Endometriosis: The enigma

Endometriosis is a complex gynaecological condition characterised by the abnormal growth of endometrial tissue outside the uterus. The uterus is a female reproductive organ with the main function of caring for the baby during pregnancy.

The uterus is made up of two layers: the nonregenerating muscular layer and a regenerating inner layer, the endometrium, which is shed as menstruation monthly in a non-pregnant woman.

The uterus opens into the abdomen through tinny tubes known as fallopian tubes of the uterus. During menstruation, menstrual blood contains the endometrium layer, which may travel into the abdomen through the fallopian tubes. How endometriosis develops continues to evade medical knowledge to this date, as only some women develop the disease. It is believed that once the endometrium is in the abdomen, it has the potential to grow outside the uterus. Once implanted, the endometrial tissue outside of the uterus responds to the woman’s hormones, causing menstrual pain every month.

Endometriosis causes internal organs such as the intestines and uterus to be attached. According to World Health Organisation (WHO) data, approximately 10% of reproductive-aged women (190 million) globally are diagnosed with this condition. The peak age of patients is in the timeframe between 25 and 45 years.

Endometriosis has a variable range of manifestations, from accidentally found asymptomatic lesions to severe conditions, which do not depend on the size of the lesion. The main symptoms caused by endometriosis are chronic lower abdominal pain, severely painful menstrual periods, painful sexual intercourse, pain during urination and/or painful defecation, abdominal bloating, and constipation.

The other manifestation of endometriosis is infertility without any other symptoms; 40% to 50% of infertile women are diagnosed with endometriosis. Endometriosis has a significant negative impact on the quality of life and social well-being of patients. Due to pain and other symptoms like fatigue, severe bleeding or mood swings, women have to skip their studies or work, and might tend to avoid sex.

It may also increase the risk of mental health issues, such as anxiety and depression. While there is no cure for endometriosis, the disease can be controlled using birth control, typically a pill, a patch or a vaginal ring, but sometimes a hormonal IUD. The only way to effectively diagnose endometriosis is through laparoscopy, a surgery which involves a small incision in the abdomen. During the procedure, doctors may also remove or cauterise endometrial implants.

Emerging research is investigating what causes endometriosi,s and why some people may be more susceptible than others. One of the significant challenges faced by people with endometriosis is receiving a diagnosis. It is estimated that patients experience an average delay of five years from the onset of symptoms to diagnosis. Therefore, women suspected of having endometriosis must seek an assessment by a gynaecologist.