Endometriosis is a severe condition that affects the reproductive system of a woman. It is a chronic inflammatory disease when the endometrium is located outside the uterus. The endometrium is a tissue that lines the inside of the womb (Symons et al., 2018). Parasar, Ozcan, and Terry (2017) explain the development process of endometriotic lesions. One of the possibilities for endometriosis to appear is retrograde menstruation, a condition of the menstrual cycle in both human and non-human primates, characterized by “an outflow of the endometrial lining through the patent fallopian tubes into the pelvic space” (p. 2).
Retrograde menstruation is considered a risk for seeding the endometrium outside the uterus in ectopic sites. However, this retrograde menstruation is more common than endometriosis, meaning it is not necessarily the only cause for the disease to develop.
Several risk factors suggest the presence of endometriosis. Parasar, Ozcan, and Terry (2017) indicate that hormonal variation is the most significant risk for developing the disease. High risk is associated with the first occurrence of menstruation at an early age and short menstrual cycle length. In contrast, the low risk is associated with oral contraceptive usage and parity (pregnancies reaching viable gestational age) (Parasar, Ozcan, and Terry, 2017). They also suggest a positive association between body mass index (BMI) and endometriosis, related to the difference in hormonal levels between women with different BMIs. Women with a higher BMI are more likely to develop endometriosis than women with lower BMI.
Family history can also be considered as a risk factor for the development of endometriosis. Agarwal et al. (2019) mention the possible factors of endometriosis such as pelvic surgery, ovarian pain, or benign ovarian cysts. Chapron et al. (2019) add other family factors such as “the patient was born prematurely, neonatal uterine bleeding or low birth weight, formula-fed infant, early-life small body size, sexual and emotional abuse during childhood” (p. 672). Therefore, while investigating the possible causes for the development of the inflammation, healthcare professionals must inspect the medical history of the patient and the patient’s family.
Particular lifestyle also makes an impact on the development of endometriosis. Parasar, Ozcan, and Terry (2017) evaluate the effect of lifestyle choices on the development of the disease, particularly smoking and alcohol and caffeine consumption. Their findings show that it is unclear whether smoking increases the chances of endometriosis development. Further investigation revealed that smoking is associated with a lower risk of endometriosis in some cases but not all. It is important to note that directly inhaling cigarette smoke decreases the risk of the disease; however, passive smoking exposure during childhood years increases this risk (Parasar, Ozcan, and Terry, 2017).
The impact of alcohol and caffeine depends on the fertility of the woman. Infertile women are at higher risk of developing endometriosis with higher alcohol and caffeine intake. Parasar, Ozcan, and Terry (2017) did not find any relationship between endometriosis and physical activity; however, dietary patterns with higher consumption of omega-3 fatty acids decreased the risk of the disease.
Before treating endometriosis, it is crucial to understand its mechanics and impact on the patient’s uterus. Chapron et al. (2019) describe how endometriosis affects the tissue of the uterus. Endometrial fragments are transported by menses “through the fallopian tubes to the peritoneal cavity, where they can implant, develop and sometimes invade other tissues of the pelvis” (p. 667). The disease has three phenotypes: superficial peritoneal lesions (SUP), ovarian endometriomas (OMA) and deep infiltrating endometriosis (DIE). SUP is characterized by the occurrence of endometrial lesions on the peritoneum. OMA occurs when cystic masses grow within the ovary.
DIE is the most severe form of endometriosis when subperitoneal lesions penetrate tissue under the peritoneal surface deeper than 5 mm or infiltrate the muscularis propia of the organs near the uterus such as bladder or intestine (Chapron et al., 2019). Agarwal et al. (2019) mention that endometriosis might lead to infertility or subfertility if left untreated. Therefore, it is crucial to investigate the causes of pelvic pain to prevent the severe development of endometriosis.
The symptoms of endometriosis are not visible; therefore, it becomes the patient’s responsibility to reach medical attention in time. Agarwal et al. (2019) discuss the common symptoms of endometriosis. One of the main symptoms is pelvic pain; however, it is insufficient alone to indicate the presence of the disease because it can be an indicator of other gynecologic and non-gynecologic illnesses. Response to the said pain might be a valid indicator of endometriosis. The scholars warn that it is crucial not to dismiss the pain as an indicator of dysmenorrhea, which is a condition of painful menstruation. In other words, there are cases when dysmenorrhea does not provoke any additional gynaecological problems, and there are cases that it might be the first symptom of endometriosis.
The medical professionals suggest several ways of treating endometriosis. Ferrero, Evangelisti, and Barra (2018) explain that current hormonal therapy does not cure endometriosis but only reduces the pelvic pain associated with the disease. Agarwal et al. (2019) suggest the physical examination as the best method for diagnosing endometriosis as it has the highest accuracy. The pelvic examination includes the assessment of “palpable nodularity, stiffened and thickened pelvic anatomy, especially the uterosacral ligaments, vagina, rectovaginal space, pouch of Douglas, adnexa, rectosigmoid, or posterior wall of the urinary bladder” (Agarwal et al., 2019).
Chapron et al. (2019) mention that “modern endometriosis management requires a broad-based approach, centred on a patient’s symptoms and priorities” (p. 678). In conclusion, the combination of several factors such as constant pelvic pain, patient history with previous generation suffering from endometriosis, and the finding from physical examinations suggest that the patient has endometriosis.
References
Agarwal, S. K., Chapron, C., Giudice, L. C., Laufer, M. R., Leyland, N., Missmer, S. A., Singh, S. S., & Taylor, H. S. (2019). Clinical diagnosis of endometriosis: A call to action. American Journal of Obstetrics and Gynecology, 220(4), 354-e1.
Chapron, C., Marcellin, L., Borghese, B., & Santulli, P. (2019). Rethinking mechanisms, diagnosis and management of endometriosis. Nature Reviews Endocrinology, 15(11), 666-682.
Ferrero, S., Evangelisti, G., & Barra, F. (2018). Current and emerging treatment options for endometriosis. Expert Opinion on Pharmacotherapy, 19(10), 1109-1125. Web.
Parasar, P., Ozcan, P., & Terry, K. L. (2017). Endometriosis: Epidemiology, diagnosis and clinical management. Current Obstetrics and Gynecology Reports, 6(1), 34-41.
Symons, L. K., Miller, J. E., Kay, V. R., Marks, R. M., Liblik, K., Koti, M., & Tayade, C. (2018). The immunopathophysiology of endometriosis. Trends in Molecular Medicine, 24(9), 748-762.