Endometriosis is a common chronic medical condition affecting up to 10% of females. Endometriosis is characterized by endometrial-like cells outside the uterus. Endometrial cells are the cells that line the uterine cavity. Endometrial cells are hormonally responsive and are the basis for menstruation. The endometrial cells proliferate in response to estrogen, then when not pregnant, the excess endometrial cells are shed in the form of menses. In endometriosis, though, there is a proliferation of the endometrial-like cells without an outflow tract. This trapped menstrual-like fluid then results in inflammation and all the symptoms of endometriosis.
How is the diagnosis of endometriosis made?
From the onset of symptoms to the actual time of diagnosis may be 5-10 years. Common symptoms that suggest endometriosis are abdominal pain, menstrual pain, pelvic pain, infertility, change in bowel and/or bladder habits, and painful sex. There are less common symptoms that include back pain and fatigue. However, some women with endometriosis are asymptomatic.
In the past, endometriosis has been a surgical diagnosis, which means in order to be diagnosed with endometriosis, a woman needed to have a surgical biopsy of a suspicious lesion, usually in her abdomen during a laparoscopy (a surgery where a camera is inserted into the abdomen and pelvis through small incisions), confirming the microscopic features of endometriosis.
In relatively recent years, there has been a shift away from surgery and towards diagnosing endometriosis based on symptoms and response to medical therapies. Sometimes gynecologic ultrasound may suggest the presence of endometriosis, but a normal pelvic ultrasound does not mean endometriosis is absent. Also, at times, a pelvic exam by a skilled physician can detect endometriosis by the pelvic tissue changes present in some people with endometriosis.
What medical conditions are associated with endometriosis?
If the endometrial-like cells are implanted in the abdominal cavity, which is common, they can cause inflammation within the abdominal cavity. This may present as various bowel symptoms consistent with irritable bowel syndrome (IBS). There may also be a change in the bowel motility resulting in small intestinal bacterial overgrowth (SIBO), which is a form of IBS.
In women who have had endometriosis appropriately addressed, but are still symptomatic with abdominal pain and/or bowel changes, an investigation to look for IBS and/or SIBO is a necessity.
Endometriosis causes inflammation, which in susceptible women, may lead to an immune imbalance. This immune balance can be the trigger that stimulates autoimmunity. The autoimmune condition that is recognized to be associated most closely with endometriosis is Hashimoto’s thyroiditis. Other autoimmune conditions that are associated with endometriosis are multiple sclerosis, lupus, celiac disease, inflammatory bowel disease, and rheumatoid arthritis.
In women who have the diagnosis of endometriosis and symptoms associated with the above conditions, investigating for the presence of an autoimmune disease is recommended.
Some uncommon cancers are related to endometriosis, including clear cell ovarian cancer and endometrioid ovarian cancer. In a woman with endometriosis the risk of developing one of these two types of ovarian cancer is elevated when compared to a woman without endometriosis; however, it is still less than 1% chance of developing one of these two types of cancer even in the woman with endometriosis.
PCOS (polycystic ovarian syndrome)
Endometriosis and PCOS can be diagnosed in the same person. PCOS is a disorder with underlying issues of inflammation and hormonal imbalances. Both endometriosis and PCOS share the underlying issue of inflammation.
In women who have issues of abdominal pain, abnormal menstruation, blood sugar abnormalities, infertility, and/or signs of excess male hormones, such as male patterned hair changes and acne, investigating for the presence of PCOS in addition to endometriosis is definitely worth your time.