With March being endometriosis awareness month, and includes International Women's Day, it is important to discuss this well disregarded topic. While there has only been 16 cases of endometriosis in men, 10% of reproductive-age women - around 190 million - are affected [1,2]! Even though a considerable amount of people have this disease, it is often under diagnosed and neglected due to the belief that pain is part of premenstrual symptoms or “women are just exaggerating.” Why is endometriosis not a “normal cramp”?
Endometriosis is a disease where the endometrial tissue (which lines the uterus) is present outside the uterus [1]. It would commonly develop in the ovaries, fallopian tubes, vagina, cervix or vulva (for more information about the women’s reproductive system, check out this post). However, it can also grow in the bowel, bladder or rectum, and, on rare occasions, it can be found in the lungs or the brain [3].
In the uterus, the endometrial tissue thickens and sheds with each menstrual cycle (more information about this process here). However, with endometriosis, the tissue will not be able to exit the body [4]. This causes chronic inflammation, which can lead to the formation of scar tissue.
Although there are different theories on the cause of endometriosis, there is not enough research to pinpoint the exact source [3-5]. The most common theories are:
Rather than the tissue shedding in the vagina, the flow reverses towards the Fallopian tubes into other areas like the pelvis (retrograde menstruation).
Hereditary condition.
Estrogen appears to promote endometriosis. In fact, exposure to estrogen therapy is the main risk factor proposed for male endometriosis [2].
During surgery in the abdominal area (for example a C-section), endometrial tissue could be moved to nearby parts.
Endometrial cells could be transported to other parts of the body through blood or lymph vessels.
The immune system is not able to recognize and destroy the endometrial tissue growing outside the uterus.
There is very little correlation between the extent of the endometriosis lesions and the severity of the symptoms; some women might have large lesions and barely any symptoms, while some might few lesions but more severe symptoms [1, 4]. Because of the broad symptoms and their similarity with other conditions such as irritable bowel syndrome (IBS) or pelvic inflammatory disease (PID) , it can be difficult to get an early diagnosis [4,6]. The most common symptoms are [1,3-4]:
Pelvic pain, often associated with menstrual periods (dysmenorrhea).
Pain during sexual intercourse or bowel movements/urination.
Heavy menstrual periods or bleeding between periods.
Infertility.
Digestive problems including: diarrhea, constipation, bloating, or nausea.
Fatigue.
Depression or anxiety.
There are different treatments depending on the patient and their symptoms, lesions, and desired outcome [1]. In some cases, painkillers or hormonal contraceptives might be enough to manage this disease, while in extreme cases, surgery might be needed. Therefore, if you suspects you may have endometriosis, it is important to consult your healthcare provider about all the available options in order to make an informed decision for your specific situation and get treatment as soon as possible.
In many cases, pelvic pain is normalized and stigmatized, as many are not aware of how distressing it can be. Even though there is more research and awareness about endometriosis nowadays, we have to keep spreading the word! There is still a lot to be done in terms of ensuring early detection and improving the management of this disease.
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Written by: María
Edited by: Natasha
BioDecoded is a volunteer group committed to sharing accurate scientific information. We cannot offer any specific health advice. If you have any doubts about your personal health, please speak with your healthcare professional or family physician. Your doctor can revise your medical history and advise you on the best path to follow. If you have any questions about this topic or would like to learn more, please comment below or send us your questions.
References:
Endometriosis (2021). World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/endometriosis (Accessed: 9 March 2023).
Rei, C., et al. (2018) "Endometriosis in a Man as a Rare Source of Abdominal Pain: A Case Report and Review of the Literature", Case Reports in Obstetrics and Gynecology, pp. 1-6. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5833878/
Endometriosis (2023). Office on Women's Health. Available at: https://www.womenshealth.gov/a-z-topics/endometriosis (Accessed: 9 March 2023).
Endometriosis - Symptoms and causes (2023). Available at: https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656# (Accessed: 9 March 2023).
Acién, P. and Velasco, I. (2013) "Endometriosis: A Disease That Remains Enigmatic", ISRN Obstetrics and Gynecology, pp. 1-12. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3730176/
Agarwal SK, et al. (2019). “Clinical diagnosis of endometriosis: a call to action”. American Journal of Obstetric and Ginecology 220 (4): 354.e1-354.e12. Available at: https://pubmed.ncbi.nlm.nih.gov/30625295/
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