Endometriosis is a disease of the uterus (womb). It is mistakenly thought to be uncommon but it has an incidence of 10-15 per cent of women worldwide.
Endometriosis is an oestrogen-dependent disease and, thus, usually affects women of reproductive age, although it has been reported in pre-menarchial (before the commencement of menstrual cycle) girls.
This condition has very debilitating effects in affected women, ranging from abnormal menstrual flow - which could either be excessive blood flow, lengthened period or frequent period - to excruciating pain during menstruation or chronic pelvic pain, loss of productive days, psychological affectations, infertility and an overall poor quality of life. With these, we can say that endometriosis is a disease of very great importance, such that the public should be aware of it as well as the ways to treat it.
The saying now is that once a woman is in her late 30s and has no child, one must rule out endometriosis if she has infertility problem.
Endometriosis is the presence of tissues of the endometrium - the inner lining of the womb - at other sites. Commonest of these sights are: the ovaries, surrounding pelvic region, the large intestine (rectum, precisely), the bladder and the distal ureters. This displaced endometrial tissue continues to act as it normally would: it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit the body, it becomes trapped. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions (abnormal tissue that binds organs together).
According to Wikipedia, the exact cause of endometriosis remains unknown. Many theories have been presented to better understand and explain its development. These concepts do not necessarily exclude each other. The Mayo Clinic explains that the pathophysiology of endometriosis is likely to be multifactorial and to involve interplay between several factors which include:
- Retrograde menstruation: This is the most likely explanation for endometriosis. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
- Metaplasia/embryonic cell growth: Metaplasia, or the changing from one normal type of tissue to another normal type of tissue, is another theory .The cells lining the abdominal and pelvic cavities come from embryonic cells. When one or more small areas of the abdominal lining turn into endometrial tissue, endometriosis can develop.
- Surgical scar implantation: After any obstetric or gynaecologic surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
- Endometrial cells transport: The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
- Immune system disorder: It's possible that a problem with the immune system may make the body unable to recognise and destroy endometrial tissue that's growing outside the uterus.
Several factors place you at greater risk of developing endometriosisand they include:
- Never giving birth
- Genetics - One or more relatives (mother, aunt or sister) with endometriosis
- Any medical condition that prevents the normal passage of menstrual flow out of the body.
- History of pelvic infection
- Uterine abnormalities
- Diet is linked to endometriosis. One study found that there was a 40 per cent decreased risk of endometriosis in women with higher consumption of green vegetables and fresh fruit and an 80 percent increased risk in women who ate high amounts of beef and other red meats.
- Environmental exposure:
Many chemicals have hormone-disrupting properties, including bisphenol A found in canned foods and plastic bottles; organochlorines found in food and water; phthalates found in plastic food storage containers and cling wrap; pesticides and polycyclic aromatic hydrocarbons found in food; solvents found in paint, and chemicals found in some household cleaning products.
Even heavy metals such as cadmium and mercury are shown to have endocrine-disrupting properties.
The role of hormones in the pathogenesis of endometriosis is clear, and new evidence has directly linked hormone-disrupting chemicals to endometriosis. Organochlorine compounds such as dioxin and polychlorinated biphenols (PCBs) contaminate our food and water, and women are exposed to low doses on a daily basis.
Deep endometriotic nodules are associated with high blood levels of dioxin and PCBs. Phthalates are used in the plastic industry and are in everything - from plastic water bottles to plastic food storage containers.
A recent study showed that 55 per cent of women with endometriosis had elevated blood levels of phthalates, compared with controls.