improve quality of life.

  • Pain medication
    One of the most common treatment options is the use of pain medication to control severe menstrual pain and abdominal pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and reduce inflammation.
  • Hormone therapy
    Hormone therapy is another common treatment option for endometriosis. This involves inducing hormonal changes in the body to control the growth of abnormal endometrial tissue.
  • Surgical interventions
    In some cases, surgery may be needed to remove the abnormal endometrial tissue. Laparoscopic surgery, in which the tissue is removed in a minimally invasive manner, is a commonly used method. In more severe cases, open abdominal surgery may be required. The extent of the surgical procedure depends on the extent of the endometriosis lesions and the individual needs of the patient.
  • Alternative therapies
    Affected women report good experiences with nutritional supplements, CBD oil, hot water bottles, mud wraps, herbal therapy and much more. Even the scientific guidelines on endometriosis acknowledge potential for naturopathic therapies. It is important to use alternative therapies in consultation with a qualified physician or therapist.

Choosing treatment options for endometriosis depends on several factors, including the severity of the disease, symptoms and a woman's individual goals. A comprehensive consultation with an experienced physician is critical to choosing the appropriate treatment options and achieving the best possible results.

Tips for relieving endometriosis symptoms

Aside from medical treatments, women with endometriosis can make lifestyle adjustments to relieve their symptoms and improve their quality of life. Here are some tips:

  • Get regular exercise
    Regular exercise is an important part of a healthy lifestyle and can help reduce the symptoms of endometriosis. Physical activity can improve circulation, elevate mood and relieve pain. It is advisable to incorporate regular, moderate exercise into your daily routine, such as walking, yoga, swimming or cycling.
  • Balanced diet
    A balanced diet can also have a positive impact on endometriosis symptoms. It is recommended to eat a healthy diet rich in fruits, vegetables, whole grains and lean protein. It may also be helpful to avoid foods that can promote inflammation, such as processed foods, refined carbohydrates and saturated fats.
  • Stress management
    Stress management is another important aspect of managing endometriosis. Chronic stress can lead to worsening of symptoms. It is important to learn stress-reducing techniques such as relaxation exercises, meditation, breathing techniques, or stress management classes and incorporate them into your daily routine.
  • Sufficient sleep
    Getting enough sleep is essential for overall well-being. It is recommended to ensure a regular sleep routine and to schedule sufficient rest time. Adequate sleep can help reduce pain and increase energy levels.
  • Individual diet
    In addition, it is advisable to avoid certain foods that can promote inflammation. These may include foods rich in saturated fat, sugar or artificial additives. Each woman with endometriosis may react individually to certain foods, so it is important to pay attention to personal symptoms and possibly keep a food diary to identify problematic foods.

Effects of endometriosis on fertility

Endometriosis can affect a woman's fertility and lead to challenges in conceiving. The abnormal growth of endometrial tissue can lead to adhesions that can block or gum up the fallopian tubes. This makes it difficult for the eggs to travel to fertilization. In addition, the presence of endometriosis lesions in the ovaries can cause dysfunction and affect the quality of the eggs. The impact of endometriosis on fertility varies from woman to woman and depends on several factors, including the severity of the disease, the location of the endometriosis lesions, and individual hormonal and reproductive conditions. Some women with endometriosis may have only minor fertility impairments, while others may have a reduced likelihood of natural conception.

Endometriosis myths

There are many myths and misconceptions about endometriosis that can lead to confusion and misconceptions. To promote a better understanding of the condition and provide appropriate support for women with endometriosis, it is important to debunk these myths and provide educational information.

Myth 1: Endometriosis is a normal type of menstruation.

A common myth is that endometriosis is a normal and acceptable type of menstruation. However, this is not the case. Endometriosis is a medical condition in which the endometrial tissue grows outside the uterus. It is not a normal variation of menstruation and requires appropriate medical care.
 

Myth 2: Endometriosis is only associated with menstrual pain.

Another myth is that endometriosis is exclusively associated with menstrual pain. While severe menstrual pain is a common symptom of endometriosis, the condition can also cause other symptoms such as pain during intercourse, abdominal pain outside of menstruation, bleeding between periods and infertility. It is important to recognize the variety of symptoms and understand that not all women with endometriosis have the same symptoms.

Myth 3: Endometriosis only occurs in older women.

Another misconception is that endometriosis only occurs in older women. In fact, endometriosis can affect women of any age, including young girls who have just started menstruating. Early detection and treatment are critical to avoid complications and curb progression of the disease.

Myth 4: Pregnancy cures endometriosis.

Another myth is that pregnancy can cure endometriosis. While some women may experience temporary relief from their symptoms during pregnancy, pregnancy is not a permanent cure for endometriosis. The condition can recur after pregnancy and cause symptoms again.

Fertility Tracking with endometriosis

Fertiility Tracking with Daysy can be beneficial for women with endometriosis, allowing them to better understand and track their symptoms, the progression of the disease, and the impact of the menstrual cycle on fertility.

Advantages of cycle monitoring

Endometriosis is strongly influenced by hormonal changes in the menstrual cycle. By regularly charting their menstrual cycle, women with endometriosis can identify patterns and relationships between their menstrual cycle and their symptoms. This can help them respond early to symptoms such as pain or bleeding and take appropriate action.

Support in working with medical specialists

In addition, those affected can recognize indications of impaired or limited fertility. Close observation of the cycle enables affected women to present concrete data about their cycle progression and fertility, which can facilitate collaboration with medical specialists.

Conclusion

Endometriosis is a complex condition in which endometrial tissue grows outside the uterus and can cause a variety of symptoms. The exact causes of endometriosis are not yet fully understood, but hormonal, genetic and immunological factors play a role.

Diagnosis of endometriosis requires a careful history, physical examination, and possibly imaging or laparoscopy. Treatment for endometriosis may include pain medication, hormone therapy, surgical intervention, or alternative therapies.

Endometriosis can affect fertility, but there are treatment options to improve fertility. Women with endometriosis should adjust their lifestyle and practice self-care to relieve their symptoms.

It is important to debunk myths about endometriosis and provide accurate information to improve understanding and support for affected women. Cycle monitoring with Daysy can help women with endometriosis better understand and track their symptoms, cycle progression and fertility. However, it is important to get an accurate diagnosis from a doctor and receive comprehensive treatment.

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Authored by Dr. Niels van de Roemere

Sources:

Endometriosis Center of Erlangen University Hospital brochure: https://www.uk-erlangen.de/fileadmin/dateien/content_pool_dateien/infobroschueren/UEZ_endometriose_broschuere.pdf

Tu FF et al: The influence of prior oral contraceptive use on risk of endometriosis is conditional on parity, Fertility and Sterility, Volume 101, Issue 6, 2014, Pages 1697-1704, https://doi.org/10.1016/j.fertnstert.2014.02.014

Endometriosis Association Germany e.V.: https://www.endometriose-vereinigung.de/sefzertifizierte-endometriosezentren.html

Stiftung Warentest (2021): Drugs for endometriosis: https://www.test.de/medikamente/krankheit/endometriose-k265/

Endometriosis Association (2021): https://www.endometriose-vereinigung.de/literaturtipps.html#schmerzen

Interdisciplinary S2k guideline (2020): https://www.endometriose-vereinigung.de/files/endometriose/015-045l_S2k_Diagnostik_Therapie_Endometriose_2020-09.pdf