All about endometriosis

Women have periods. Periods oftentimes cause cramps, and cramps oftentimes hurt. A lot.

While pre and during-period cramps should never keep us from living our daily lives, there is oftentimes a discrete issue behind the discomfort that can be addressed with lifestyle changes and perhaps medication, or even surgery for cases being caused by cysts or fibroids.

However, some cases of chronic pelvic pain are not as easily diagnosable. One of the not-easily-diagnosable catalysts behind debilitating cramping - as well as “mystery” chronic pain in other parts of your body ranging from your GI tract to your lungs - is a condition called endometriosis.

What is endometriosis?

If you’re new to the world of reproductive and hormonal health, endometriosis may be a new term. This often-painful condition is defined by when endometrial cells (which normally line the inside of our uterus) grow outside the uterus (1).

Now, we all know that our bodies are smart. They produce different types of cells for different functions (e.g., thank goodness our tongue cells do not grow on our feet - think about how confusing and gross that would be!) but sometimes, they get confused. Endometriosis is one of these cases.

The interesting thing about our endometrial cells is that they are designed to shed each month if the egg that our body releases during ovulation is not implanted with a sperm (read: if we’re not pregnant). This process is what causes our period: the bleeding that we experience at the end of our cycles each month is quite literally our uterus shedding its lining. Gross? Nah, we think it’s pretty neat.

But! If you have endometriosis (“endo”), your endometrial cells are extra exploratory (and yes, a tad confused) and have decided to grow outside of your uterus. Most often, it’s in the areas surrounding our uterus such as around our ovaries and fallopian tubes. But in many cases this can extend to our intestinal tract, stomach, lungs, and more - unfortunately, for the most severe cases of endometriosis, there really seems to be no limit.

But, these misplaced endometrial cells still want to shed each month that our body tells them it’s not pregnant.

While the cells that are properly located in our uterus have an easy exit out of their home through our cervix and vagina, the confused endometrial cells lining and surrounding our other organs don’t have a clear path out. In fact, they have no path out at all: and so they build up, month after month, and subsequently result in a varying amount of pain.

But endo does not cause just intense cramps. Other symptoms include painful urination and bowel movements, painful sex, heavy bleeding during periods, infertility, gastrointestinal issues, and more.

Who has endometriosis?

The answer: a whole lot of us.

Like PCOS, this condition impacts 1 in 10 women of reproductive age. That is nearly 200M women worldwide, and while some women may have mild cases with subsequently minor symptoms, it can be a debilitating disorder to live with in more sever instances.

Endometriosis is often lumped in with hormonal imbalances, but did you know it’s actually not a hormonal health condition at its core? We like to call it an inflammatory reproductive health disorder.

While we’ve shared that the exact cause of endo is still unknown, there’s a variety of factors that have been identified as risk factors and triggers, such as genetics (it’s commonly seen in families), poor diet, exposure to endocrine disruptors, poor liver function, and more.

That said, making sure that your hormones are balanced is key to managing the pain and symptoms that come along with this disorder. It thrives on estrogen - estrogen dominance relative to progesterone, to be exact - and some research has started to indicate that having an abnormally high estrogen:progesterone ratio may be one of the (many potential) root causes of endo.

And, there is a high correlation between endometriosis and more “textbook” hormonal imbalances like PCOS (2). That means that many women struggling with endometriosis may also be trying to manage other hormonal imbalance symptoms.

Also, similar to conditions like PCOS, there is preliminary evidence suggesting that endo and autoimmune issues may be linked (3).

How is it diagnosed?

One of the most frustrating aspects about endo is average time to diagnosis: it takes most women 6-10 years from symptom onset to diagnosis, with a median duration of 8 years (4).

Let that sink in for a moment.

The reason for this drawn-out process? Most physicians test for endometriosis as a last resort, as many cases can only be identified through an invasive laparoscopic procedure. While there are other tactics such as pelvic exams, external and transvaginal ultrasounds, and MRIs, identifying misplaced endometrial cells at earlier stages (e.g., before they have formed a large enough mass that would show as an abnormality on an ultrasounds, for example) is tricky.

Hence the invasive laparoscopy. This procedure is costly for medical providers and an intense procedure for patients to undergo with its risks of internal bleeding, hernias, and infections, and for this reason much time is wasted on alternative explanations and other testing methods.

Luckily, pioneers like DotLab are working hard to revolutionize the way we test for endometriosis. DotLab’s current product in testing, DotEndo, is a non-invasive way that applies advanced biostatistics to blood and saliva biomarkers to diagnosis endometriosis in a safe, accurate, and rapid way.

Conclusion

While there is currently no cure for endometriosis, there are certainly ways to minimize symptoms through lifestyle changes and medication.

• Lifestyle: For some, sticking to an anti-inflammatory diet, minimizing stress, and using natural pain relief is enough to keep symptoms manageable.
• Hormonal therapy: Hormonal birth control can also be a helpful way to decrease pain, since the pill keeps our body from ovulating and we therefore do not build up new endometrial cells each month.
• Surgery: Although more invasive than other tactics, surgery always remains an option. There are two main types of surgery for endometriosis: conservative surgery, which removes as much of the endometrial tissue as possible while preserving your reproductive organs, and a hysterectomy, where a surgeon will remove your uterus and possible your cervix and ovaries.

If you have endometriosis or suspect you do, one of the most important things you can do is find a support team that you trust and enjoy working with. Strategies that work for one person may not work for another, and patience is key when it comes to testing symptom management tactics for endo. While you may not be able to cure your endometriosis with a provider, finding someone who listens and advocates for you can make a world of difference.

Sources:

1. Mayo Clinic
2. Holoch, Kristin & Savaris, Ricardo & Forstein, David & Miller, Paul & Iii, H. & Likes, Creighton & Lessey, Bruce. (2014). Coexistence of polycystic ovary syndrome and endometriosis in women with infertility. Journal of Endometriosis and Pelvic Pain Disorders. 6. 78-83. 10.5301/je.500181.
3. Human Reproduction Update, Volume 25, Issue 4, July-August 2019, Pages 486–503, https://doi.org/10.1093/humupd/dmz014
4. Obstet Gynaecol. 2020. Jan;40(1):83-89. doi: 10.1080/01443615.2019.1603217. Epub 2019 Jul 22.

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