What organs affect endometriosis?

Endometriosis

Endometriosis can occur in women if the endometrial tissue that lines the uterus grows on the outside of the uterus, most commonly into organs near the uterus. For instance, the most common location for endometriosis is the lining of the uterus or endometrium. Other locations include the deep pelvic sidewall, bladder, and rectum.

The disorder may cause pelvic pain when a woman has a period and may cause uterine scarring. The endometrium, or the lining of the uterus, responds to hormonal changes, and menstrual bleeding is the result of decreasing progesterone levels at the end of the cycle. The abnormally located endometrial tissue also responds to these hormonal changes and therefore bleeds and causes symptoms and scarring.

Endometriosis primarily affects females age 15 to 45 who are of reproductive age. According to the National Institutes of Health, 10% – 15% of women in this age group will have the disease. The cause of endometriosis is unknown. Researchers have found that estrogen can exacerbate the disorder. Studies have shown that menopausal women with this condition generally experience a decrease in estrogen and stop having symptoms.

Endometriosis at a glance

• Endometriosis occurs when the tissue of a woman’s endometrium, or uterine lining, grows on the outside of the uterus, sometimes in adjacent organs.
• The leading theory for why endometriosis occurs is that during a woman’s menstrual cycle, flow occurs both vaginally as well as retrograde, meaning through the fallopian tubes into the abdominal cavity.
• The disease affects 6 to 10 percent of women of childbearing age, or about 5 million women in the United States, and probably affects many more women who don’t know they have it, according to the National Institutes of Health.
• Many women do not show symptoms, but some women experience pain in the pelvis and abdomen.
• Treatments for symptoms of endometriosis include surgery or medications, but there is not a known cure.

Symptoms of the disorder

Pain and infertility are the two most commonly diagnosed symptoms of endometriosis. Many women do not experience any symptoms. Other symptoms commonly found in women with the disorder are:

• Pain in the pelvic region heightened during menstruation
• Abnormal menstrual bleeding
• Difficulty becoming pregnant
• Ovarian cysts that do not go away
• Nausea, diarrhea, or bloating
• Pain during or after sexual intercourse
• Pain when urinating or with bowel movements

Endometriosis and fertility

This disease can affect a woman’s fertility in many ways. Lesions or scars that develop from endometriosis can damage the reproductive organs.

Sometimes lesions can block the passage between a woman’s fallopian tubes, preventing the fallopian tubes from receiving an egg after ovulation. Lesions also can make it hard for the fertilized egg to pass through the fallopian tube to the uterus. Lesions can also impair the connection due to the tube or ovary being forced into an abnormal location in the woman’s body.

Endometriosis may affect a woman’s egg quality, but researchers have not discovered why it does.

Specific reasons for the cause of pain associated with the disease are unknown. Researchers found that unusually high levels of chemical messengers in women with the disorder can heighten pain perception.

Diagnosis and treatment of endometriosis

The presence of endometriosis is generally discovered by a doctor since many women do not experience symptoms. Our doctors can conduct an examination of a woman’s pelvic area if she is having symptoms or issues with becoming pregnant.

The physician will look for uncommon uterine positioning or abnormal cysts of the ovaries. Lesions can be seen in the vagina or cervix in some cases. The disease can only be confirmed by a doctor through surgery in order to positively identify lesions. At the time of laparoscopy, the physician can either remove or ablate the endometriosis that is present.

After a woman is diagnosed with the disorder, the doctor will evaluate the best course of treatment depending on if the symptoms are severe and if the woman is trying to become pregnant soon. No known cure exists for it, but treatment is available to help symptoms.

Doctors discuss the available forms of treatment with patients based on a woman’s symptoms and condition. Women with endometriosis usually can still carry a child depending on the severity of their condition.

Some treatments for endometriosis include:

Medications

Over-the-counter pain medication can help lessen pain caused by endometriosis. Birth control medication can reduce the amount of hormones in women, helping to lessen the symptoms of endometriosis. After the medication is stopped, lesions usually present because the hormones are no longer suppressed.

Surgery

Laparoscopy is a minimally invasive surgery common for treating endometriosis. This surgery is best performed by a fertility specialist who will insert a narrow instrument to view the inner reproductive organs while surgically ablating lesions with a laser or removing the lesions. Laparoscopic surgery for women with endometriosis generally decreases pain in 60 to 80 percent of cases. For women wishing to conceive, laparoscopy is the preferred treatment since the patient can resume attempts at achieving pregnancy quicker than with medications.

As with any surgery, risks include reaction to anesthesia, damage to tissue and organs, blood loss or clotting, infection, and pain.

Can endometriosis attack other organs? An expert tells you all about it!

To mark the Endometriosis Awareness Week, let’s look into whether this condition can hamper the health of your other organs.

Dr Aruna Muralidhar Published: 9 Mar 2022, 12:00 pm IST

Endometriosis is a mysterious condition that affects many women. It may affect about 10 percent of women in the reproductive age group, starting as early as adolescence. And this Endometriosis Awareness Week, let’s talk about an intriguing aspect about the condition.

Sadly, it is a chronic disease and can affect the quality of life for many women. It is not an infection or cancer and is certainly not contagious. The paradox of this condition is that mild disease may cause severe symptoms and severe disease may cause mild or no symptoms at all.

What are the symptoms of endometriosis?

The symptoms of endometriosis are many. The common symptoms are:

* Pain before the period,
* Pelvic pain and heaviness
* Deep pelvic pain during sex
* Heavy or prolonged menstrual bleeding
* Bloating
* Pain when passing motions or urine
* Inability to conceive

The symptoms depend on the organ of involvement. For example, if there are bladder deposits, there may be blood in the urine during the period.

What causes endometriosis?

Although many theories have been proposed about the cause, the oft-quoted theory is that there is a backflow of the menstrual blood during the period through the tubes with deposition of the endometrial blood and glands in various sites of the pelvis and abdomen.

These glands respond to the hormones which regulate the menstrual cycle which in turn cause the symptoms of endometriosis.

It is indeed intriguing that endometriosis can affect almost any organ in the pelvic and abdominal region. Research on surgical data shows that the most common site is the ovary followed by the abdominal soft tissue.

The urinary bladder and various sites of the intestines also can be affected. Interestingly, these glands show an affinity to scars such as caesarean section scar and the episiotomy (cut given during vaginal delivery) scar.

Also, pelvic sites are common, extra-pelvic sites are also involved in about 3-4 percent. These include the vulva (private parts of a woman), vagina (the birth canal or the front passage) and the cervix (neck of the womb).

Interestingly, although rarely, the glands can reach the adrenal glands (seated on the kidneys), lungs, skins, and even the brain.

The retrograde menstruation theory does not explain this wide spread of endometriosis in the body. One other theory says that it may result from spread through blood and lymph vessels.

How to diagnose endometriosis?

Due to the varied symptoms of endometriosis, it may be difficult to diagnose the condition early. Hence, the healthcare provider must be aware of the relation of the symptom to the period and also run the appropriate investigations.

Ultrasound may not pick up endometriosis unless there is an endometriotic cyst in the ovary. However, if done in a centre where there is expertise in dealing with cases of endometriosis, early diagnosis can be achieved.

This chronic disease does not have a definitive cure. The management would depend on the symptoms and is aimed towards the relief of the ailing symptom.

Awareness of the condition, early diagnosis and management may slow or even halt the natural progression of the disease. The burden of the symptoms and the effect on the quality of life can be improved too.

About the Author

Dr Aruna Muralidhar

Dr Aruna Muralidhar, Senior Consultant Obstetrician and Gynaecologist, Fortis La Femme Hospital, Richmond Road, Bengaluru . Read More

About endometriosis

Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrial stroma and glands, which should only be located inside the uterus) is found elsewhere in the body [1].

It is generally acknowledged that an estimated 10% of all women during their reproductive years (from the onset of menstruation to menopause) are affected by endometriosis [2]. This equates to 176 million women throughout the world, who have to deal with the symptoms of endometriosis during the prime years of their lives [3].

Common locations of endometriosis

Endometriosis lesions can be found anywhere in the pelvic cavity:

• on the ovaries
• the fallopian tubes
• on the pelvic side-wall (peritoneum)
• the uterosacral ligaments,
• the cul-de-sac,
• the Pouch of Douglas
• the rectal-vaginal septum

In addition, it can be found in:

• caesarian-section scars
• laparoscopy/laparotomy scars
• on the bladder
• on the bowel
• on the intestines, colon, appendix, and rectum.

But these locations are not so common. In even more rare cases, endometriosis has been found inside the vagina, inside the bladder, on the skin, in the lung, spine, and brain.

Symptoms of endometriosis

The most common symptom of endometriosis is pelvic pain.

The pain often correlates to the menstrual cycle, but a woman with endometriosis may also experience pain that doesn’t correlate to her cycle – this is what makes this disease/condition so unpredictable and frustrating.

For many women, the pain of endometriosis is so severe and debilitating that it impacts their lives in significant ways.

Endometriosis can also cause scar tissue and adhesions to develop that can distort a woman’s internal anatomy. In advanced stages, internal organs may fuse together, causing a condition known as a “frozen pelvis.” This is not common, but it does happen.

It is estimated that 30-40% of women with endometriosis may not be able to have children (if you suspect you suffer from infertility, please see our section on endometriosis and infertility).

If you, or someone you care about, has endometriosis, it is important to research the disease as much as possible. Many myths and misconceptions about endometriosis still persist, even in the medical literature.

For many women, management of this disease may be a long-term process. Therefore, it is important to educate yourself, take the time to find a good doctor, and consider joining a local support group.

Summary of endometriosis, symptoms, and treatments

Please share this film with anyone you feel need to know more about endometriosis!

References

1. Kennedy S, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Human Reprod 2005;20(10):2698-2704.
2. Rogers PA, et al. Priorities for endometriosis research: recommendations from an international consensus workshop. Reprod Sci 2009;16(4):335-46.
3. Adamson GD, et al. Creating solutions in endometriosis: global collaboration through the World Endometriosis Research Foundation. J of Endometriosis 2010;2(1):3-6.

Acknowledgments

* images courtesy of Dan Martin MD