What Is Endometriosis?

Understanding Endometriosis - A brief overview

March is recognized as Endometriosis Awareness Month, a time to increase understanding and awareness of this chronic disease that affects millions of people worldwide. Endometriosis is a complex condition that often goes undiagnosed for years, causing debilitating symptoms such as painful periods, chronic pelvic pain, and gastrointestinal issues. Despite its prevalence, there is still much to learn about the causes and management of endometriosis. In this blog post, we provide a brief overview of endometriosis, including commonly reported symptoms, paths to diagnosis, and management.

What is Endometriosis?

Endometriosis (informally called “endo”) is a chronic inflammatory disease that affects approximately 190 million people of reproductive age worldwide. It happens when cells that are similar to the lining of the uterus (endometrial tissue) are found growing outside of the uterus. This misplaced tissue behaves like the endometrial tissue lining in the uterus by responding to the hormonal changes of the menstrual cycle each month. It builds and breaks down, resulting in bleeding inside the pelvis (or elsewhere), but the blood does not exit the body as would happen with normal menstrual bleeding. This leads to swelling, inflammation and scarring of the normal tissue around the endometriosis implants. The affected tissue can involve the reproductive organs, the intestines, the bladder, and the pelvic cavity lining. In rare cases, abnormal endometrial-like tissue has been found in organs outside of the pelvic cavity such as the lungs.1

Common Reported Symptoms:

The most common debilitating symptoms and complaints among people living with endometriosis are painful periods and chronic pelvic pain (with or without menstruation). In addition, those living with endometriosis can experience painful bowel movements and other gastrointestinal issues, painful urination, chronic fatigue, infertility, pain during or after sexual intercourse, depression, and anxiety. These symptoms of endometriosis can significantly compromise the quality of life of those living with this condition.2,3

Diagnosis:

Diagnosis is also not easily done, and there is often a lengthy delay between the onset of symptoms and a diagnosis. In a 2017 cross-sectional survey of 30,000 Canadian women conducted by researchers at the University of British Columbia, the median time from the onset of symptoms to a confirmed diagnosis of endometriosis was approximately 5.4 years, with some women waiting longer. This study also found that women with endometriosis reported experiencing symptoms for at least three years on average before seeking medical attention.4

Endometriosis may be suspected based on a pelvic exam, medical history, reports of symptoms, and imaging studies (MRI, CT, and Ultrasound). However, in many cases, surgical, diagnostic laparoscopy is often required for an accurate and absolute diagnosis.5

Management:

There is no known cure for endometriosis. Although there are various theories regarding the cause of endometriosis, the reason someone develops this condition remains unknown. Methods used to manage endometriosis generally include the use of pain medication to manage the pain associated with inflammation, hormonal medication to reduce the rate of endometrial tissue growth and support fertility, and surgery to remove existing endometriosis lesions to reduce associated pain and restore fertility when able. 6

In addition to medical interventions, some people living with endometriosis opt to explore holistic therapies and practices to reduce pain, increase pain tolerance and support their overall well-being, especially when medical interventions are not providing adequate relief from their endometriosis-related symptoms. Holistic self-care for those living with endometriosis may include nutrition interventions, stress management, pelvic floor theory, yoga, acupuncture, and naturopathy. 7-9. Research is ongoing on the outcomes of these practices; however, some people living with endometriosis report some symptom relief with holistic approaches.

Due to its complexity, endometriosis can impact people living with the condition in various ways. Those living with endo may consider multidisciplinary care based on their unique healthcare needs and seek out professionals that are knowledgeable and have experience working with those living with endometriosis. Multidisciplinary care is an approach to healthcare that involves a team of healthcare professionals from different specialties working together to provide coordinated care for patients with complex medical conditions.11 If you are someone living with endometriosis, it's important to understand that you are not alone. With increased awareness and advocacy, we can hope for better understanding, improved management, and ultimately a cure for endometriosis.

References

1. Mecha E, Makunja R, Maoga JB, Mwaura AN, Riaz MA, Omwandho COA, Meinhold-Heerlein I, Konrad L. The Importance of Stromal Endometriosis in Thoracic Endometriosis. Cells. 2021; 10(1):180. https://doi.org/10.3390/cells10010180

2. Facchin F, Barbara G, Saita E, et al. Impact of endometriosis on quality of life and mental health: pelvic pain makes the difference. J Psychosom Obstet Gynaecol. 2015;36(4):135-141. doi:10.3109/0167482X.2015.1074173

3. Nnoaham KE, Hummelshoj L, Webster P, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011;96(2):366-373.e8. doi:10.1016/j.fertnstert.2011.05.090

4. Bush D, Brick L, Culley L, et al. Prevalence, symptomatic burden, and diagnosis of endometriosis in Canada: cross-sectional survey of 30 000 women. J Obstet Gynaecol Can. 2017;39(7):526-535. doi: 10.1016/j.jogc.2017.01.014.

5. Alberta Health Services. Endometriosis. MyHealth Alberta. Updated February 22, 2021. Accessed February 22, 2023. https://myhealth.alberta.ca/health/pages/conditions.aspx?Hwid=hw102998

6. Allaire, D. C., Aksoy, T., Bedaiwy, M., Britnell, S., Noga, H. L., Yager, H., & Yong, P. J. (2017). An Interdisciplinary Approach to Endometriosis-associated Persistent Pelvic Pain. Journal of Endometriosis and Pelvic Pain Disorders.https://doi.org/10.5301/jeppd.5000284

7. Karlsson, J. V., Patel, H., & Premberg, A. (2019). Original research: Experiences of health after dietary changes in endometriosis: a qualitative interview study. BMJ Open, 10(2).https://doi.org/10.1136/bmjopen-2019-032321

8. Xu, Y., Zhao, W., Li, T., Zhao, Y., Bu, H., & Song, S. (2016). Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis. PLoS ONE, 12(10). https://doi.org/10.1371/journal.pone.0186616

9. Rowe, H., & Fisher, J. (2018). Self-management in condition-specific health: a systematic review of the evidence among women diagnosed with endometriosis. BMC Women's Health, 19. https://doi.org/10.1186/s12905-019-0774-6

10. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382(13):1244-1256. doi:10.1056/NEJMra1810764.