• Mohamed Badaou

Endometriosis - What you should know

Endometriosis is a relatively common condition in menstruating women, yet there’s a tonne we still don’t know about it . The condition occurs in up to 1 in 4 women with fertility problems (1). This makes it one of the most common causes of reduced fertility. But what exactly is endometriosis, where does it come from, and the most important question: can you do something about it?


What exactly is endometriosis?

Simply put, endometriosis is the abnormal growth of tissue that resembles your endometrium outside of your uterus. In non-doctor speak: the wall of your vagina starts growing in other places. It can occur in several places, such as your ovaries, fallopian tubes, intestines, peritoneum or bladder(2, 3). In very exceptional cases, you may also have endometriosis in your lungs or your peritoneum(4).

image from: John Hopkins Medicine


What causes endometriosis?

There is no clear answer to this question yet. However, there are a number of factors that may play a role in the development of endometriosis. Currently, it is believed that endometriosis is a condition caused by both genetic and environmental factors (5). If a first-degree family member suffers from endometriosis, the chance of you developing it is six times higher than if you don't (6).


The most accepted theory about the onset of endometriosis is that of retrograde, or reflux, menstruation (6, 7). According to this theory, the blood and mucus of menstruation flows back through the fallopian tubes, after which they can enter the abdominal and pelvic region. If the blood and mucus cells settle in here, you can develop endometriosis. Other factors, such as your hormones, immune system and inflammatory processes, also play a role in the development of endometriosis (7).


Many women have retrograde periods every once in a while, but a lot less women actually develop endometriosis. This means that having a retrograde period every once in a while does not necessarily mean that you definitely will develop endometriosis. So don't worry about developing endometriosis the next time you get your period (and all the times after that).



What are the most common endometriosis symptoms?

The most common endometriosis symptoms are:

  1. Severe pain during menstruation;

  2. Reduced fertility;

  3. Chronic (read: long-term) pelvic pain;

  4. Pain during sex;

  5. Pain when urinating. (8)

What is the relationship between endometriosis and reduced fertility?

With endometriosis, you have growth of your uterine tissue outside of your uterus. This tissue doesn't belong here, and your body is able to recognize it. As a result, an inflammatory reaction occurs. It is beneficial that your body has a clean-up mechanism, but the disadvantage is that this mechanism creates scar tissue.


In some cases, this scar tissue may develop around and in the fallopian tube; the scar tissue then stops your eggs and your partner's sperm from reaching each other. Think of it as a blockade on the only highway from point A to B. This may complicate getting pregnant, but fortunately it is not impossible. Research shows that 1 in 3 women with endometriosis naturally become pregnant within three years. (9)

What can I do against (the development of) endometriosis?

Unfortunately, an official drug for endometriosis is not yet available. Existing treatments mainly focus on symptom control. There is some evidence that sufficient exercise and avoiding large amounts of alcohol could reduce your risk of endometriosis(10). To relieve pain in endometriosis, you can use anti-inflammatory drugs, such as naproxen and ibuprofen, or oral contraception. Research shows that both have a relieving effect on the pain associated with endometriosis(11, 12, 13).


To protect against reduced fertility from a mild form of endometriosis, it is possible to undergo surgery. During this operation, the extra (scar) tissue are removed(14). Another option is to take hormones (GnRH agonists). Because of the hormones, you will temporarily not produce estrogens or get your period. A major drawback of the hormones are the side effects, such as hot flashes, a dry vagina or acne(15). If it is not possible to get pregnant naturally, IVF is also an option for endometriosis. (9)


On average, endometriosis is diagnosed 6.7 years after the first symptoms(16). Often the endometriosis is then extremer. The sooner you get diagnosed, the less effect it has on your body. If your period pains are hurting more than the normal cramps, we recommend that you discuss this with your GP as soon as possible. You should not need to take painkillers during your menstruation.

References

  1. Stekkinger E, van der Linden P. Levenorgestrelhoudend IUD voor de behandeling van Endometriose. Nederlands Tijdschrift voor Geneeskunde [Internet]. 2007 [cited 1 November 2020];151:2372-2376. Available from: https://www-ntvg-nl.vu-nl.idm.oclc.org/system/files/publications/2007123720001a.pdf

  2. About Endometriosis [Internet]. Eunice Kennedy Shriver National Institute of Child Health and Human Development. 2020 [cited 21 February 2020]. Available from: https://www.nichd.nih.gov/health/topics/endometri/conditioninfo

  3. Ik heb endometriose | Thuisarts [Internet]. Thuisarts.nl. 2020 [cited 1 November 2020]. Available from: https://www.thuisarts.nl/endometriose/ik-heb-endometriose-0

  4. Hufnagel D, Li F, Cosar E, Krikun G, Taylor H. The Role of Stem Cells in the Etiology and Pathophysiology of Endometriosis. Seminars in Reproductive Medicine. 2015;33(05):333-340.

  5. Fauser B, Diedrich K, Bouchard P, Dominguez F, Matzuk M, Franks S et al. Contemporary genetic technologies and female reproduction. Human Reproduction Update. 2011;17(6):829-847.

  6. Giudice L, Kao L. Endometriosis. The Lancet. 2004;364(9447):1789-1799.

  7. Endometriosis [Internet]. nhs.uk. 2019 [cited 1 November 2020]. Available from: https://www.nhs.uk/conditions/endometriosis/

  8. Endometriosis [Internet]. The American College of Obstetricians and Gynecologists. 2019 [cited 1 November 2020]. Available from: https://www.acog.org/womens-health/faqs/endometriosis

  9. Macer M, Taylor H. Endometriosis and Infertility. Obstetrics and Gynecology Clinics of North America. 2012;39(4):535-549.

  10. Endometriosis | Womenshealth.gov [Internet]. U.S. Department of Health & Human Services: Office on Women's Health. 2019 [cited 1 November 2020]. Available from: https://www.womenshealth.gov/a-z-topics/endometriosis

  11. Grandi G, Barra F, Ferrero S, Sileo F, Bertucci E, Napolitano A et al. Hormonal contraception in women with endometriosis: a systematic review. The European Journal of Contraception & Reproductive Health Care. 2019;24(1):61-70.

  12. Rafique S, Decherney A. Medical Management of Endometriosis. Clinical Obstetrics and Gynecology. 2017;60(3):485-496.

  13. Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertility and Sterility. 2014;101(4):927-935.

  14. European Society of Human Reproduction and Embryology. Management of Women with Endometriosis. European Society of Human Reproduction and Embryology; 2013.

  15. Zorginstituut Nederland. Gosereline (GnRH-agonist) [Internet]. www.farmacotherapeutischkompas.nl. Available from: https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/g/gosereline#indicaties

  16. Parasar P, Ozcan P, Terry K. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Current Obstetrics and Gynecology Reports. 2017;6(1):34-41.

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