Endometriosis

What Is Endometriosis ?

Endometriosis is a gynaecological condition that involves the inner layer of the uterus called the endometrium. In endometriosis, the inner layer of the uterus is present in areas of the pelvis other than its normal location. Endometrial tissue may be present on abdominal and pelvic organs. The organs often affected include the bladder, ovaries and fallopian tubes. The endometrial tissue functions normally as it does in the uterus, even when placed on other organs, and this leads to symptoms. Endometrial tissue continues to bleed with every menstrual cycle, and this leads to inflammation and scarring of abdominal or pelvic tissues, and formation of pelvic adhesions that may cause chronic pain.

Endometriomas may also be present in the pelvic space. Endometriomas are cysts composed of endometrial tissue, most often located on the ovaries.

Prostaglandin release (a normal inflammatory response of the body) is responsible for normal period pain. Prostaglandins are also implicated in cyclical pain associated with endometriosis.

The average age at diagnosis is twenty years of age. Six to ten percent of the female population is affected, and close to 170 million women worldwide suffer symptoms as a result of endometriosis.

Diagnosis is made on radiological visualisation of endometrial tissue. This may be done through pelvic sonar or CT scans. Often diagnostic and therapeutic laparoscopy and endometrial scraping or ablations are done simultaneously. Conservative management includes non-steroidal anti-inflammatories and the progesterone only contraceptive pill. High dose progesterone combined oral contraceptives may also be helpful.

In very severe cases, postmenopausal women may need a hysterectomy.

What Are The Symptoms Of Endometriosis ?

Endometriosis causes symptoms because of localised inflammation or formation of adhesions. These include symptoms such as:

• Persistent lower abdominal pain
• Dyspareunia
• Dysmenorrhoea
• Pain on urination or when passing stools
• Chronic pelvic pain (in seventy percent of pelvic pain cases)
• Menstrual bleeding abnormalities- metro- and/or menorrhagia.
• Endometriosis can also be a cause of infertility(in twenty-five to fifty percent of infertility cases). Forty percent of women who have endometriosis may be infertile.
• Psychological consequences of endometriosis (due to infertility or chronic pain) include anxiety and depression and may also occur commonly.

What Are The Causes Of Endometriosis ?

No specific cause for endometriosis has yet been identified.

The most commonly accepted pathophysiological explanation is that endometrial tissue that is normalyl shed during menstruation may flow back into the fallopian tubes (retrograde flow) and lead to implantation of the endometrial tissue on other organs in the abdomen and pelvis.

A positive family history of endometriosis (grandmother, mother or aunt affected) increases the chances of developing endometriosis by almost six times.

Other identified factors that may play a role in endometriosis include:

• Early age at onset of menstruation (menarche)
• Late age of menopause
• Delayed age at childbearing or having no children

What Are The Things One Should Do To Manage Endometriosis ?

• Exercise increases blood flow to tissues, reduces inflammation and assist in management of chronic pain due to release of endorphins
• Weight loss- Pain due to endometriosis is oestrogen mediated. Oestrogen is stored in fat cells. Weight loss (especially fat reduction) will lower circulating oestrogen and reduce symptoms

What Are The Things One Should Avoid To Manage Endometriosis ?

• Psychological symptoms such as anxiety and depression should not go untreated.  Seek help from a psychologist or psychiatrist. Treatment of comorbid psychological symptoms may assist in reducing pain
• Don’t leave stress unmanaged.  Stress increases the inflammatory burden on the body. Stress reduction techniques and mindfulness are essential
• Do not smoke as it increases pain and inflammation

What Are The Best Foods For Endometriosis ?

A low-inflammatory diet may improve symptoms associated with endometriosis. Anti-inflammatory foods include:

• Green leafy vegetables (kale, spinach, broccoli, watercress, swiss chard)
• Blueberries, strawberries
• Chia seeds, Flax seeds, Walnuts
• Omega 3 rich fish such as salmon

If you suffer from excessive or abnormal bleeding, foods high in iron may replenish iron stores:

• Spinach, kale, broccoli, artichokes
• Beans and legumes
• Egg (yolk)
• Ginger and turmeric help with chronic pain as well as lowering inflammation.

What Are The Worst Foods For Endometriosis ?

• Foods that are high in oestrogen content should be avoided.
• Red meats- increase prostaglandins and inflammation.
• Caffeine- can increase oestrogen levels.
• Refined carbohydrates, processed foods and unsaturated fatty acids- increase inflammation and prostaglandins.
• Alcohol- depletes vitamin B levels and increases toxic load on the system.
• Soy products- soy increases oestrogen levels.

What Are The Medicines For Endometriosis ?

What Are The Tips To Manage Endometriosis ?

• Acupuncture may be beneficial in reducing pain associated with endometriosis
• Essential oils such as sage assist in hormone balancing and pain reduction