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Understanding Endometriosis: A Comprehensive Overview

Understanding Endometriosis: A Comprehensive Overview

Understanding Endometriosis: A Comprehensive Overview

10 Comments November 2023 10 min Read

Endometriosis is a medical condition that affects millions of women worldwide, yet its complexity often leads to misunderstanding and diagnostic delays. Endometriosis as a disease has many faces as it can present with varying symptoms. That might explain why it is called a chameleon. And once suspected or diagnosed, it is hard to estimate the extent of the disease; thus, it has been compared with an iceberg as a major part of the lesion can hiding under the surface.

It is hormone dependent yet cannot be cured by hormones. In this blog we will be briefing on what you need to know about endometriosis.


The presently agreed definition of endometriosis as characterized by the presence of functional endometrial-like tissue outside the uterus, but in the pelvic cavity, or even outside, with evidence that lesions are cellularly active, or have an effect on normal physiology.

Unlike the normal endometrial tissue, these growths have no direct route for exit, causing inflammation, pain, and the formation of scar tissue.

Why does Endometriosis happen?

The exact cause of endometriosis remains uncertain. However, several theories suggest retrograde menstruation, genetic factors, immune system issues, and hormonal imbalances could contribute to its development. Understanding these factors is crucial for effective management.

Lets explain it in a simple way. It happens because of a mix of things like your genes and the environment around you. Genes are like instructions for your body, and some people might have genes that make them more likely to get endometriosis. But it's not just about genes - things in your environment can also play a part.

We now know that besides hormones, which are chemicals in your body, the immune system is also important. It helps protect your body, but sometimes it can react against the cells from the lining of the uterus that go the wrong way and end up where they shouldn't. This can cause inflammation and the growth of endometriosis.

People used to think that endometriosis only happened because of a backward flow of menstrual tissue ,but now we know it's more complicated than that. Even though estrogen, a hormone, is thought to be a big player, there's also an inflammatory side to it, with certain genes being more active.

So, in simpler terms, endometriosis is caused by a mix of genetic and environmental factors, and it involves not just hormones but also how your body's defenses react to things they shouldn't. It's a bit like a puzzle with pieces that we're still figuring out.

Various Phenotypes of Endometriosis

Endometriosis manifests in various phenotypes, each presenting distinct challenges and symptoms.

The Ovarian Endometrioma - Involves the formation of cysts on the ovaries, often causing pain and impacting fertility.

Deep Endometriotic Nodules these type of endometriosis penetrate into surrounding tissues, leading to adhesions, severe pain and potential organ dysfunction.

Superficial Peritoneal Lesions Can contribute to abdominal pain, bloating and inflammation.

Adenomyosis Endometriosis of uterus, signifies the presence of endometrial tissue within the uterine wall.

Understanding these diverse phenotypes is crucial for accurate diagnosis and tailored treatment approaches.

Why so much diagnostic delay?

One significant challenge in managing endometriosis is the often-prolonged period between the onset of symptoms and an accurate diagnosis. The symptoms, such as pelvic pain and irregular menstrual cycles, can be attributed to other conditions, leading to misdiagnosis or dismissal of symptoms. Increased awareness among healthcare professionals and the general public is essential to reduce diagnostic delays.

Endometriosis as a Whole-Body Disease

Endometriosis isn't just a problem in the pelvic area, as many people might think. It's now understood to affect the entire body, having potential impacts on different systems like the digestive, urinary, overall well-being, and nervous systems. Recognizing that it's a condition that can affect the whole body is important for providing thorough and effective care.

Common and Rare Symptoms of Endometriosis

Endometriosis can present with a variety of symptoms, varying from mild to intense. Common symptoms include pelvic pain, painful periods, and pain during intercourse. Yet, it's crucial to note that endometriosis goes beyond the expected; it can lead to fatigue, digestive problems, issues with the urinary tract, nerve-related pain, and, in uncommon instances, even chest discomfort depending on the organs affected. Being aware of this broad spectrum of symptoms is vital for catching the condition early on and seeking timely medical attention.

Endometriosis and Infertility

Endometriosis is a leading cause of infertility among women. The presence of endometrial tissue outside the uterus can interfere with ovulation, fertilization, and implantation. The presence of endometrial tissue outside the uterus can disrupt the normal reproductive processes. The adhesions and scar tissue formed by endometriosis may interfere with the release of eggs, block fallopian tubes, or affect the implantation of a fertilized egg in the uterus. Additionally, the chronic inflammation associated with endometriosis can create an inhospitable environment for conception.

Diagnosing Endometriosis

Diagnosing endometriosis often involves a combination of medical history, pelvic examinations, imaging studies, and minimally invasive procedures like laparoscopy.

When it comes to diagnosing endometriosis, transvaginal ultrasound (TVS) is often the initial non-invasive choice for assessing patients suspected of having deep endometriosis.

There are three principaltypes of endometriotic lesions:

peritoneal or superficial endometriosis, ovarian endometriosis, and deep infiltrating endometriosis (DIE).

Transvaginal ultrasound demonstrates high diagnostic accuracy for endometriomas, deep lesions, and pelvic adhesions. However, it has limitations in detecting superficial implants.

Comparatively, magnetic resonance imaging (MRI) is also employed for diagnosing deep infiltrating endometriosis, with similar diagnostic performance to TVS in experienced hands, especially for detecting ovarian endometriomas, adenomyosis, and DIE involving the rectosigmoid.

In recent developments, there is emerging research on the use of salivary mRNA in the detection of endometriosis, showcasing a potential non-invasive method that could complement existing diagnostic approaches.

Treatment Options

Treatment for endometriosis aims to alleviate symptoms, manage pain, and improve quality of life. Options include pain medications, hormone therapy, and surgery. Personalized treatment plans, considering the severity of symptoms and the desire for fertility, are essential for effective management.

In conclusion, understanding endometriosis requires a holistic approach that considers its definition, potential causes, diagnostic challenges, systemic nature, symptoms, impact on fertility, and available treatment options. By increasing awareness and fostering open conversations, we can empower women to seek timely and appropriate care for this often-misunderstood condition.

Dr Alphy S Puthiyidom
Appointments 800-1999