What is endometriosis?
Endometriosis is an inflammatory condition marked by the presence of endometrial-like tissue lesions outside the uterus.
These lesions are more often found in the peritoneum lining of the pelvic cavity, outside the uterus, fallopian tubes, ovaries, pouch of Douglas, and uterosacral ligaments. However, they can also be found in the bowel, the tip of the appendix, the bladder, the ureter, and the diaphragm.
(John Hopkins Medicine, 2024)
Similar to the endometrium lining the uterine cavity, the lesions outside the uterus respond to ovarian hormones and bleed cyclically. However, unlike the endometrium, these lesions do not shed, leading to chronic inflammation and scarring. This can cause symptoms such as dysmenorrhea (painful periods), pelvic pain, heavy menstrual bleeding, dyspareunia (difficult or painful sexual penetration), fatigue, and infertility. Many women may be asymptomatic and are often diagnosed with endometriosis incidentally during treatment for another condition.
How does endometriosis develop?
The development of endometriosis is still debated, because, let’s be honest, there hasn’t been any interest or funding directed to supporting women’s health in the past. It was only brought to the attention of the Australian parliament due to Scott Morrison’s wife having the disease.
Hence there are still several theories as to how endometriosis develops these being:
Retrograde Menstruation: During menstruation, some of the menstrual fluid, which contains endometrial cells, can flow backwards through the fallopian tubes into the pelvic area instead of leaving the body.
Metaplasia: This is when normal tissue in the pelvic area changes into tissue similar to the lining of the uterus.
Hormones: Endometrial lesions grow because of estrogen, and they do not respond well to the controlling effects of progesterone, leading to their continued growth.
Oxidative Stress and Inflammation: Chronic inflammation in the pelvic area and the uterus can cause changes in the immune system, which encourages the growth of endometrial tissue outside the uterus.
Immune Dysfunction: The immune system fails to clear away menstrual debris, allowing endometrial tissue to implant and grow outside the uterus.
Apoptosis Suppression: Endometrial cells survive longer than they should because the body's usual process of eliminating old cells (apoptosis) is reduced.
Genetic Factors: Some people inherit genetic changes that make it easier for endometrial cells to implant and grow outside the uterus.
Embryonic Remnants: Cells left over from early development can turn into endometrial tissue when exposed to estrogen, starting at puberty or when exposed to similar substances.
Stem Cells: Stem cells that are shed backward during menstruation can turn into endometrial tissue and regenerate in the pelvic area.
As you can see, there's still a lot of mystery surrounding exactly how endometriosis starts.
Stages of endometriosis
Endometriosis is graded during laparoscopy to help gynaecologists describe the pathology and severity of the disease and guide treatment options. Studies have shown that there is no link between the stage of the disease and the severity of symptoms, such as pain or fertility issues.
Stage I (minimal): There are small patches (1-5 points) of endometrial-like tissue that are superficial lesions.
Stage II (mild): shows more significant growth but is still limited in number and size (6-15 points). There are superficial lesions and some deeper lesions (Tissue has grown more than 5 millimetres deep beneath the lining of the abdomen - peritoneal surface)
Stage III (moderate): more significant growth (16-40 points) including endometriomas and minor adhesions involving larger lesions and deeper tissue penetration.
Stage IV (severe): is characterized by extensive growth (>40 points), large cysts, significant adhesions and severe damage to the pouch of Dougals.
(Brisbane Centre for Endometriosis, 2024)
If you're concerned about your menstrual symptoms and think you might have endometriosis, consider using the RANZCOG tool below to help assess your condition. For further support, Collective Care with Jo offers counselling and medical advocacy to assist you through the process.
References:
Brisbane Centre for Endometriosis, 2024, ‘Patient Information’, <https://brisbanecentreforendometriosis.com.au/patient-information/>
Culley L, Law C, Hudson N, Denny E, Mitchell H, Baumgarten M, et al. The social and psychological impact of endometriosis on women's lives: A critical narrative review. Human reproduction update [Electronic]. 2013 Nov-Dec;19(6):625-39. DOI: 10.1093/humupd/dmt027
Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, et al. ESHRE guideline: management of women with endometriosis. Human Reproduction [Electronic]. 2014 Mar;29(3):400-12. DOI: 10.1093/humrep/det457
Johns Hopkins Medicine, 2024, ‘Endometriosis’, <https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis>
Johnson NP, Hummelshoj L, et al., for the World Endometriosis Society. Consensus on current management of endometriosis. Human Reproduction [Electronic]. 2013 Jun;28(6):1552-68. DOI: 10.1093/humrep/det050
Royal Australian and New Zealand College of Obstetricians and Gynaecologists, 2024, ‘Endometriosis eLearning Module’.
Zondervan K, Becker CM, Koga K, Missmer SA, Taylor RN, Viganò P, et al. Endometriosis. Nature Reviews; Disease Primers. 2018 July 19;4(1):9.
If you have a specific question you would like answered please email it to jo@collectivecare.net.au