What is endometriosis? in women
What is endometriosis?
a condition resulting from the appearance of endometrial tissue outside the uterus and causing pelvic pain, especially associated with menstruation.
Endometrial implants can be found in various areas of the body including the vagina, vulva, cervix, uterus, fallopian tubes, ovaries, ureterosacral ligaments, peritoneum, pelvic cavity, bladder, bowel, intestines, appendix and or rectum.3
In more rare situations, endometrial implants can also be present in the lungs, brain and on the skin.2
The disease not only causes physical symptoms such as pain, but also can affect other areas of a woman's life including their professional and financial lives, relationships and quality of life.3
Causes of endometriosis
The exact cause of endometriosis is not currently fully understood. However, there are some explanations for development of the disease and include:
illustration of endometriosis
Endometriosis is a long-term (chronic) condition that causes painful periods or heavy periods.
Retrograde menstruation: this condition causes menstrual blood to back up into the fallopian tubes and pelvis instead of normal expulsion.1-3 Additional research in this area is needed to determine why only some women manifest endometriosis during retrograde menstruation3
Embryonic cell growth: at times embryonic cells lining the abdomen and pelvis develop into endometrial tissue within those cavities1
Fetal development: data show that endometriosis can be present in a developing fetus; pubertal estrogen levels are thought to trigger the disease3
Surgical scar: endometrial cells can attach to an incision made for a procedure such as a hysterectomy or c-section1,2
Endometrial cell transport: the lymphatic system can transport endometrial cells to various parts of the body1
Genetics: there is possibly an inherited component to endometriosis.2 There is a 5-7x increased risk for a girl to develop endometriosis if she has a close female relative with the disease3
Hormones: endometriosis is stimulated by the hormone estrogen2
Immune system: problems with the immune system can prohibit destruction of extrauterine endometrial tissue.1-3
Symptoms of endometriosis
Other medical conditions such as pelvic inflammatory disease (PID), ovarian cysts and irritable bowel syndrome (IBS) can mimic the symptoms of endometriosis.1 Concerning symptoms should be evaluated by your health care provider so an accurate diagnosis can be made.
woman with cramps from endometriosis
The most common symptoms of endometriosis include painful or heavy periods, pain in the lower abdomen, pelvis or lower back pain and bleeding between periods.
Symptoms of endometriosis include:1-3
Severe menstrual cramps unrelieved with NSAIDS
Long-term lower back and pelvic pain
Longer than average periods lasting more than 7 days in duration
Heavy menstrual bleeding causing the need to change your pad or tampon every 1-2 hours
Bowel and urinary problems including pain, diarrhea, constipation and bloating
Bloody stool or urine
Nausea and vomiting
Fatigue
Painful sex
Intermenstrual spotting/bleeding
Infertility can be experienced in 30-40% of those with endometriosis.
While pain is the most common indication of endometriosis, the severity of the pain itself does not always correlate with the extent of the disease, as some women will experience excruciating pain and only exhibit mild disease or vice versa.1
Often, pain will resolve following menopause when estrogen production is over however if hormone therapy is used during menopause, symptoms may persist.1,2 Pregnancy may provide temporary relief to symptoms.1
Risk factors and complications
While anyone can develop endometriosis, there are certain risk factors placing some women at a higher risk of developing endometriosis and include:1,2
Age: most commonly experienced in women ages 30-40
Null parity: never giving birth
Genetics: one or more relatives with the disease (mother, aunt, sister, etc.)
Medical history: having a condition preventing expulsion of menstrual blood, pelvic infection or uterine abnormalities
Menstrual history: menses lasting more than 7 days or menstrual cycles <27 days.
Complications of endometriosis include infertility, increased risk of developing ovarian cancer or endometriosis-associated adenocarcinoma, ovarian cysts, inflammation, scar tissue and adhesion development and intestinal and bladder complications.1,2
Heat and comfort
A simple hot water bottle or hot bath may help to reduce pain. Some women also find heated wheat bags to be effective.. Being comfortable and reducing stress will also be beneficial.
Painkillers:
NSAIDs such as Ibuprofen, Voltarol and Ponstan (mefanemic acid) block the production of prostaglandins in the body. Prostaglandins occur naturally, in response to injury or disease, and cause pain and inflammation. They have a number of functions including making the womb contract during a period (which helps with the shedding of the womb lining). These contractions can cause pain. It is thought that women with endometriosis may produce more prostaglandins than women without the condition.
NSAIDs only work effectively if they are taken before the body produces prostaglandins. Many people take NSAIDs as they would other painkillers such as paracetamol. It is best to start taking NSAIDs the day before, or several days before, a period or pain is expected. Common side effects of NSAIDs include nausea, vomiting, diarrhoea, stomach upsets and stomach ulcers. These side effects can be reduced by taking the drugs with food or milk.
Codeine-based painkillers are effective painkillers but can cause constipation and gastro-intestinal upset, which may aggravate symptoms in women with endometriosis.
Simple analgesics such as paracetamol can be used to treat mild pain.
Physiotherapy
Physiotherapists can develop a programme of exercise and relaxation techniques designed to help strengthen pelvic floor muscles, reduce pain, and manage stress and anxiety. After surgery, rehabilitation in the form of gentle exercises, yoga, or Pilates can help the body get back into shape by strengthening compromised abdominal and back muscles.
Pain modifiers
These drugs work by altering the body’s perception of pain. Tricyclic anti-depressants (example – Amitriptyline) are drugs that are mainly used to treat depression but have been found to have an effect on the nervous system and the way the body manages pain. The pain messages travel through the body’s central nervous system, but these drugs can help to stop those messages from reaching the brain.
Transcutaneous Electrical Nerve Stimulator (TENS) machines
TENS machines are an alternative to pain killers. They are small, unobtrusive machines with electrodes that attach to the skin and send electrical pulses into the body. This does not hurt but instead feels mildly ticklish. The electrical pulses are thought to work by either blocking the pain messages as they travel through the nerves or by helping the body produce endorphins which are natural pain-fighters. Some TENS machines can be clipped to a belt. Check with your GP before using a TENS machine as they are not suitable for those who may be pregnant or who have a heart condition.
a condition resulting from the appearance of endometrial tissue outside the uterus and causing pelvic pain, especially associated with menstruation.
Endometrial implants can be found in various areas of the body including the vagina, vulva, cervix, uterus, fallopian tubes, ovaries, ureterosacral ligaments, peritoneum, pelvic cavity, bladder, bowel, intestines, appendix and or rectum.3
In more rare situations, endometrial implants can also be present in the lungs, brain and on the skin.2
The disease not only causes physical symptoms such as pain, but also can affect other areas of a woman's life including their professional and financial lives, relationships and quality of life.3
Causes of endometriosis
The exact cause of endometriosis is not currently fully understood. However, there are some explanations for development of the disease and include:
illustration of endometriosis
Endometriosis is a long-term (chronic) condition that causes painful periods or heavy periods.
Retrograde menstruation: this condition causes menstrual blood to back up into the fallopian tubes and pelvis instead of normal expulsion.1-3 Additional research in this area is needed to determine why only some women manifest endometriosis during retrograde menstruation3
Embryonic cell growth: at times embryonic cells lining the abdomen and pelvis develop into endometrial tissue within those cavities1
Fetal development: data show that endometriosis can be present in a developing fetus; pubertal estrogen levels are thought to trigger the disease3
Surgical scar: endometrial cells can attach to an incision made for a procedure such as a hysterectomy or c-section1,2
Endometrial cell transport: the lymphatic system can transport endometrial cells to various parts of the body1
Genetics: there is possibly an inherited component to endometriosis.2 There is a 5-7x increased risk for a girl to develop endometriosis if she has a close female relative with the disease3
Hormones: endometriosis is stimulated by the hormone estrogen2
Immune system: problems with the immune system can prohibit destruction of extrauterine endometrial tissue.1-3
Symptoms of endometriosis
Other medical conditions such as pelvic inflammatory disease (PID), ovarian cysts and irritable bowel syndrome (IBS) can mimic the symptoms of endometriosis.1 Concerning symptoms should be evaluated by your health care provider so an accurate diagnosis can be made.
woman with cramps from endometriosis
The most common symptoms of endometriosis include painful or heavy periods, pain in the lower abdomen, pelvis or lower back pain and bleeding between periods.
Symptoms of endometriosis include:1-3
Severe menstrual cramps unrelieved with NSAIDS
Long-term lower back and pelvic pain
Longer than average periods lasting more than 7 days in duration
Heavy menstrual bleeding causing the need to change your pad or tampon every 1-2 hours
Bowel and urinary problems including pain, diarrhea, constipation and bloating
Bloody stool or urine
Nausea and vomiting
Fatigue
Painful sex
Intermenstrual spotting/bleeding
Infertility can be experienced in 30-40% of those with endometriosis.
While pain is the most common indication of endometriosis, the severity of the pain itself does not always correlate with the extent of the disease, as some women will experience excruciating pain and only exhibit mild disease or vice versa.1
Often, pain will resolve following menopause when estrogen production is over however if hormone therapy is used during menopause, symptoms may persist.1,2 Pregnancy may provide temporary relief to symptoms.1
Risk factors and complications
While anyone can develop endometriosis, there are certain risk factors placing some women at a higher risk of developing endometriosis and include:1,2
Age: most commonly experienced in women ages 30-40
Null parity: never giving birth
Genetics: one or more relatives with the disease (mother, aunt, sister, etc.)
Medical history: having a condition preventing expulsion of menstrual blood, pelvic infection or uterine abnormalities
Menstrual history: menses lasting more than 7 days or menstrual cycles <27 days.
Complications of endometriosis include infertility, increased risk of developing ovarian cancer or endometriosis-associated adenocarcinoma, ovarian cysts, inflammation, scar tissue and adhesion development and intestinal and bladder complications.1,2
Heat and comfort
A simple hot water bottle or hot bath may help to reduce pain. Some women also find heated wheat bags to be effective.. Being comfortable and reducing stress will also be beneficial.
Painkillers:
NSAIDs such as Ibuprofen, Voltarol and Ponstan (mefanemic acid) block the production of prostaglandins in the body. Prostaglandins occur naturally, in response to injury or disease, and cause pain and inflammation. They have a number of functions including making the womb contract during a period (which helps with the shedding of the womb lining). These contractions can cause pain. It is thought that women with endometriosis may produce more prostaglandins than women without the condition.
NSAIDs only work effectively if they are taken before the body produces prostaglandins. Many people take NSAIDs as they would other painkillers such as paracetamol. It is best to start taking NSAIDs the day before, or several days before, a period or pain is expected. Common side effects of NSAIDs include nausea, vomiting, diarrhoea, stomach upsets and stomach ulcers. These side effects can be reduced by taking the drugs with food or milk.
Codeine-based painkillers are effective painkillers but can cause constipation and gastro-intestinal upset, which may aggravate symptoms in women with endometriosis.
Simple analgesics such as paracetamol can be used to treat mild pain.
Physiotherapy
Physiotherapists can develop a programme of exercise and relaxation techniques designed to help strengthen pelvic floor muscles, reduce pain, and manage stress and anxiety. After surgery, rehabilitation in the form of gentle exercises, yoga, or Pilates can help the body get back into shape by strengthening compromised abdominal and back muscles.
Pain modifiers
These drugs work by altering the body’s perception of pain. Tricyclic anti-depressants (example – Amitriptyline) are drugs that are mainly used to treat depression but have been found to have an effect on the nervous system and the way the body manages pain. The pain messages travel through the body’s central nervous system, but these drugs can help to stop those messages from reaching the brain.
Transcutaneous Electrical Nerve Stimulator (TENS) machines
TENS machines are an alternative to pain killers. They are small, unobtrusive machines with electrodes that attach to the skin and send electrical pulses into the body. This does not hurt but instead feels mildly ticklish. The electrical pulses are thought to work by either blocking the pain messages as they travel through the nerves or by helping the body produce endorphins which are natural pain-fighters. Some TENS machines can be clipped to a belt. Check with your GP before using a TENS machine as they are not suitable for those who may be pregnant or who have a heart condition.
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