What is Endometriosis? Know why is it very common yet most often undiagnosed
Endometriosis is not restricted to the pelvis; it can also damage distant organs such as the liver and lungs. The underlying cause of this illness is increased amounts of a hormone called oestrogen. Know more about it
FollowEndometriosis is a widespread gynaecological problem, ranking as the second most common after fibroids. However, its true incidence is often underestimated, with only around 10% of cases officially diagnosed due to frequent misdiagnosis or no diagnosis. Often, it remains undetected until it manifests as subfertility, leading to a significant portion of affected individuals experiencing fertility challenges.
What is Endometriosis?
Endometriosis is the growth of endometrial tissue outside the uterus (womb). It tends to run in families, with a strong positive family history often observed among affected individuals. Normally, this tissue lines the inner walls of the uterus, where it undergoes periodic shedding during menstruation and gets cleared every month.
However, in patients with endometriosis, this tissue finds its way outside the womb through the fallopian tubes and spills out into the pelvic cavity which is the most common area. It can spread to other areas outside the womb such as the ovaries, bladder, or bowel where it gets trapped, leading to scar formation and local tissue damage over time. This is when the debilitating symptoms manifest such as chronic pelvic pain, dysmenorrhea (period pain), dyspareunia (painful sexual intercourse), and gastrointestinal disturbances.
Endometriosis is not limited to the pelvic region; it can affect distant sites like the liver and lungs. The root cause of this condition lies in the elevated hormone levels called estrogen.
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Why is it Difficult to Diagnose Endometriosis?
Endometriosis is commonly misdiagnosed because of its varied clinical presentation and lack of definitive diagnostic tests. An ultrasound cannot usually detect this condition unless a cyst has formed due to endometriosis. The gold standard for detecting endometriosis involves visualizing endometriotic lesions through laparoscopy.
MicroRNA-based noninvasive tools are making their way into the market, promising to revolutionize the diagnosis of endometriosis. Recently, it has been reported that microbiota may have a role in the development of endometriosis, highlighting the need to investigate the role of infections in the disease etiology. However, the reports on microRNA-based biomarkers and the link between microbial agents and endometriosis need to be validated before drawing any conclusions.
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The treatment for endometriosis mainly aims to suppress or control estrogen levels through medical intervention. These methods can offer only temporary relief to pain as surgical clearance via laparoscopy is the definitive cure where when these lesions can be visualized and removed. Pregnancy can also temporarily halt the progression of endometriosis due to no menstruation for 9 months, but the symptoms may return post-delivery.
To sum up…
Endometriosis presents a significant burden to affected individuals with pain and fertility issues. It requires a multifaceted approach to management, including both medical and surgical interventions, considering the overall health of these affected women.
(This article is authored by Dr. Manjushree Pai, Consultant - Obstetrics and Gynaecology, Manipal Hospital Jayanagar, Bengaluru.)
