When every period  cramp hurts, you need to consider a condition called endometriosis.

When the cells of the uterus start growing in other normal tissues outside the uterus, it is known as endometriosis. This condition can lead to severe pain, especially during periods. Apart from being painful, it can interfere with pregnancy, by blocking fallopian tubes or damaging the eggs. Adequate and effective treatment can help relieve endometriosis symptoms and prevent complications.

What is endometriosis?

Endometriosis means the tissue of inner lining of uterus is growing outside the  uterus. As the inner lining of uterus is called endometrium, this condition is known as endometriosis.

This endometrium can grow anywhere, on the ovaries, walls of pelvis or even on the large bowel. During the monthly menstrual cycle, each menstrual phase affects this endometrial tissue along with the normal endometrial tissue in the uterus. This leads to inflammation and pain. This tissue behaves just like the normal uterus endometrium; that means it grows, becomes thick and breaks down causing bleeding.

What causes endometriosis in a menstruating woman?

The exact reason of endometriosis is not known but there are many theories about the cause of endometriosis.

Possible endometriosis causes include:

• Retrograde menstruation – This is the reverse flow of blood into the fallopian tubes, during menstruation.
• Displacement – The endometrial cells may be displaced into the pelvic flood, urinary bladder, rectum or even ovaries during embryonic development and after menarche, they start responding to hormones.
• Hormonal transformation – This theory suggests that certain cells outside the uterus get transformed into endometrium due to hormones and cause endometriosis.
• Previous surgery or scar – Menstrual blood may leak into the pelvis during periods through a scar of previous surgeries like Caesarean section.

What are endometriosis symptoms and signs?

The main symptom of endometriosis is pain in pelvic region, usually along with the monthly period. Although some pain is felt with regular menses too, the endometriosis pain is much severe and worse.

Other endometriosis symptoms include:

• Severe dysmenorrhea – severe pain and cramps in pelvic area before and during your periods
• Pain during sexual intercourse
• Profuse or heavy menstrual bleeding
• Bleeding in between periods
• Painful urination or bowel evacuations
• Infertility

Severity of symptoms and disease is based on its stages.

Endometriosis Stages

• Minimal – There are small lesions in your ovary or around pelvic cavity.
• Mild – These are small lesions and shallow implants around pelvis and ovary.
• Moderate – These are deep implants in the pelvic lining and ovary.
• Severe – These are deep lesions in the ovary, pelvis and may involve the bowel and fallopian tubes too.

Sometimes symptoms of endometriosis may mimic other conditions like an ovarian cyst or polycystic ovary syndrome, endometrial cyst, fibroid tumor and pelvic inflammatory disease.

How is endometriosis diagnosed?

Endometriosis symptoms may mimic other gynaecological conditions, thus a careful history and pelvic examination is essential for endometriosis diagnosis.

Apart from a direct pelvic examination, an ultrasound through the vagina (transvaginal ultrasound) can help in identifying endometriosis. But a confirmed diagnosis of endometriosis is possible only through a laparoscopy, in which a scope is inserted inside the pelvic area and tissues are viewed directly using that camera attached to the scope. Small amount of tissue is picked up and endometrial biopsy is performed, which is the confirmatory test.

How can I get rid of endometriosis?

Endometriosis treatment includes oral medicines or surgery. The decision of treatment depends on the severity of symptoms and family planning.

Oral medications include:

• Pain killers – To ease the pain and colic of menstruation
• Hormone medications– Hormones play a vital role in menstruation. So hormonal preparations to normalize the tissue growth and prevent new implants can help in relieving pain as well as excessive blood loss.

Surgical options are purely dependent on whether you are trying to become pregnant. If you wish for a pregnancy in the future, then surgery purely focuses on removing the endometriosis implants and the reproductive organs are all preserved. This conservative surgery helps in reducing the pain. In case you have completed your family or have no desire to be pregnant in the future, or if you have severe endometriosis, hysterectomy (removal of uterus with or without ovaries) can be performed.

Endometriosis natural treatment that can help includes lifestyle changes i.e. regular exercising helps in improving symptoms, warm bath or heat bags can relax pelvic muscles and reduces cramps and pains while some of the over-the-counter pain-relievers can help you to cope with pain.

Talk to your gynaecologist about what is the best strategy to deal with your situation based on your lifestyle and preferences.

Also read: The Ultimate Guide on PolyCystic Ovarian Syndrome (PCOS): Part 1

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