Endometriosis
In this condition, tissue normally found only in the uterus starts to
grow outside the uterus — in the ovaries, fallopian tubes, or other
parts of the pelvic cavity. It can cause abnormal bleeding,
dysmenorrhea, general pelvic pain, and lower back pain.
Endometriosis is a gynecological medical condition in which cells from the lining of the uterus (endometrium) appear and flourish outside the uterine cavity,
most commonly on the peritoneum which lines the abdominal cavity. The
uterine cavity is lined with endometrial cells, which are under the
influence of female hormones.
Endometrial-like cells in areas outside the uterus (endometriosis) are
influenced by hormonal changes and respond in a way that is similar to
the cells found inside the uterus. Symptoms often worsen with the menstrual cycle.
Endometriosis is typically seen during the reproductive years; it has
been estimated that endometriosis occurs in roughly 6–10% of women. Symptoms may depend on the site of active endometriosis. Its main but not universal symptom is pelvic pain in various manifestations. Endometriosis is a common finding in women with infertility.
Signs and symptoms
Pelvic pain
A major symptom of endometriosis is recurring pelvic pain.
The pain can range from mild to severe cramping that occurs on both
sides of the pelvis, in the lower back and rectal area, and even down
the legs. The amount of pain a woman feels correlates poorly with the
extent or stage (1 through 4) of endometriosis, with some women having
little or no pain despite having extensive endometriosis or
endometriosis with scarring, while other women may have severe pain even
though they have only a few small areas of endometriosis
Symptoms of endometriosis-related pain may include:
- dysmenorrhea – painful, sometimes disabling cramps during menses; pain may get worse over time (progressive pain), also lower back pains linked to the pelvis
- chronic pelvic pain – typically accompanied by lower back pain or abdominal pain
- dyspareunia – painful sex
- dysuria – urinary urgency, frequency, and sometimes painful voiding
Throbbing, gnawing, and dragging pain to the legs are reported more commonly by women with endometriosis.
Compared with women with superficial endometriosis, those with deep
disease appear to be more likely to report shooting rectal pain and a
sense of their insides being pulled down.
Individual pain areas and pain intensity appears to be unrelated to the
surgical diagnosis, and the area of pain unrelated to area of
endometriosis.
Endometriosis lesions react to hormonal stimulation and may "bleed"
at the time of menstruation. The blood accumulates locally, causes
swelling, and triggers inflammatory responses with the activation of cytokines. This process may cause pain. Pain can also occur from adhesions
(internal scar tissue) binding internal organs to each other, causing
organ dislocation. Fallopian tubes, ovaries, the uterus, the bowels, and
the bladder can be bound together in ways that are painful on a daily
basis, not just during menstrual periods.
Also, endometriotic lesions can develop their own nerve supply,
thereby creating a direct and two-way interaction between lesions and
the central nervous system,
potentially producing a variety of individual differences in pain that
can, in some women, become independent of the disease itself.