Understanding Endometriosis: Causes, Diagnosis, and Treatment Options

Endometriosis is more than a physical ailment; it’s a complex condition that deeply impacts a woman’s wellbeing. It affects not only their overall physical health but also their emotional resilience, and quality of life in general. According to the Australian Department of Health and Care, endometriosis affects at least one in nine women, showing that the condition itself is prevalent in the country. This article will dive deep into what causes endometriosis, how it’s diagnosed, what the side effects are, and what medications and treatments are available to manage this challenging condition.

What Causes Endometriosis?

Endometriosis usually occurs for the first time during a woman’s menstrual period and may last until their menopause period. The condition itself is apparent when a tissue resembling the uterine lining grows outside of the uterus. These growths can appear on the ovaries, fallopian tubes, the exterior of the uterus, or the intestines, causing severe pain in the pelvis area and also making it harder to get pregnant. While the exact cause of endometriosis remains unknown, several theories may explain its development:

  • Retrograde Menstruation
    Commonly known as Sampson’s theory, the occurrence of retrograde menstruation means that during menstruation, some of the menstrual tissue backs up through the fallopian tubes into the abdomen, where it implants and metastases. Sampson’s theory is the most widely accepted hypothesis to detect endometriosis, with multiple studies being derived from this theory.
  • Genetic Factors
    It’s been known that a hereditary aspect plays a role in causing endometriosis, in which women with a family history of the condition are more likely to develop it. One study has found that there was a shared genetic basis for endometriosis which also suggested that it could run in families, and therefore heritability plays a role in how it develops in some women, although it is not fully conclusive yet.
  • Hormonal Imbalances
    Endometriosis may be caused by an imbalance in hormones, specifically oestrogen, which plays a role in the development and regulation process of the female reproductive system and also menstrual cycles. One study has shown that an imbalance of hormones, which in this case is an excess amount of oestrogen, occurs in patients who have endometriosis.
  • Immune System Disorders
    A research study has found that there is overwhelming evidence that immune factors such as cytokines may be involved in the pathophysiology and aetiology of endometriosis, suggesting that the condition might have correlated with autoimmune disorders.

Symptoms of Endometriosis

There are a handful of symptoms that might have a correlation with endometriosis, mostly revolving around the nervous and genital areas. Here are some of the most common symptoms of endometriosis:

  • Painful Periods
    Painful periods, or also known as dysmenorrhea, can be one of the most common symptoms of endometriosis, especially in adolescents, as mentioned by one study. Some of the side effects such as nausea, vomiting, diarrhoea, headaches, and muscle cramps are the symptoms of dysmenorrhea that are associated with adolescents that have endometriosis.
  • Pelvic Pain
    Chronic pelvic pain is another symptom usually associated with endometriosis, which occurs either during their menstrual cycle or outside of their cycle. A study that conducted an interview of 40 US women who have endometriosis concluded that pelvic pain became one of the most commonly reported symptoms, which impacted their daily life activities and other attributes in both physical and mental aspects.
  • Dyspareunia
    One study amplifies the high prevalence of painful sex, or known as dyspareunia, in women with endometriosis, affecting nearly 70 percent of the study participants, despite limitations in the amount.  This pain can significantly impact a woman’s life, affecting sexual satisfaction, intimacy, mental health, and relationships.
Endometriosis symptoms

Diagnosing Endometriosis

With multiple probable causes of endometriosis needing to be factored in, the process of diagnosing endometriosis in the early stages can be certainly challenging. Another thing that can be challenging is that symptoms of endometriosis vary widely, and the severity of pain does not always reflect the extent of the condition. However, there are common diagnostic methods to detect endometriosis, which as follows:

  • Laparoscopy
    Considered the gold standard for diagnosing endometriosis, the laparoscopy procedure involves inserting a scope into the pelvis through a small incision near the navel, or the belly button area. By doing this method, it allows doctors to directly view the pelvic organs and detect any endometriosis occurring.
  • Pelvic Exam
    Doctors manually feel for abnormalities, such as cysts on reproductive organs or scars behind the uterus.
  • Ultrasound
    This imaging test uses high-frequency sound waves to create images of the inside of the body and can identify cysts that are commonly associated with endometriosis.
  • MRI
    An MRI scan provides a detailed image of organs and tissues, helping to plan surgery by showing the location and size of endometrial implants.

Medications and Treatments for Endometriosis

Managing endometriosis primarily involves medications and surgery, with the goals of reducing symptoms, slowing the growth of endometrial tissue, and preserving fertility where desired.

Pain Relief Medications

The treatment of endometriosis often includes pain relief medications, with non-steroidal anti-inflammatory drugs (NSAIDs) commonly used as a first-line option. These medications are aimed at reducing inflammation and alleviating pain associated with endometriosis.

NSAIDs, such as naproxen, are frequently prescribed to manage the pain associated with endometriosis. However, the efficacy of NSAIDs in this context can be variable. For example, a review highlighted that there is inconclusive evidence to show whether NSAIDs are effective in managing pain caused by endometriosis, suggesting that while some women may experience pain relief, others may not notice significant improvements.

The use of NSAIDs is not without potential side effects. Common issues include gastrointestinal problems such as stomach pain, heartburn, and ulcers. More severe complications, though less common, can involve cardiovascular problems like heart attack and stroke, as well as kidney damage. 

Hormone Therapy

Hormone therapy is a common approach to managing the symptoms of endometriosis, a condition characterised by the growth of endometrial-like tissue outside the uterus. This therapy focuses on manipulating hormonal balances to reduce pain and prevent further growth of endometrial tissue.

Gonadotropin-Releasing Hormone (GnRH) Agonists
These drugs create a temporary menopausal state by decreasing oestrogen production. They are effective in reducing endometriosis symptoms and shrinking lesions. However, the hypoestrogenic state they induce can cause significant side effects, such as hot flushes, decreased libido, vaginal dryness, and potential bone density loss. 

Progestins
These are used to suppress menstruation and the growth of endometrial tissue. While effective, side effects can include weight gain, mood changes, and irregular bleeding. Progestins are often considered more tolerable than GnRH agonists and do not typically cause bone density loss.

Danazol

This drug suppresses the growth of endometriosis by creating an androgenic environment. Side effects are significant and include weight gain, hirsutism (excessive hair growth), acne, and voice deepening, which may affect patient compliance.

Combined Oral Contraceptives
These pills are used to regulate menstrual cycles, reduce menstrual flow, and limit the growth of new endometrial tissue. They can be very effective in managing pain and are often used as a long-term treatment strategy. The side effects are usually milder but can include nausea, breast tenderness, and mood changes.

Conservative Surgery

Conservative surgery, commonly performed via laparoscopy, is a frequent approach to treating endometriosis, particularly for patients experiencing significant pain or infertility linked with the disease. This type of surgery aims to remove or destroy endometrial growths without removing the reproductive organs, hence preserving fertility.

Conservative surgery for endometriosis might involve procedures like laparoscopic excision or ablation of endometriotic lesions, removal of ovarian cysts (endometriomas), and adhesiolysis (separation of adhesions). 

The effectiveness of these interventions in alleviating pain and improving fertility is well-documented, though the benefits can diminish over time. For example, a study found that the absolute benefit increase of destroying lesions compared with diagnostic surgery only was about 30-40% for pain relief shortly after surgery, but this tends to decrease over time, with a re-operation rate as high as 50% due to recurrence of symptoms or disease.

While conservative surgery is less invasive and aims to preserve fertility, it is not without risks or potential side effects:

  • Recurrence of Endometriosis: The recurrence rates of pain and endometriosis are significant. Approximately 20-25% of women may require additional surgeries, and about 50% may need to revert to analgesics or hormonal treatments within a year following the initial surgery.
  • Surgical Complications: These may include damage to organs near the endometriosis lesions, such as the bladder or bowel, and risks associated with anaesthesia.
  • Postoperative Infections: Although relatively rare, any surgical procedure carries a risk of infection.
  • Adhesion Formation: Surgery can lead to the development of new adhesions which may cause pain or further complicate fertility.

Hysterectomy

Hysterectomy, which involves the surgical removal of the uterus, is a treatment option for endometriosis when other therapies have failed or when the disease is severe. This procedure is considered a last resort, particularly for women who do not wish to preserve their fertility, as it eliminates any possibility of pregnancy. Hysterectomy may involve removing the uterus alone or along with other reproductive organs such as the ovaries and fallopian tubes (total hysterectomy with bilateral salpingo-oophorectomy). Removing the ovaries along with the uterus is often recommended for endometriosis to decrease the likelihood of disease recurrence by reducing oestrogen levels that can fuel endometrial growth. A study examining the outcomes of laparoscopic hysterectomy for endometriosis found that this procedure significantly decreases symptoms and recurrence rates. For example, no recurrence was observed in patients who underwent total laparoscopic hysterectomy plus bilateral salpingo-oophorectomy, highlighting the effectiveness of complete removal of oestrogen-producing organs in preventing recurrence.

Medical Cannabis

One study found that cannabis-based products might have therapeutic effects towards multiple symptoms of endometriosis. However, the results from the study are somewhat inconclusive.   The clinical research on cannabis as a treatment for endometriosis is still evolving. There is a need for more robust clinical trials to better understand the efficacy and safety of cannabis for this condition, especially given the complex legal and medical landscape surrounding its use. More clinical trials and research are needed to establish definitive guidelines and ensure safe, effective, and regulated use of cannabis for endometriosis. Given the potential risks involved in using cannabis-based products, any use of medical cannabis to assist with endometriosis symptoms needs to be on the advice of an appropriately qualified health professional.

Diagnosing Endometriosis Early To Prevent Future Risks

Endometriosis is a challenging and often painful condition that can significantly affect a woman’s life, physically and mentally. Diagnosing the causes as early as possible and opting for the safe, available treatments is the first step toward management of the condition. By seeking a combination of medical advice, personal coping management or any strategies to reduce the symptoms and the side effects, women with endometriosis can lead fulfilling lives despite the challenges posed by the condition.
Written by

Priyom holds a Ph.D. in Plant Biology and Biotechnology from the University of Madras, India. She is an active researcher and an experienced science writer. Priyom has also co-authored several original research articles that have been published in reputed peer-reviewed journals. She is also an avid reader and an amateur photographer.

Written by

Priyom holds a Ph.D. in Plant Biology and Biotechnology from the University of Madras, India. She is an active researcher and an experienced science writer. Priyom has also co-authored several original research articles that have been published in reputed peer-reviewed journals. She is also an avid reader and an amateur photographer.

Latest News

6 Foods To Improve Brain Function
Beginner's Guide To Basic Meditation

Suggested Reading

6 Foods To Improve Brain Function