Understanding
endometriosis
Volumes has been written about endometriosis – but what is
it? What causes it and what can be done about it?
Endometriosis is when cells of the womb
lining – called endometrial tissue – gets into the pelvis and other parts of the
body. Under the influence of oestrogen, this tissue grows and bleeds with every
menstrual cycle, and cannot escape. Over time, it interferes with the
functioning of surrounding organs like the womb, ovaries, bladder and bowel.
This mostly causes pain – painful periods, ovulation, sex, defecation and
urinating. Women with endometriosis also struggle to get pregnant.
Because endometriosis is most common in
childless (usually working) women in their 30’s and 40’s, it’s been called a
career-woman’s condition, but this is not strictly true. Endometriosis can
happen to young girls. Not all women have the same symptoms. Pregnancy can put
endometriosis on pause (especially if the woman breastfeeds) and menopause
usually brings welcome relief.
What
causes endometriosis?
Harvey J. Kliman, M.D., Ph.D., a research
scientist in the Department of Obstetrics and Gynaecology and lead author of
the study published in the June issue of Gynaecological and Obstetric
Investigation suggests the following possible causes of endometriosis:
- Retrograde menstruation. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the Fallopian tubes and into the pelvic cavity instead of out of the body.
- Transformation of peritoneal cells. In what's known as the "induction theory," experts propose that hormones or immune factors promote transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial cells.
- Embryonic cell transformation. Hormones such as oestrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial cell implants during puberty.
- Surgical scar implantation. After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
- Endometrial cells transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
- Immune system disorder. It's possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that's growing outside the uterus.
- Klimin’s research also found that douching did not appear to decrease the risk of endometriosis, but sexual activity (period sex), orgasm and tampon use (at night) did.
What
are the symptoms?
Painful
periods:
Women with endometriosis struggle with very painful
periods. This pain is usually felt in the lower part of the abdomen, pelvis or
back. It may begin before a period starts and lasts until her period ends.
Painful
sex:
This pain happens during sex, especially when
there is pressure or vigorous sex.
Abnormal
periods:
Periods may be heavy, light and/or irregular
with a period between periods.
Bladder
problems:
Women experience urgency and the need to pass
urine more often. It may also be bloodstained.
Bowel
problems:
Feeling bloated with alternating diarrhoea
and constipation and painful defecation.
Who
is more at risk?
According to Klimin, the following women are
more at risk:
- Those who have never giving birth
- Starting your period at an early age
- Going through menopause at an older age
- Short menstrual cycles — for instance, less than 27 days
- Having higher levels of oestrogen in your body or a greater lifetime exposure to oestrogen your body produces
- Low body mass index
- Alcohol consumption
- One or more relatives (mother, aunt or sister) with endometriosis
- Any medical condition that prevents the normal passage of menstrual flow out of the body
- Uterine abnormalities
Making a diagnosis:
Diagnosing endometriosis is mostly according
to symptoms and a medical history. A laparoscopy (looking into the pelvis and
abdomen with a laparoscope) can help identify patches of endometriosis.
Mild
endometriosis is when patches of endometrium are found, but there is no scarred
tissue.
Moderate
endometriosis has larger, widely spread patches. There may look like
‘spider-webs’ joined to the ovaries, fallopian tubes and ligaments. Cysts
(fluid-filled bubbles) may also be found.
Severe
endometriosis is when most of the organs in the pelvis are affected by patches
of endometrium with scarred tissue. The fallopian tubes are often also blocked.
Treating
endometriosis:
This depends on the diagnosis and severity:
Hormonal – usually progesterone. While the
contraceptive pill (combined oestrogen and progesterone) may relieve symptoms,
these have side-effects that affect fertility.
Surgical – removing the endometrial tissue.
In extreme cases, a hysterectomy (removing the womb) may be unavoidable
Natural therapies – herbs and natural
progesterone
A combination of the above.
It is important to have endometriosis
diagnosed and treated by a gynaecologist – ideally one who specialises in
endometriosis.
For more information about periods, go to the
Kotex website: www.kotex.co.za/what-girls-are-asking/
