Recognizing endometriosis

Even the name is scary. The first thing that comes to mind when I hear the word endometriosis is “pain.” In my humble opinion, for a condition that affects one in ten women, it certainly doesn’t get talked about nearly enough. While the underlying mechanism is known, the cause isn’t. Could you recognize the symptoms?

PMS

asktheexpert
Sonia Chartier
@AVogel_ca


30 May 2018

As women, we have an intimate understanding of our reproductive cycles because we’re reminded of them every month… assuming we have regular periods, that is. During each cycle, our body prepares a cosy nest called the endometrium to host a fertilized ovum (or egg). The endometrium lines the wall of the uterus, grows and thickens as our hormones fluctuate. If the egg isn’t fertilized, which is what happens during most of the cycles in a woman’s life, even if she’s had 14 children, the endometrium detaches itself from the wall of the uterus and leaves via the vagina. This phenomenon is called menstruation.

Imagine what would happen if, instead of making its exit through your vagina, your endometrium moved back up through your Fallopian tubes and ended up in your abdominal cavity. Then imagine what would happen if those endometrial cells decided to set up shop there. During every cycle, you’d become fertile and the endometrium would thicken to welcome an egg, but on your ovaries, Fallopian tubes or rectum instead of inside your uterus. So when your period arrives and you bleed, the endometrium, which is stuck inside you, would bleed too. But with no available exit, it would stay there. And it would hurt, really badly. The blood would then be reabsorbed by the peritoneum (the membrane that lines the abdominal cavity) or form cysts or scar tissue. That, in a nutshell, is endometriosis.

Symptoms of endometriosis

Because it’s linked to the menstrual cycle, endometriosis affects women in their childbearing years and ends with the onset of menopause. The first sign of endometriosis is excruciating pain, but the symptoms can be described more accurately as follows:

  • Intense pain during menstruation (dysmenorrhea if you prefer the medical term). Menstrual cramps affect many women, but with endometriosis, the pain women describe is much more violent, starts just before their period and lasts several days from the time their period starts.
  • Pain during sex that varies according to the position and point in the cycle.
  • Pain in the lower back, rectum, pelvic area or abdomen during menstruation, sometimes becoming chronic.
  • Heavy bleeding and abnormal bleeding between cycles.
  • Blood in the stools and urine. During menstruation, urinating or defecating is sometimes painful.
  • Infertility: 20% to 40% of women who consult with infertility issues suffer from endometriosis.
  • Fatigue and digestive problems such as constipation, diarrhea, nausea and bloating.
  • Retroversion of the uterus, which is when it rotates toward the back of the vagina. However, not all women with uterine retroversion have endometriosis.

Given that the symptoms closely resemble those of many other conditions such as fibromas, pelvic inflammatory disease (PID) or irritable bowel syndrome, endometriosis can be hard to diagnose.

Possible causes

To this day the exact cause of endometriosis is unknown, though many possible causes have been posited:

  • Retrograde menstrual flow: instead of being ejected by muscular contractions through the vagina, the flow reverses, moving into the Fallopian tubes and ending up in the pelvic cavity. When that happens, the blood can carry endometrial cells outside the uterus.
  • Another theory derived from this first explanation suggests that the retrograde flow causes cells in surrounding tissues to become endometrial cells. In both cases, the endometrial cells end up outside the uterus and react to hormonal fluctuations the same way as every normal endometrial cell.
  • According to the theory of induction, the cells of the peritoneum are transformed into endometrial cells in response to genetic or environmental factors.
  • Endometrial cells could also attach themselves to a surgical scar (caesarian section or hysterectomy).
  • An autoimmune disease could prevent the body from destroying endometrial cells that end up outside the uterus.
  • Lymph could transport endometrial cells outside the uterus.

In addition to these theories on the mechanism, we know about certain risk factors:

  • Not having had children
  • Genetics: Women are more at risk if a close relative has had it too
  • Early menarche (first menstruation)
  • Late menopause
  • Short menstrual cycle (less than 27 days)
  • A congenital deformity that impedes the normal evacuation of the menstrual flow
  • Uterine anomalies
  • High estrogen levels
  • A low body mass index (BMI)
  • Being Caucasian or Asian
  • Alcohol consumption

Treatments for endometriosis

While endometriosis is generally treated with pain medication, hormone treatments or surgery, none of these treatments yields permanent results. Only menopause can put a definite end to endometriosis. One study found that melatonin reduced pain by 39% and the need for analgesics by 46%. Using melatonin relieved pain during menstruation, sex and bowel movements.

Chasteberry (Vitex agnus-castus) can be useful for its effect in regulating the hormones involved in the menstrual cycle. However, vitex should be avoided by anyone using hormone therapy.

Experts recommend making a few diet and lifestyle changes to reduce inflammation and lower estrogen levels.

  • Eat more fruits and vegetables: vegetarian women are at lower risk of suffering from endometriosis.
  • Choose the right fats: omega-3 from fatty fish (tuna, salmon, etc.), nuts, flax seeds. You can take omega-3 in supplement form if you don’t like fish or don’t want to it.
  • Eat less beef, pork and red meat in general.
  • Get moving! Although you might feel like curling up with a good blanket and hot water bottle when you’re suffering, women who engage in an aerobic activity report having less pain. Being active can lower your estrogen levels while simultaneously boosting endorphins, the “happy hormones” that make you less sensitive to pain. Take advantage of moments where you’re in less pain to get moving!
  • Go easy on the alcohol, because it can have an effect on estrogen and potentially aggravate the symptoms. What’s more, women who drink a lot of alcohol have a greater risk of suffering from endometriosis.
  • Stay zen. Stress makes pain worse, so it’s a good idea to take up an activity such as yoga or tai chi, have a massage or practice deep breathing.

While there’s no miracle cure other than menopause, these tips will hopefully help you improve your quality of life.

References:
https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
https://www.webmd.com/women/endometriosis/know-endometriosis-18/slideshow-endometriosis-lifestyle-changes
https://www.passeportsante.net/fr/Maux/Problemes/Fiche.aspx?doc=endometriose_pm
https://jpwillem.lettre-medecin-sante.com/endometriose-miracle-possible/
Schwertner A, et al. Pain. 2013;154(6):874-81.

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