Endometriosis is a widespread condition that impacts millions of women globally, yet it remains frequently misunderstood. Despite its prevalence, many people are unaware of what endometriosis is, how it manifests, and the impact it can have on a woman’s reproductive health. To put it simply, in many cases, women’s fertility problems are associated with unresolved endometriosis. In cases where the condition becomes too complex to be operated on, it can lead to permanent infertility in women.

Endometriosis affects approximately 190 million women and girls of reproductive age worldwide, accounting for around 10% of this population. India accounts for 25% of the global burden, with an estimated 43 million women suffering from this condition. This blog aims to shed light on this condition, discuss its symptoms, and explore the available treatment options extensively. But first, let’s understand what is endometriosis.

What is Endometriosis?

Endometriosis develops when tissue similar to the uterine lining, called the endometrium, begins to grow outside the uterus. This abnormal tissue growth can occur on the ovaries, fallopian tubes, and pelvic lining, and in rare cases, it may spread beyond the pelvic organs. Even though it is outside the uterus, this tissue functions like the uterine lining—thickening, breaking down, and bleeding with each menstrual cycle. However, since it has no exit, it remains trapped, causing various complications.

Signs and Symptoms of Endometriosis

Endometriosis presents with a wide range of symptoms, which can vary significantly from one individual to another. Endometrial tissue, which normally lines the uterus, can grow outside it, leading to the painful symptoms of endometriosis. While some women may experience only mild discomfort, others may suffer from severe and debilitating symptoms that impact their daily lives. The most common endometriosis symptoms are: 

Pelvic Pain

The main sign of endometriosis is ongoing pelvic pain. This pain typically begins before menstruation and can persist for several days, often worsening during menstruation. The pain may start in the pelvic area but can radiate to the lower back and abdomen. For some women, this pain can be severe enough to interfere with daily activities and may be mistaken for other conditions such as irritable bowel syndrome or ovarian cysts. A thorough diagnosis is required to understand the underlying cause of the pelvic pain. Imaging tests may be prescribed by doctors to determine the underlying cause of pelvic pain.

Pain During Intercourse

Pain during sexual intercourse, known as dyspareunia, is a common symptom linked to endometriosis. This discomfort, which may be experienced during or after intercourse, is often described as deep, aching, or sharp. The discomfort can make sexual activity distressing and may lead to a decline in sexual desire or avoidance of intimacy altogether, thereby affecting relationships and overall quality of life. It is crucial to point out this pain to doctors to get an accurate diagnosis of the pain you’re experiencing.

Heavy Menstrual Bleeding

Many women with endometriosis experience menorrhagia or heavy menstrual bleeding. This can involve soaking through pads or tampons in less than an hour, needing to use both a pad and tampon simultaneously, or passing large blood clots. Some women may also experience bleeding between periods (spotting), which can be both physically and emotionally taxing. Heavy loss of blood during periods can lead to iron deficiency in women and can lead to other conditions like anaemia.

Painful Periods (Dysmenorrhea)

Dysmenorrhea refers to painful menstrual cramps that are more intense and prolonged in women with endometriosis compared to those without the condition. These cramps can start before menstruation begins and may continue for several days, sometimes becoming progressively worse with each cycle. The pain is often described as sharp, throbbing, or cramping and can be accompanied by other symptoms like nausea or vomiting.

Infertility

Endometriosis plays a major role in infertility, impacting around 30-50% of women who have the condition. The presence of endometrial tissue outside the uterus can cause inflammation, scarring, and adhesions, which may obstruct the fallopian tubes or disrupt the normal function of the ovaries. This can make it difficult for eggs to be released, fertilised, or implanted, leading to challenges in conceiving. Women who have endometriosis without symptoms are often only diagnosed when they are unable to conceive due to the condition, and imaging tests are conducted.

Other Symptoms

In addition to the primary symptoms, endometriosis can cause a variety of other issues, particularly during menstruation:

• Fatigue: Many women with endometriosis report feeling extremely tired, even after a full night's sleep. This fatigue can be constant or worsen during menstruation.
  
   
• Gastrointestinal Issues: Endometriosis can affect the digestive system, leading to symptoms like diarrhea, constipation, bloating, and nausea. These symptoms may be mistaken for irritable bowel syndrome (IBS) but are often linked to the menstrual cycle.
  
   
• Bladder Issues: Some women may experience pain during urination or notice blood in their urine, particularly during menstruation. This can be a sign that endometrial tissue has spread to the bladder.
  
   
• Lower Back and Leg Pain: Endometriosis can cause pain that extends beyond the pelvic area, reaching into the lower back and legs. This pain can be continuous or flare up during menstruation.

Endometriosis is a complex condition with a variety of symptoms that can significantly impact a woman's life. If you notice any of these symptoms, it’s crucial to consult a healthcare provider for an accurate diagnosis and proper treatment. Early detection and management of endometriosis can reduce symptoms and enhance your overall quality of life. It also allows you to go through easier treatment options rather than having to opt for invasive treatment.

Treatment Options for Endometriosis

Although there is currently no cure for endometriosis, there are several endometriosis treatment options available that can help manage symptoms and improve the quality of life for those affected by the condition. The treatment approach typically depends on the severity of symptoms, the location of the endometrial tissue, and the patient's desire for pregnancy. Here’s a closer look at the main treatment options for endometriosis:

Pain Management

For many women with endometriosis, especially those with mild to moderate discomfort, pain management is often the initial step in treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen, are often recommended as over-the-counter pain relievers to help reduce pain. These medications help reduce inflammation and are especially effective in relieving menstrual cramps and pelvic pain linked to endometriosis.

Prescription pain medications: For those with more severe pain, doctors may prescribe stronger medications, including opioids. However, due to the potential for dependency and side effects, these are typically used only when necessary and for short durations. It is important to understand that pain management can only help manage the symptoms, other treatment options are used in conjunction with pain management to offer further symptomatic relief to patients.

Hormonal Therapy

Hormonal therapy is a key treatment approach for managing endometriosis, as it targets the hormonal fluctuations that trigger the growth and bleeding of endometrial tissue. The primary goal of hormonal treatments is to reduce or stop menstruation, which can, in turn, slow the growth of endometrial tissue and alleviate symptoms.

• Birth control pills: Oral contraceptives, which combine estrogen and progesterone, are often prescribed to regulate or stop menstrual periods. This can reduce pain and the progression of endometriosis. Continuous use of birth control pills (skipping the placebo week) can help prevent menstruation entirely.
  
   
• Hormone-releasing intrauterine devices (IUDs): A hormone-releasing IUD, such as one that releases progestin, can provide long-term relief from endometriosis symptoms by thinning the uterine lining and reducing or eliminating menstrual bleeding.
  
   
• Gonadotropin-releasing hormone (GnRH) agonists: These drugs reduce estrogen levels, a hormone that supports the growth of endometrial tissue.GnRH agonists effectively put the body into a temporary menopausal state, reducing or eliminating menstruation and associated symptoms. While effective, these medications can cause menopausal-like side effects, such as hot flashes and bone density loss, so they are typically used for short periods.
  
   
• Progestin therapy: Progestin-only medications, such as norethindrone, can help shrink endometrial tissue and reduce pain by counteracting the effects of estrogen.

Surgical Treatment

When endometriosis symptoms are severe and do not respond to other treatments, surgery may be recommended as a more aggressive approach.

• Laparoscopy: This minimally invasive procedure is the most common surgical treatment for endometriosis. During a laparoscopy, the surgeon inserts a thin tube with a camera through a small incision in the abdomen. This allows the surgeon to see the endometrial tissue and remove or destroy it using various techniques, such as excision or laser ablation. Laparoscopy can significantly reduce pain and improve fertility outcomes, but the condition can recur in some cases.
  
   
• Hysterectomy: In severe cases where other treatments have not been successful, a hysterectomy (removal of the uterus) might be an option. This procedure is generally considered for women who have finished having children or do not plan to conceive, as it permanently eliminates the possibility of pregnancy. Sometimes, the ovaries and fallopian tubes are also removed to reduce the chances of recurrence, as they are sources of estrogen production.

Fertility Treatment

For women with endometriosis who are experiencing infertility, specific fertility treatments may be necessary to help achieve pregnancy.

• In vitro fertilization (IVF): IVF is a common fertility treatment for women with endometriosis. This process includes stimulating the ovaries to produce several eggs, collecting the eggs, fertilizing them with sperm in a lab, and then transferring the embryos into the uterus. IVF can bypass some of the fertility challenges caused by endometriosis, such as blocked fallopian tubes or poor egg quality.
• Surgical intervention: In some cases, surgical removal of endometrial tissue may improve fertility, particularly if it is affecting the ovaries or fallopian tubes. Surgery can enhance the chances of natural conception or improve the success rates of fertility treatments like IVF.

Conclusion

Understanding what is endometriosis and recognizing its symptoms is crucial for early diagnosis and effective management. If you suspect you may have endometriosis or are experiencing pelvic pain or other related symptoms, it’s important to seek medical advice. Early intervention can help manage the condition, reduce symptoms, and improve your overall reproductive health. 

For more information about endometriosis treatment and fertility treatment for endometriosis, check out MASSH. We provide dedicated support to patients with endometriosis who want to conceive. Our experts formulate a personalised treatment plan that details the treatment, recovery, and conception process for patients. For more information, be sure to check out our website and request a callback from our team today.