Endometriosis is a condition whereby tissue that resembles that usually found inside the lining of the uterus - the endometrium - is found growing outside of the uterus. These tissues, also referred to as lesions, can be found on the reproductive organs (ovaries, fallopian tubes, outer surface of uterus, the cervix) and other organs of the abdominal cavity (bladder, large bowel, intestines, rectum).
Endometriosis can be given a grade to determine the extent of the disease. Grade 1 is classified as mild with minimal superficial lesions and no scarring present. Grade 2 has more lesions, some of which might be deeper and some scarring. Grade 3 has many deep lesions, thick scarring and there might be cysts found on the ovaries. Grade 4 is the most severe and is characterised by widespread deep lesions and scarring, and large cysts on the ovaries.
Grading Endometriosis from 1-4 can put into perspective the extent of the pathology inside the body, however, the relationship between grading and symptoms felt does not always correlate. The symptoms experienced by those suffering from Grade 1 may be felt more intensely than the symptoms of someone with Grade 4. Unfortunately, the reason for this and why some women don’t have any symptoms at all has not yet been conclusive.
What are the symptoms?
The symptom most associated with Endometriosis is pain and this is different for every sufferer. Some women experience pain on the day before their period arrives, some women experience pain the whole time they have their period, and some women experience pain all throughout their cycle. Women might have pain localised to the reproductive organ area of their abdomen, whereas others might also have back pain or pain down the backs of their legs. Pain can be present during sexual intercourse, when passing bowel movements, or when holding in urine. Some women who have Endometriosis don’t have pain at all and only find out they have Endometriosis by chance, often when trying to fall pregnant or undergoing unrelated surgeries.
Outside of pain there are some other common signs and symptoms that point towards Endometriosis. As with pain, not all sufferers will experience all of these:
Heavy periods
Bloating
Irregular bowel movements
Fatigue
Difficulty conceiving
Causes
The reason why Endometriosis develops is still not known. As research into the disease progresses, it has been found that while hormones and in particular high levels of oestrogen can stimulate the condition, they are not the cause, meaning Endometriosis is not a hormonal condition. It was originally thought that retrograde (flowing in the wrong direction) menstruation was a cause, however, as most women will experience retrograde menstruation throughout their life, it is likely also a trigger or stimulant for Endometriosis, not the cause.
Recent research into Endometriosis has found that there is an immune component to the disease. It has not been classified as an autoimmune condition, however, some disordered patterns in the immune system are likely behind the inflammatory nature of Endometriosis.
There is also a correlation between women with Endometriosis and:
Frequent or shorter menstrual cycles
A family history of Endometriosis
Menstruating from a young age
Other immune or autoimmune conditions
Not having children or older pregnancies
Heavy and long periods
Low body weight
Getting a diagnosis
If you think you might have Endometriosis you will need to get a referral for a gynaecologist to have your diagnosis. The reason is that the only way at this current time to be diagnosed is via a laparoscopic (keyhole) surgery so the doctor can physically sight the lesions. Due to the miniscule size and positioning of some of these lesions, diagnostic imaging tools are not able to pick up on most Endometriosis. The doctor will likely send you for pelvic scans prior to your surgery to rule out other conditions with similar symptoms. If you do have laparoscopic surgery and the doctor finds Endometriosis lesions, they will remove them by either cutting them out or destroying them via diathermy (electrical currents).
Now what?
Now that you have your diagnosis, what are your next steps? For some women, the removal of their lesions during their laparoscopy provides complete relief from their Endometriosis which is fantastic. However, unfortunately for a lot of women, they may only experience relief for a short amount of time as the lesions grow back. To avoid having multiple surgeries there are some additional options to explore. From a medical perspective, your doctor might recommend hormonal medications like The Pill to shut down your menstruation. This might be effective for reducing pain while on The Pill but it is likely to return if and when you decide to come off it. Painkillers and anti-inflammatories may also be recommended with varying results.
From a naturopathic perspective we want to address the underlying inflammation as well as providing symptom relief. Some of the things we might suggest are:
Turmeric extract
Magnesium
N-acetyl cysteine
Gluten free diet
Dairy free diet
Fish oil
Acupuncture
Before you begin trying any of these treatments it is highly recommended that you speak with a qualified practitioner to ensure these are the right tools for you and that you are getting the appropriate dose. If you think that you have Endometriosis or you have already been diagnosed, come in for a chat and I can discuss with you what the next steps should be.