Often it takes years for women to get a proper diagnosis of endometriosis, and they can be left dealing with unbearable symptoms month after month, given Band-Aid solutions without properly addressing the root cause, or simply shrugged off as having “normal period problems”.
Introduction to Endometriosis
One of the obstacles with diagnosing endometriosis is it cannot be done through a simple blood test, report of patient symptoms or even an ultrasound.
All of these tools can be used in conjunction to elevate suspicion of an endometriosis diagnosis, but the actual gold standard diagnostically is a laparoscopy.
A laparoscopy or “belly-button surgery” allows for both diagnosing endometriosis as well as removing lesions, but it is obviously more invasive and like any surgery does not come without risks.
Unfortunately, symptoms or lesions can persist after surgery as the removal of endometrial implants doesn’t necessarily impact or change the environment/terrain in which they developed in the first place.
By improving our understanding of endometriosis, we can hope to decrease the amount of time it to takes to diagnose and treat endometriosis as well as look at the root causes as to why some women deal with endometriosis and others do not, or why some women’s symptoms are more tolerable than others.
Have you been wondering if your symptoms are normal or has your suspicion around endometriosis been elevated?
It’s important to have an open and honest dialogue about endometriosis, as it can and does affect countless women worldwide.
Let’s get into it.
Quickly, This is The Most Common Symptom of Endometriosis
If you feel that you might have endometriosis, you should know that 95% of all endometriosis patients deal with dysmenorrhea.
Dysmenorrhea is pain during menstruation. This pain can be cyclical and chronic and may include pelvic pain/congestion, cramping, low back pain, pain radiating down the legs/vaginally, nausea, vomiting, diarrhea, fatigue, dizziness and headaches.
There are however other causes of dysmenorrhea, continue reading for a more in depth look at endometriosis!
What is Endometriosis?
Endometriosis is the presence of endometrial-like tissue outside of the uterus. The endometrium is the vascular inner lining of the uterus that is shed during menstruation or where an embryo implants during a pregnancy.
When we see endometrial tissue outside of its normal environment within the uterus, we often see pelvic pain as well as other symptoms.
Where are the Tissues Implanted?
*Diagram courtesy of https://www.endonews.com/atypical-sites-of-deeply-infiltrative-endometriosis
When dealing with endometriosis, the endometrial tissues are usually located in the pelvis: ovaries, anterior and posterior cul-de-sac, posterior broad ligaments, uterosacral ligaments, uterus, fallopian tubes, sigmoid colon & appendix, and around ligaments.
The most common location for these implants are on the ovaries, and these cysts are called endometriomas (or chocolate cysts). Endometriomas can be picked up on an ultrasound.
Other locations of implants include the vagina, cervix, recto-vaginal septum, cecum, ileum, inguinal canals, abdominal and perineal scars, bladder, ureters, umbilicus.
Not surprisingly, we can see pain showing up in some areas that may seem very strange or atypical during a period.
Some of the rarer locations that these tissues will be implanted include:
What Causes Endometriosis?
Although we are unsure of the exact cause of endometriosis, the most commonly accepted theory is retrograde menstruation. This is when menstrual fluid not only flows out of the vagina during menstruation, but also moves up the fallopian tubes and into the peritoneal (abdominal) cavity leading to endometrial implants.
Interestingly, studies show that nearly all women experience some degree of retrograde menstruation, but only some women develop endometriosis. When the immune system is functioning optimally, retrograde menstrual flow is met by an immune response, destroying the tissue before it has a chance to develop and grow.
When there is some dysfunction in the immune system, the body is unable to recognize and properly mount an immune response to endometrial fragments within the pelvic cavity and implants are created. Immune dysfunction is a central theory to endometriosis.
These implants act in a similar way to the endometrium, and are impacted by the hormonal changes of the menstrual cycle. Estrogen stimulates endometrial tissue growth both inside and outside of the uterus. As you can imagine, endometrial tissue bleeding outside of the uterus can cause significant discomfort.
If you look back to the “rarer locations of implants” you will see some locations that would be very hard to explain based solely on the retrograde theory, and that’s why there are multiple working theories to date.
How Common is Endometriosis?
Endometriosis is estimated to affect approximately 7-10% of all women, and over 60% of women with chronic pelvic pain are assumed to have endometriosis.
Furthermore, experts figure that up to 50% of women struggling with fertility have endometriosis.
Genetics play a part here as well. Women with a first degree relative with endometriosis are at a 3-9x higher risk of developing endometriosis.
What are the Signs and Symptoms of Endometriosis?
The inflammatory process and hyper-estrogenic stimulation caused by endometriosis are associated with a range of symptoms and complications that can significantly impact a woman’s quality of life. Surprisingly, the grade or degree of endometriosis in the body does not necessarily impact the severity of symptoms.
Pelvic Pain: Endometriosis often causes significant pelvic pain, particularly during menstruation or even up to a week before menstruation. This pain can range from mild to severe and can be debilitating for some women. We can see pain also present during ovulation (mid-cycle), during sex or penetration, or during bowel movements or urination. Women with endometriosis may also notice low back pain, or pain that refers down their legs or vaginally.
Excessive bleeding: This can include heavy periods, long periods, bleeding between periods, and spotting.
Infertility: Endometriosis is a common cause of infertility in women. The exact mechanism is not fully understood yet, but it’s thought that the inflammatory process and scarring caused by endometriosis can interfere with the ability of the fallopian tubes and ovaries to function properly.
Adhesions: Endometriosis can cause adhesions, or scar tissue, to form in the pelvic area. These adhesions can cause organs to stick together, which can lead to pain and infertility.
Endometriomas: Endometriomas are cysts on the ovaries that are the most common site of endometrial implants. They are often called “chocolate cysts” as they are dark brown and contain thick menstrual blood/debris.
Fatigue: Chronic pain and inflammation can lead to fatigue that makes day to day life significantly more difficult.
Bowel and Bladder Problems: Endometriosis can cause bowel and bladder problems, such as painful bowel movements, constipation, diarrhea, bloating and pain while urinating. Often women may have also been diagnosed with IBS (Irritable Bowel Syndrome) and notice a flare-up in symptoms before or during their period.
Depression and Anxiety: Living with a chronic condition like endometriosis can take a toll on a woman's mental health, leading to depression, anxiety, and other mood disorders.
For a Proper Diagnosis, Speak with Your Doctor
If you or a woman you know has been dealing with any of these symptoms talk with your doctor.
Although laparoscopy is the gold standard for diagnosis, endometriosis can certainly be picked up prior to surgery, and surgery will not always be the best option for everyone.
Working with a licensed ND or MD is your best course of action to find a treatment plan that works well for you.
If you’re in the Calgary, Alberta area and are seeking treatment, don’t hesitate to reach out to me by sending a message the contact form below.
Always remember, healing and recovery are possible if you create an effective treatment plan specific to you and your unique lifestyle!