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Endometriosis 101

An Introduction to Endometriosis

By Leilani H

What is endometriosis?

Endometriosis is a disorder in which tissue that normally lines the uterus grows outside the uterus. With endometriosis, the tissue can be found on the bladder, ovaries, fallopian tubes or the intestines around the pelvic cavity. The condition usually affects women ages 25-40, but symptoms may begin at puberty.

Endometriosis is classified into one of four stages:

  • Stage I: Minimal
    • Small lesions/wounds, shallow implants on your ovary, inflammation around pelvic cavity
  • Stage II: Mild
    • Light lesions, shallow implants on ovaries and pelvic lining
  • Stage III: Moderate
    • More lesions, deep implants on ovaries and pelvic lining
  • Stage IV: Severe
    • More lesions on fallopian tubes and bowels/intestines, deep implants on ovaries and pelvic lining

based upon the exact location, extent, and depth of the endometriosis implants as well as the presence and severity of scar tissue. Doctors will also assess the presence and size of endometrial implants in the ovaries.

What are the symptoms? How can I tell? 🤷‍♀️

Some symptoms of endometriosis include:

  • Severe, debilitating abdominal cramps - so painful that you cannot function in daily life
  • Pelvic pain, usually worse during a period.
  • Short cycles
  • Long periods/menstrual phase
  • Heavy menstrual flow
  • Nausea and/or vomiting
  • Pain/cramping during or after sexual intercourse
  • Bowel and urinary disorders
  • Painful bowel movements or urination during menstruation

Do not self-diagnose or self-treat. The symptoms are often not specific to endometriosis and may be similar to other conditions such as ovarian cysts and pelvic inflammatory disease. Make sure you see a gynecologist to confirm endometriosis diagnosis. A doctor might do one or more tests. Here’s what you may expect at an office visit:

  • Detailed History
    • Noting symptoms, family history and/or general health assessment
  • Pelvic Exam
    • The doctor will feel and examine your abdomen for cysts or scars behind the uterus. During a pelvic exam, you will lie on an exam table, put your legs on footrests to spread your legs. The doctor will then visually inspect and insert an instrument called a speculum into the vagina to gain a better look at your organs. You may feel tense but relax, breathe deeply!
  • Ultrasound
    • Transvaginal ultrasound (TVUS) or an abdominal ultrasound can be used to provide images of your ovaries, uterus and other reproductive organs. It will help your doctor identify abnormalities such as cysts associated with endometriosis.
  • Laparoscopy
    • A minor surgical procedure that allows the doctor to view it directly and certainly identify endometriosis. Once diagnosed, the tissue can be removed in the same procedure.


Endometriosis Treatments 👩‍⚕️🏥

There is no cure to endometriosis, but you can learn to manage your symptoms. If left untreated Your doctor may first try conservative treatments. These include:

  • Pain medications
    • Ibuprofen, short relief from symptoms.
  • Hormone therapy
    • Supplementary hormones may help prevent the progression of endometriosis and relieve pain. It acts to regulate the monthly hormonal changes linked to endometrial tissue growth in endometriosis.
  • Hormonal contraceptives
    • Hormonal contraceptives such as the ring, birth control pills, patches can eliminate or lessen pain in minimal or mild endometriosis. They work to prevent the monthly growth of endometrial tissue whilst decreasing fertility.
  • Gonadotropin releasing hormone (GnRH) agonists and antagonists
    • GnRH therapy block the production of estrogen that stimulates the ovaries. It prevents menstruation and creates artificial menopause. Some side effects include vaginal dryness or hot flashes.

Doctors may then recommend surgery if your condition doesn’t improve. Medical and surgical options are available to help reduce your symptoms and manage any potential complications.

  • Conservative surgery
    • When hormone treatments don’t work. Doctors may suggest conservative surgery to women who want to get pregnant.
  • Last-resort surgery (hysterectomy)
    • A total hysterectomy involves the removal of the uterus, cervix, and implant lesions. It also involves the removal of ovaries, organs that release the estrogen causing the growth of endometrial tissue.
    • Usually, a hysterectomy is not a treatment option as you would be unable to get pregnant after a hysterectomy. This is something to think about.

Remember that everyone reacts differently to treatment options. Your doctor will help you find the one that works best for you.


What causes endometriosis? 🤔

During a regular menstrual cycle, your body sheds the lining of your uterus allowing menstrual blood to flow from the uterus out of the cervix and out the vagina.

Currently, we do not know what causes endometriosis and no single theory has been proven. However there are several theories:

Theory 1: Retrograde Menstruation
Menstrual blood flows back through your fallopian tubes into your pelvic cavity instead of flowing out of the body through the vagina (as your period).

Theory 2: Abdomen Converting into Endometrial Tissue
Small areas of the abdomen convert to endometrial tissue. Abdomen cells grow from embryonic cells that can change shape and act similar to endometrial cells. These displaced endometrial cells exist on pelvic walls, bladder, ovaries, and rectum and can grow, thick, and bleed during your menstrual cycle.

Theory 3: Surgical Scars
Menstrual blood leaks into the pelvic cavity via a surgical scar (like after a c-section).

Theory 4: Transport of Endometrial Cells
Endometrial cells transported out of the uterus via the lymphatic system, or a faulty immune system that does not destroy the traveling endometrial cells.

Theory 5: Mullerian Theory
Endometriosis started in the fetal period with misplaced cell tissue that begins to respond to the hormones of puberty (estrogen etc.). Endometriosis might be linked to genetics or environmental toxins.

Next Steps

If you suspect that you may have endometriosis, schedule a visit with your OB-GYN! Be honest and transparent with your symptoms so that they may help you achieve an accurate diagnosis.

Have you been diagnosed with endometriosis? Comment down below and engage with Nona on Instagram @nonawoman. We’d love to learn from you and your experience as an #endowarrior . Stay strong, Nona!

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