Hello steemians!!!, I'm glad you stopped by again and I hope you learn something new from this post

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About 2 weeks ago, I had menstrual cramps; It happens often, but on that particular day I decided to do a little research. I came across a lot; symptoms, causes and even things that could be done to relieve the pain. During the course of my research, a word caught my attention; Endometriosis, it was listed as a probable cause for menstrual cramps. Due to the fact that I've probably heard about it, I decided to read up on it and what it's all about. I'll be sharing the things I learnt about this medical condition in this post.

About 10.8 million people are affected globally as of 2015 and about 6–10% of women are affected. Endometriosis is common in those in their thirties and forties but it can begin in girls as early as 8 years old. It results in few deaths.
Source

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First of, what is endometriosis??

It is a condition where the endometrial tissue that normally lines the inside of the uterus grows outside the uterus, either on the Ovaries or Fallopian tubes.

An illustration depicting the growth of endometriosis on the ovary, uterus and fallopian tube: image from wikimedia licensed under CC3

In normal situations, that is, when the endometrial tissue grows inside the uterus like it's supposed to, the endometrial tissues are usually filled with blood vessels in preparation for pregnancy and in the absence of pregnancy, part of the endometrial tissue breaks down, causing menstrual bleeding. In the case of endometriosis, the same thing happen with the tissue that has grown outside of the uterus, it becomes filled with blood vessels and is broken down and shed as menstrual bleeding.

For some women affected with the condition, it could be painful while some don't even feel pain at all and the degree of pain varies; from mild to severe.

Endometriosis causes pain, although 20–25% of patients are asymptomatic.Source

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What causes endometriosis??

While the exact cause is not clear, there are theories and also risk factors that have been thought to lead to the development of endometriosis

• Retrograde Menstruation: This theory was first proposed by John A. Sampson. It is the most widely accepted theory for the formation of endometriosis. The theory suggests that during menstrual flow, menstrual blood containing endometrial cells flow back through the Fallopian tube into the peritoneal cavity. The cells then begin to attach themselves to the lining of the abdominal cavity, then start to grow, thicken, and bleed during each menstrual cycle.

• Peritoneal cells transformation: The theory proposes that hormones or immune factors induce the transformation of peritoneal cells into endometrial cells. It is also known as the "induction theory".

• Embryonic cell transformation: this theory proposes that hormones such as estrogen could transform embryonic cells into endometrial cell implants during puberty

Risk factors

These factors increase the chances of being affected with endometriosis.

• Genetics: Female relatives (sisters, daughters) of women with endometriosis have a higher chance of being affected with endometriosis.

There is a six fold increased incidence of the condition in women with an affected first degree relative
It has been proposed that it's development is similar to that of cancer, in that it results from a series of multiple hits within target genes. The initial mutation in this case could be somatic or heritable.Source

Other factors include;

• Never giving birth

• Early start of menstruation

• Delayed menopause

• Medical conditions that prevents normal menstrual flow out of the body.

Symptoms of endometriosis

Infertility and pain are the main symptoms of endometriosis.

• Infertility: About 40% of women affected with endometriosis are infertile. The determination of the disease is most times dependent on the stage of the disease, with the later stage disease leading to distorted pelvic anatomy and adhesions which in turn increases the chances of infertility.

• Pelvic pain: Most times, this pain is often associated with the menstrual period. It most times affect the lower back and legs too. The pain starts before the menstrual period and continues in the course of the menstrual flow.

Many women tend to disregard excess menstrual pain but it might involve other complications so it's best to complain to the doctor early enough

• Pain during or after sex

• Pain during bowel movement

• Excessive bleeding either during menstrual flow or between periods.

The severity of the pain experienced is not an indication of the stage of the condition. Some women might experience extensive pain but still have mild endometriosis while some with advanced endometriosis experience little pain.

How is it diagnosed??

After experiencing these symptoms, the best thing to do is to book an appointment with your doctor, so as to undergo some tests. The tests that could be carried out by your doctor include:

• Pelvic examination : During this exam, your doctor manually feels for abnormalities such as cysts around your pelvic area. It is usually impossible to feel small areas of endometriosis unless they've formed a cyst.

• Ultrasound : This test doesn't definitely tell whether you're affected with endometriosis but it can identify cysts associated with endometriosis. A device called a transducer is used to capture images from inside the body. It is either just pressed against the abdomen or inserted into the vagina.

• Laparoscopy: To be certain you have endometriosis, your doctor then refers you to a surgeon for a surgical procedure known as laparoscopy. During the surgery, a tiny incision is made near the navel, then a viewing instrument (a laparoscope) is inserted to check for the location and size of the endometriosis and this helps in choosing the best treatment option.

An illustration showing the laparoscope being used: image from wikimedia licensed under CC3.

What are the treatment options??

After diagnosis,depending on the severity of the condition, the doctor recommends two options for treatment; Medication or Surgery.

Medications

Pain Medication
Over the counter pain relievers such as non-steroidal anti-inflammatory drugs (NSAIDs), Ibuprofen or naproxene could be recommended by the doctor.

Hormone therapy

During the menstrual cycle, hormones are usually not stable and this causes the thickening and break down of endometrial cells. Supplementary hormones could help to slow the growth of endometrial cells and even stop new growth. This treatment option is only effective for as long as you keep taking the hormone supplements. Types of supplements that could be used include:

• Hormonal contraceptives such as birth control pills, patches and vaginal rings.

• Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists that act to reduce estrogen levels and prevent menstruation.

• Danazol which acts by suppressing the growth of the endometrium by stopping the production of ovarian-stimulating hormones which prevents menstruation and the symptoms of endometriosis.

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Surgery
Conservative Surgery
If these medications don't reduce the pain of endometriosis, Surgery is now considered.
Conservative surgery is usually done to remove as much endometrial tissue as possible while protecting the uterus and ovaries so as to increase the chances of pregnancy. The down side to the conservative surgery is that there is a chance of the pain and endometriosis recurring.

Assisted Reproductive Technology could be used if the conservative surgery is not successful.

Hysterectomy

As a last resort, especially in patients that experience severe pain, hysterectomy is recommended. It involves the total removal of the uterus, cervix and ovaries too.
It is better to consult with a doctor you're familar with and it is also advisable to get a second opinion before deciding treatment options.

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Conclusion

While endometriosis is a condition that could be managed and treated, it still kills. This is due to the ignorance of many about the condition, therefore, awareness of endometriosis should be increased and this will curb the mortality rate.

Thank you for taking time to read this!!!

Sources

Endometriosis: symptoms and causes

Endometriosis

Endometriosis and infertility

A systematic analysis for the Global Burden of Disease Study 2015

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