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Endometriosis is a chronic condition where tissue that is similar to uterine lining grows outside of the uterus. It is estimated to affect over 100,000 Jamaican women.
Typically, endometriosis grows on organs in the abdominal cavity, like other parts of the woman’s reproductive system, other organs in the pelvis and on the peritoneum (i.e. the thin membrane that lines the abdominal cavity).
However, Consultant OBGYN Professor Horace Fletcher notes, "It can actually grow all over the body, even on the lungs and brain.”
So what happens during endometriosis?
As the endometrial growths are made up of tissue similar to that of the uterus, they act much like the uterine lining during the menstrual cycle. “Endometrial tissue bleeds wherever it is found,” Professor Fletcher explains. "In all these areas, the clue that it is endometriosis is that problems occur during the menses.”
With nowhere to go, this blood can irritate the surrounding tissue, causing pain and inflammation. Over time, scar tissue, called adhesions, can form between different organs.
Types of Endometriosis
There are different types of endometriosis, characterized by where they are formed.
Cystic Ovarian Endometriosis: Also called endometriomas, one study found it impacted 17–44% of women with endometriosis. As the name suggests, it develops as benign, dark, fluid-filled cysts on the ovaries.
Superficial Endometriosis: It typically forms on the pelvic peritoneum, the thin membrane that lines the pelvis and abdominal cavity.
Deep Endometriosis: This is a very aggressive form of endometriosis. It is the term used for endometriosis that is found in the bladder, the bowel or the recto-vaginal septum (the thin layer of skin that separates the vagina from the rectum). Due to the growth's location, bleeding can result in symptoms like blood in the urine or stool.
Abdominal wall endometriosis: This is a less common form of endometriosis in which endometrial tissue attaches to a surgical incision, like that of a Caesarean section (C-section). It is also called scar endometriosis.
Extra‐pelvic endometriosis: This is a rare type of endometriosis that occurs far away from the gynaecological organs. It includes intestinal endometriosis, which occurs in the bowels, cerebral endometriosis, which occurs in the brain, and thoracic endometriosis, which occurs in and around the lungs.
What are the symptoms?
Endometriosis symptoms are often related to the location of the endometriosis. For example, with cerebral endometriosis, epilepsy and headaches are common symptoms, while thoracic endometriosis can cause shortness of breath and lung collapse. Symptoms may also start before your period and continue after the period ends, but as Professor Fletcher noted above, however, the clue that it is endometriosis is that symptoms occur during the menstrual period.
As the most common type of endometriosis (endometriomas) occurs in the ovaries, heavy periods are very common symptoms of the condition. “Technically, a period is considered to be heavy if the woman is passing over 80 mls of blood per cycle,” explains Professor Fletcher.
“In more practical terms, your period may be considered heavy if:
The bleeding lasts for more than five days,
Pads are often soaked through, forcing you to change them several times a day, or
You are passing clots.”
Menstrual cups and tampons may also need to be emptied (e.g. more than twice a day) or changed (e.g. more than three to six times a day) frequently. Another common symptom is dysmenorrhea or painful menstrual cramps. This pain can occur in spasms or as a dull ache.
Note: While generally safe, wearing a pad, tampon or menstrual cup for a prolonged period of time (e.g. over eight hours) can cause toxic shock syndrome (TSS). This rare but life-threatening infection is caused by an overgrowth of certain common bacteria that normally cause no issues. However, when this overgrowth occurs, they can release toxins that enter the bloodstream sending the body into shock. Symptoms include many common signs of infection like fever, flu-like symptoms, diarrhoea or skin rashes. They can onset quickly and can be mistaken for something else. When left untreated, it can cause serious complications, like organ failure, and death.
Other common endometriosis symptoms include:
Pain during sex
Back pain
Abdominal pain
Abdominal swelling
Infertility
Where endometriosis is located in the urinary tract, recto-vaginal septum or intestines, symptoms can include:
Pain when passing stool or urinating
Blood in stool or urine.
Getting Diagnosed
"Endometriosis is typically diagnosed clinically, based on the patient's symptoms," says Professor Fletcher. "It also diagnosed through a physical examination, to feel for nodules in the umbilicus (the navel), vagina or in scars." Other diagnostic methods include a pelvic or vaginal ultrasound or a magnetic resonance imaging (MRI).
In some cases, laparoscopy may need to be performed. Professor Fletcher explains, “Laparoscopy is a minimally invasive surgical procedure, where a laparoscope (a thin lighted tube with a camera at the end) is inserted into the abdomen through a small incision.” The camera allows the doctor to see inside the pelvis for any endometrial growth. Patients will require general anaesthesia for this.
How is it treated?
Hormone Therapy: As the endometrial-like tissue from endometriosis responds to the same hormones (oestrogen or estrogen) that tell the uterus to shed its lining during your period, treatment options include hormone therapies that will reduce oestrogen levels, rendering the endometriosis inactive. Increasing levels of progesterone can also reduce the chance of it getting worse.
2. Surgery: “In some cases, like with endometriomas, surgery is recommended,” says Professor Fletcher. However, he warns, “There is a possibility that the endometrial tissue or growths will return.”
Final Words
Endometriosis can happen to any woman. “While family history and genetics do seem to play a part," Professor Fletcher says, "no one knows for sure why some women get it and others don’t. ”
"On its own, endometriosis is not life-threatening," says Professor Fletcher. "It isn't, for example, associated with endometrial cancer." However, he notes that because of the symptoms "like pain and infertility, it can be debilitating." Also, the degree of symptoms does not always indicate the extent of the disease.
Finally, while experiencing pain and bleeding during your period is normal if your menses are having a negative impact on your life, don't hesitate to make an appointment with your OBGYN. "Whether it is endometriosis, or something else, there are treatment options that can make your period easier to manage."
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