Endometriosis Treatment

Endometriosis, a prevalent gynecological condition, occurs when tissue resembling the uterine lining (endometrium) grows outside the uterus, triggering inflammation and severe pelvic discomfort. According to the National Institute of Child Health and Human Development (NICHD), it affects approximately 1 in 10 women globally, totaling around 176 million individuals, regardless of age, ethnicity, or socioeconomic background. This disease spans across various life stages, impacting teenagers, mothers, those delaying childbirth, and even women in postmenopause. Its symptoms often lead to a prolonged diagnostic journey, with an average delay of 7 to 10 years from onset.

In this condition, endometrial tissue, containing glands and stroma, migrates beyond its natural location, causing irritation and occasionally bleeding in adjacent tissues. The immune system responds by releasing inflammatory proteins, resulting in swelling and pain. Over time, the formation of scar tissue and adhesions between pelvic organs can further exacerbate symptoms and decrease quality of life for affected individuals.

Endometriosis may be suspected when a woman experiences pelvic pain, cyclical discomfort, painful intercourse, bowel movements, or urination, along with gastrointestinal symptoms like diarrhea, constipation, nausea, bloating, and abdominal cramps. During a pelvic examination, the patient may report tenderness and pain in specific areas, while the physician might detect nodularity behind the uterus. However, a definitive diagnosis requires surgery, during which biopsies of abnormal tissue are obtained and examined under a microscope to confirm the presence of endometrial-like glands and stroma by a pathologist.

Further Reading: “What are the common endometriosis symptoms?”

Despite centuries of searching for answers, the cause of endometriosis remains elusive, prompting consideration of factors influencing both its development and severity. Various theories have emerged to explain its origin and manifestation, aiming to encompass our current understanding of the disease. Typically, the most plausible theory guides treatment strategies and outcomes prediction, subject to revision as new insights emerge.

The most common and long-standing theory of endometriosis is the retrograde menstruation theory of Sampson. While this theory does explain some of our observations regarding patients with endometriosis, many other observations are not well explained by this theory, including the low rate of repeat surgery and the low rate of recurrence of the disease after optimal excision. Further, many treatments offered such as hysterectomy and inducing long-term amenorrhea (no periods) are based on this theory, but they do not treat the disease itself.

Other Endometriosis theories include retrograde menstruation, immune dysfunction, Mülleriosis, stem cell involvement, among others. The complexity of the condition necessitates a comprehensive approach, acknowledging the interplay of genetic, environmental, and physiological factors.

Some of the theories proposed include:

• Genetic factors
• Environmental toxins
• Immune dysfunction theory
• Sampson's theory of retrograde menstruation
• Theory of Mülleriosis
• Embryonic rest theory
• Stem cell theory
• Theories of lymphatic and vascular spread
• Coelomic metaplasia theory

As research progresses, the prevailing theory may evolve or be replaced by competing explanations, reflecting our advancing understanding of this enigmatic disease. Ultimately, unraveling the mysteries of endometriosis requires ongoing scientific inquiry and a willingness to adapt our understanding in light of new evidence.

• Endometriosis can continue well into your reproductive years, even into menopause? In fact, the oldest documented patient treated for endometriosis was over 80 years old.
• Endometriosis is not limited to just the pelvis, in very rare cases endometriosis has been found in very unexpected locations outside the pelvis, such as the brain, liver, lung, eye and kidney.
• Endometriosis has a long history, with anecdotal reports dating back to 1825 BC in the Kahun Papyrus from ancient Egypt.
• Endometriosis can reportedly affect a wider range of individuals than previously thought, including stillborn female fetuses, girls that have not yet started puberty, and even women born without a uterus.