Endometriosis : an oracular disease that everyone should know

Have you ever thought you can have same cells as uterus anywhere in your body? Of course not but to your surprise it can happen. It is a medical condition termed as endometriosis.

Endometriosisis,a disorder found exclusively in females, as men aren’t gifted with uterus and can’t bring a new life on earth. Imagine if they could.

In endometriosis, similar tissues that form uterus lining are found outside the uterine cavity. This phenomenon is absolutely abnormal and needs medical attention.

The lining of uterus is known as endometrium. The endometrial tissue consists of cells, blood, glands and connective tissue. This layer prepares your uterus to develop the environment suitable for pregnancy. On contrary, it sheds off during menstruation. 

In endometriosis these tissues may develop in organs like ovaries, uterine tubes and pelvic lining. Sometimes they may develop beyond pelvic organ which is very rare but not impossible. The tissue growing outside the uterus is known as endometrial implant. 

These implants are a kind of mislaid tissues which are affected by hormones during menstrual cycle. During menstruation they grow thick and ultimately break down. This broken tissue has no way out and is thus trapped in pelvis.

Causes of Endometriosis

The exact cause of endometriosis is not known yet, though some theories are considered in spite of not being scientifically proven. These are- 

• Retrograde menstruation :During normal menses,accompanying blood, body sheds off endometrium from an opening present in cervix and expels it out through vagina. This is normal.

In retrograde menstruation, blood containing endometrial cells revert back into pelvic organs instead of moving out of the body. This leads in development of endometrial fragments in other sites than uterus. 

Amazed? Right? Well there is a lot more disease that will leave you awestruck.

• Direct implantation: This theory suggests that the development of endometrium in suspected individuals happens when implantation occurs at new sites like ovaries, tubes, pelvis.
• Coelomic metaplasia : Metaplasia is the term for the change from one normal type of tissue to another type of tissue. And endometrium is derivative of coelomic wall epithelium.

In coelomic metaplasia, coelomic epithelium transforms into endometrial type of tissue. This transformation may occur spontaneously. Chronic inflammation is one of its cause.

• Lymphatic theory: This theory suggests that endometrial cells are transported outside the uterus via lymphatic system.
• Mullerian theory : According to this, during fetal period the misplaced tissues may develop and start responding to the hormones of puberty. 

Yes, yes you’re thinking right all this process can start with your birth.

• Genetic and immunological factors : Genetic basis probably accounts for less than 10% of patient. The coincidence increases in 1^st degree relatives.

Defect in local cellular immunity, can sometimes be the possible cause for misplaced growth in susceptible woman.

• Environment theory: It is linked to the changes during mutation and the harmful effect of the polluted environment.

Signs and Symptoms 

• Have you ever experienced unbearable cramp while menstruating and let it go thinking its normal? Then look into it. Severe menstruations cramp (dysmenorrhea) can be a sign 
• Also, always heavy menstrual bleeding(menorrhagia) is not normal. 
• Pain during intercourse(dyspareunia)
• Spotting or bleeding between period(metrorrhagia) can be a sign too.
• Other symptoms may include long term pelvic and back pain, blood in urine or stool, nausea and vomiting, problems like diarrhoea, constipation and fatigue.

Medical conditions including PID ( Pelvic inflammatory diseases), ovarian cysts and IBS (Irritable bowel syndrome) may often be confused with endometriosis.

Endometriosis Stages

Endometriosis depending upon factors such as depth, areas affecting body can be grouped into following 4 stages- 

1. Stage 1 (Minimal) : There are a few wounds or lesions(implants) that can be found on organ like pelvis or abdomen. They may present inflammation in or around pelvic cavity.
2. Stage 2(Mild): The implants are more than in stage 1 in number. They are present deep inside the tissue.
3. Stage 3 (Moderate): These include many deep implants having small cysts in either one or both ovaries. They represent adhesions that are thick bands of scar tissues.
4. Stage 4 (Severe): In this, number of deep implants is more, both ovaries can have cyst. This is the most severe and widespread.

Types of Endometriosis 

These are on the basis of area that they effect and these are also of 4 types namely-

1. Endometiomas : Cysts are dark, filled with fluid,vary in size also known as chocolate cysts.

Areas affected – most commonly ovaries.

2. Superficial peritoneal endometriosis : It is most common. 

Areas affected –  peritoneum ( thin membrane that lines abdomen and pelvis)

3. Abdominal wall endometriosis : In some cases, endometrial tissuescan grow in abdominal wall.

Areas affected –  abdominal wall,surgical incision.

4. Deep infiltrating endometriosis (DIC) : This one is rare. Only happens to 1-5℅ people with endometriosis.

Alarming sign 

Pain is the most common indication of endometriosis but the stage of disease can’t be diagnosed on the basis of severity of pain. One may experience light or no pain and have severe form of disease. At the same time you may experience excruciating pain with less severe form of disease.

Complications of Endometriosis

• If you are suffering with endometriosis you may face problem in getting pregnant. That is a serious issue. However, women with milder forms may conceive and give birth. 
• Ovarian cysts
• Increased risk of cancer (ovarian or endometriosis associated adenocarcinoma)
• Intestinal and bowel complications.

When to seek a doctor? 

One should keep in mind that endometriosis can affect patients as young as 18. You should seek doctor if you have any sign or symptoms that may indicate endometriosis.

It is a challenging condition. Its early diagnosis may results in better management of symptoms.

Treatment 

Endometriosis is a serious condition that can disrupt your life. Thus, needs to be treated soon . Although it can’t be fully cured, but can be managed depending upon symptoms. One can be relieved by – 

• Pain medication –Non steroidal, anti inflammatory drugs such as ibuprofen can be used to counter pain.
• Hormonal therapy –As hormones affect the growth of misplaced implants, hormonal medication may slow endometrial tissue growth preventing them to form new implants.
• Danazol– It reduces symptoms by stopping menstruation and suppresses the growth of endometrial implants causing then to degenerate but at the same time it has side effects that include hirsutism and acne. So should be taken under prescription. 
• Conservative surgery– It is for those woman that want to experience pregnancy, have severe pain and in which hormonal therapy isn’t working. It goals on destroying misplaced endometrium without damaging reproductive organs.

In this laser technique – laparoscopy is used to remove growth surgically. Sometimes misplaced growths are burnt or vaporised.

• Last resort surgery (Hysterectomy) – If condition and symptoms are not relieved by any methods, then doctor may recommend total hysterectomy.

In this surgery uterus, ovaries and cervix are removed. Ovaries are removed because their secretion provide environment for growth of endometrial tissue.

Ayurvedic view of Endometriosis 

Endometriosis is not directly mentioned in Ayurveda, but depending upon sign and symptoms, site of it’s manifestations and many more things it can be relieved through ayurveda.  

Are you thinking how is this possible if it is not even named? To your answer let me tell you it is mentioned in Ayurveda text that even if a physician is unable to name a particular disease then a full knowledge of the therapeutic properties of doshas, site of it’s manifestation, etiological factors would never fail his attempt to cure a disease ( ref: Charak samhita – SU18/44)

In Ayurveda, endometriosis can be considered a tridoshaj vhayadhi which is a disease involving all three doshas ( vata, pitaa, kapha). 

All the diseases and their treatment in Ayurveda revolve around these 3 doshas. When these 3 doshas are stable then there would be no disease. 

Why vata is involved? 

Roughness,dislocation, attachment, divisions,pain is the characteristic feature of vata disease.

In endometrioses misplaced cells, their attachment to organs other than uterus and piercing pain proves vata involvement. Also retrograde menstruation suggest the improper working of Apaanvayu. ( Apan vayu is a type of vata which is responsible for excretion of body wastes, helps in discharge of semen and menstrual blood.)

Why pitta is involved?The inflammation, hormonal imbalances and excessive bleeding during menses indicate the involvement of pitta.

Why kapha is involved? Because the cells of misplaced endometrium are like tumor. And tumor can’t occur without kapha.