Endometriosis: The Top 10 Questions

1 Is endometriosis a form of cancer?

No, endometriosis is NOT a form of cancer. Endometriosis is a condition where the endometrial cells that line the uterine cavity, which is also known as the womb, are deposited outside the womb. These cells may be found in the pelvis or sometimes in other remote areas of the body. Although not a form of cancer, a patient who is diagnosed with endometriosis can have an increased chance of developing certain types of cancer later in life. The most common type of cancer that these patients are at risk of developing is ovarian cancer. They also have a high chance of developing hematopoietic cancer and breast cancer.

The longer the history of endometriosis, the higher the risk of developing ovarian cancer.

2 Is endometriosis curable?

Unfortunately, there is no cure for endometriosis as of now. However, the condition is treated symptomatically, which is very helpful for patients. The treatment of endometriosis focuses on reducing the patient's pain and fertility problems. However, treatment depends on each person, where it is specifically based on the needs of the patient, especially on the severity of the signs and symptoms, and whether or not the patient wants to get pregnant.

The treatment for endometriosis includes medications and surgery. Before surgery is considered as an option, a conservative treatment will be started.

Medical management of endometriosis includes:

• Pain relief with pain medications – Over-the-counter painkillers such as nonsteroidal anti-inflammatory drugs (NSAIDs) can be taken to reduce the pain caused by endometriosis. If the pain cannot be relieved using over-the-counter drugs, then your doctor will prescribe a stronger medication to control the pain.
• Hormonal therapy – Treatment with supplemental hormones is effective in controlling the pain due to endometriosis. The endometrial lining grows according to the changes of one's hormonal levels. Menstrual bleeding occurs when there is a hormonal decrease, which causes the thick endometrial lining to peel off. Thus, if you are treated with hormonal therapy, the thickening of the endometrial lining will be limited. For this reason, bleeding is reduced and pain will be controlled. However, hormonal therapy will not entirely cure endometriosis. The symptoms might return once hormonal therapy is stopped. Some of the hormonal therapies that are used to treat endometriosis include hormonal contraceptives, gonadotropin-releasing hormone (Gn-RH) agonists and antagonists, progestin therapy, and danazol.

Surgical management of endometriosis includes:

• Conservative surgery - this type of surgery is done where much of the endometrial tissue that lies outside the womb are removed as much as possible. A conservative surgery is recommended to those women who are trying to conceive.
• In vitro fertilization and other assisted reproductive technologies - can be adopted in women who are planning to get pregnant but are subfertile due to endometriosis.
• Hysterectomy – is the removal of the uterus and cervix with or without the ovaries. This procedure is the last option considered, especially in women who are not planning to get pregnant. A hysterectomy is the best treatment for this group of patients.

3 Does endometriosis cause bleeding?

One of the classical symptoms of endometriosis is painful, heavy bleeding during periods. However, endometriosis does not cause bleeding per se. In women who have endometriosis, the endometrial tissue, which is normally found within the uterine cavity grows outside of the uterus. This endometrial tissue undergoes thickening due to the hormonal changes that take place during the menstrual cycle. Endometrial cell growths outside of the uterine cavity also thicken in response to these hormonal changes. If the woman does not get pregnant, the endometrial cells within the uterine cavity plus the ones outside the cavity will shed and bleed. However, the blood from the shedding of the endometrial growths outside the uterine cavity has no place to leave the body, which leads to inflammation and the formation of scar tissues.

Depending on the site of the abnormal endometrial tissue, bleeding can occur in response to the hormonal changes. For example, if an endometrial tissue is found in your nose, and then you may develop cyclical epistaxis, and if there is an endometrial tissue in your urinary or gastrointestinal tract, then you may develop cyclical hematuria or bleeding with defecation, respectively.

4 What are the signs and symptoms of endometriosis?

Endometriosis is a chronic condition and its signs and symptoms vary from person-to-person. It is even possible for some patients to be completely asymptomatic, which means that they do not show any signs and symptoms.

The classical signs and symptoms of endometriosis include:

1. Heavy painful periods
2. Severe cyclical non-colicky lower abdominal pain or lower back pain around the time of menstruation

These symptoms begin a few days before the onset of menstrual periods and last until the end.

Another classical symptom of endometriosis is deep dyspareunia, which means a deep pain during or after intercourse. It usually indicates that there is endometriosis in the pouch of Douglas (a small extension of the abdominal cavity between the rectum and the back of the uterus).

Infertility is another common symptom of endometriosis.

Endometriosis in sites distant to the pelvis is responsible for other symptoms and they are less common.

If endometrial tissues are found within the urinary tract, the symptoms females can have are:

• cyclical hematuria (bloody urine)
• cyclical burning sensations when passing urine (dysuria)
• obstruction in the ureters that blocks the pathway of urine and causes renal pain on the affected side

If endometrial tissues are found within the gastrointestinal tract, the symptoms include:

• painful defecation or dyschezia
• cyclical bleeding through the rectum

If endometrial tissues are found in the lungs, it can produce cyclical hemoptysis (coughing up of blood). Sometimes, endometrial tissues are deposited on surgical scars, resulting in cyclical pain and bleeding on those sites.

You may not have all of these symptoms. The symptoms you have basically depend on the location of the abnormal endometrial tissue. Moreover, there is no correlation between the extent of the disease and the intensity of the symptoms. For instance, a small amount of tissue can be really painful for some while for the others, they may feel a little or no pain at all even after having plenty of endometrial tissues.

5 Can endometriosis cause weight gain?

Endometriosis does not directly cause weight gain. However, many women with endometriosis do experience an increase in their weight. Their weight gain may be largely due to the treatment of endometriosis. Hormonal pills are one of the treatments used in endometriosis, and it is a well-known fact that birth control pills or any other hormonal pills can cause a significant weight gain.

In addition, women with endometriosis often experience very painful periods and abdominal cramping. For this reason, most of them tend to remain in bed all day and not as active as other women. These two factors contribute to the weight gain of women who have endometriosis, although endometriosis itself does not directly cause weight gain.

6 What is an endometrium?

The endometrium is the layer of tissue that lines your uterine cavity or womb. The uterus or womb is a part of the reproductive system. It is the place where a baby develops. It is made up of smooth muscles known as the myometrium, and the cells that line the uterus is the endometrium. The endometrium plays an important role to support a pregnancy. It is the site of fertilization and implantation, which also supports the development of the placenta.

During one menstrual cycle, hormonal fluctuations cause the endometrium to undergo many changes to support the implantation of a fertilized egg. However, if fertilization does not occur, hormonal changes will cause the endometrial layer to shed, and these cells along with blood from the surrounding blood vessels will leave the body as menstrual blood. 

7 How does endometriosis occur?

The exact cause of endometriosis is not known, but there are many theories used to describe the etiology of endometriosis. However, there is not one theory that fully explains its cause.

The theories used to describe how endometriosis occur are:

• Menstrual regurgitation and implantation – This theory postulates that menstrual blood containing endometrial glands is regurgitated back into the peritoneal cavity and is implanted there.
• Coelomic epithelium transformation – This theory describes that the cells lining the peritoneal cavity go back to their primitive origin, which then transforms into endometrial cells. This transformation can be due to hormonal stimuli or due to irritation or inflammation.
• Genetic and immunological factors – This theory explains that genetic and immunological factors predispose a woman to develop endometriosis. Endometriosis has been reported to be more common among women with first-degree relatives who have the condition and also among some races.
• Vascular and lymphatic spread – This theory explains that endometrial tissues from the uterine cavity are deposited in distant sites outside the peritoneal cavity by embolization through the blood vessels or lymphatic vessels.

8 Can endometriosis cause spotting in between periods?

Yes, some women do experience spotting in between periods. Taking any birth control pills or hormonal pills as a treatment for endometriosis can also be the main cause for the bleeding in between periods.

Spotting in between periods or irregular bleeding is one classical symptom of endometriosis.

9 Can endometriosis cause infertility?

Yes, endometriosis can cause infertility. If you have been diagnosed with endometriosis, then you will have a hard time conceiving. It has been estimated that about 30-40 percent of patients diagnosed with endometriosis have a difficulty in conceiving. However, in most cases, several factors can also contribute to infertility. A number of possible mechanisms have been postulated to connect endometriosis and infertility. Some of these mechanisms are:

• anatomical distortion of the pelvis
• scarring and adhesion of the fallopian tubes
• inflammation of the structures within the pelvis
• destruction of the ovarian tissues when endometriomas develop within the ovaries
• egg pick up impairment by the fimbriated ends of the fallopian tubes during ovulation 
• motility impairment of the fallopian tubes 
• reduction in the frequency of sexual intercourse due to the deep pain experienced during intercourse (deep dyspareunia)
• impairment of implantation of the fertilized egg
• poor quality of the egg released during ovulation

Surgical ablation or excision of mild endometrial tissues can improve the chance of fertility. The surgical treatment of endometriomas also increases the rate of spontaneous pregnancy rates.

10 Can you develop endometriosis after childbirth?

Yes, you can develop endometriosis after childbirth. If you have been diagnosed with endometriosis before conceiving, then pregnancy will only act as a temporary relief for endometriosis. Because of the hormonal changes during pregnancy, it will suppress the signs and symptoms of endometriosis within nine months. However, it does not completely eradicate the condition. These symptoms will recur after the birth of your child.

The reason why pregnancy suppresses the symptoms of endometriosis is due to the high levels of progesterone during pregnancy. It is believed that high levels of progesterone produced during pregnancy suppress the growth and development of endometrial tissues. In addition to this, pregnancy is a period of amenorrhea, which means that you do not get periods while you are pregnant. This fact is also beneficial in the control of the signs and symptoms of endometriosis. The absence of menstrual periods also means no pain.