What is endometriosis?
The endometrium is the type of tissue that lines the inside of the uterus. In endometriosis, tissue similar to the endometrium grows outside the uterus. Endometriosis can be a painful condition, especially during menstruation, and endometriosis can impair fertility. Research into the patient experience of this condition has suggested that we redefine endometriosis as a syndrome that includes both these ectopic uterine tissue deposits and the symptoms they cause, since some people with ectopic endometrial tissue don’t experience any symptoms.[1]
What are the main signs and symptoms of endometriosis?
The main symptoms are pain and infertility.[2][1] Some of the common symptoms that people with endometriosis may experience are: Painful periods (dysmenorrhea); pain during or after sex (dyspareunia); pain while urinating (dysuria) or defecating (dyschezia); unusually heavy periods or bleeding between periods; infertility; and fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods. It’s possible for people with endometriosis to experience all, some, or none of these symptoms. Some people with endometriosis may experience atypical symptoms, like back pain, chest pain, leg pain, rectal bleeding, or acid reflux, and this could be related to inflammation or to the location of the lesions.[3]
How is endometriosis diagnosed?
Endometriosis has a wide symptom range, and needs to be diagnosed by a doctor; the gold standard for diagnosis is laparoscopy (minimally invasive surgery), although nonsurgical diagnostic tools are being investigated. In terms of imaging, MRI is showing the most positive results, although more studies are needed before it can replace surgical diagnosis. Transvaginal ultrasound may also be useful for endometriosis involving the rectum and sigmoid colon.[4] Blood markers could also be used for diagnosis in the future, although the appropriate marker hasn’t yet been found. Anti-endometrial autoantibodies, interleukin 6 (IL-6), and cancer antigen 125 (CA 125) have been considered, but are not accurate enough to replace the current diagnostic standard.[5]
What are some of the main medical treatments for endometriosis?
Endometriosis is a chronic condition requiring long-term treatment which focuses on symptom management. Symptoms can be managed medically through surgery to remove endometriotic tissues, and through long-term medication for hormonal management. Hormone treatment, in the form of tablets, skin patches or implants, may effectively reduce pain symptoms, but may not be appropriate in patients with infertility, or in women who are trying to become pregnant. Endometriosis-impaired fertility can be addressed by assisted reproduction techniques, such as in vitro fertilization (IVF).[6] Although surgery isn’t considered a cure (because endometriotic tissue may return after surgery), it can reduce painful symptoms in the short term, and hormonal treatment can delay the tissue’s regrowth.[7]
Have any supplements been studied for endometriosis?
Several vitamins and supplements have been studied, including vitamin D,[8] melatonin,[9] and vitamins E and C. Vitamin E, with or without vitamin C, seems to improve pain symptoms. Vitamin D also improves pain symptoms to a lesser extent. Both effects are small, but given their good safety profiles, these supplements are worth considering in conjunction with other medical interventions.[10] Melatonin has limited evidence to support its use, but it might improve pain symptoms, sleep quality, and mood symptoms in people with endometriosis.[11]
How could diet affect endometriosis?
Multiple studies have investigated the relationship between diet and endometriosis. There is weak evidence that a healthy diet, with reduced alcohol intake and increased physical activity, is associated with a lower risk of getting endometriosis.[12] A diet high in fruit, particularly citrus fruit, might lower the risk for endometriosis.[13]
Are there any other treatments for endometriosis?
Some people may find that some of their symptoms of endometriosis, such as painful menstruation, can be non-medically managed. Some people with endometriosis develop chronic pelvic pain, which may be manageable with pelvic physiotherapy and myofascial trigger point dry needling.[6]
What causes endometriosis?
The endometrium is the lining of the uterus. Endometriosis is caused by endometrium-like cells growing outside the uterus, usually accompanied by inflammation.[12] Researchers haven’t yet pinned down exactly why this happens.[14]
Examine Database: Endometriosis
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In this meta-analysis of randomized controlled trials, certain dietary supplements (e.g., vitamin D and melatonin) reduced dysmenorrhea and pelvic pain in women with endometriosis.
Frequently asked questions
The endometrium is the type of tissue that lines the inside of the uterus. In endometriosis, tissue similar to the endometrium grows outside the uterus. Endometriosis can be a painful condition, especially during menstruation, and endometriosis can impair fertility. Research into the patient experience of this condition has suggested that we redefine endometriosis as a syndrome that includes both these ectopic uterine tissue deposits and the symptoms they cause, since some people with ectopic endometrial tissue don’t experience any symptoms.[1]
Sort of, but endometriotic growths aren’t quite the same as the endometrial lining in the uterus. They’re not actually true endometrial tissue; they usually have differences that are visible under the microscope. Theories about development include “retrograde menstruation,” in which menses flow back up through the fallopian tubes and into the pelvic cavity; however, most women experience retrograde menstruation, and don’t experience endometriosis, and some people who have never menstruated have been diagnosed with endometriosis.[15][16][17] Other theories involve transformation of other cells into endometriotic cells.[18]
Endometriosis is most commonly found in the pelvic cavity, with some of the most common sites being the ovaries, fallopian tubes, and pelvic lining, but while it’s rarer outside the pelvic cavity, endometriosis can occur anywhere in the body. It’s extremely rare, but endometriosis can even occur in other organs like the kidneys, eyes, liver, pancreas, intestines, and brain.[19]
Recent research has noted an association between endometriosis and certain autoimmune disorders, such as systemic lupus, inflammatory bowel disease, rheumatoid arthritis, and celiac disease.[23] However, this association presents more questions than answers: It is difficult to establish which disease process started first, especially since endometriosis diagnoses are often delayed. Furthermore, we do not yet know whether the presence of endometriosis might lead to other autoimmune disorders (or vice versa), or whether these illnesses might share similar underlying causative pathophysiologies or genetic links.[24]
That said, there is some preliminary evidence that immunotherapy could be used to treat endometriosis in the future. The immune system and its components, including neutrophils, macrophages, T-cells, mast cells, and many more, seem to play a role in the development of endometriosis, which implies that some treatments usually used for autoimmune conditions, such as interferons or antitumor necrosis factor, could be used in endometriosis. While the current research is promising, a lot more work needs to be done before immunotherapy could become a regular part of the treatment for endometriosis.[16][24]
The main symptoms are pain and infertility.[2][1] Some of the common symptoms that people with endometriosis may experience are: Painful periods (dysmenorrhea); pain during or after sex (dyspareunia); pain while urinating (dysuria) or defecating (dyschezia); unusually heavy periods or bleeding between periods; infertility; and fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods. It’s possible for people with endometriosis to experience all, some, or none of these symptoms. Some people with endometriosis may experience atypical symptoms, like back pain, chest pain, leg pain, rectal bleeding, or acid reflux, and this could be related to inflammation or to the location of the lesions.[3]
Yes. There are three grading systems commonly in use. According to the American Society of Reproductive Medicine guidelines, an individual’s endometriosis can be classified as stages I–IV, as follows: Stage I is minimal, Stage II is mild, Stage III is moderate, Stage IV is severe.[20] Endometriosis can also be graded by the Endometriosis Fertility Index (EFI), which grades endometriosis according to its impact on fertility,[21] or the Enzian classification system, which is designed to describe both the location and severity of endometriosis.[22] The most commonly used system is the American Society of Reproductive Medicine’s, but deeply infiltrating endometriosis (DIE) is better described by the Enzian system, and the EFI is much more useful for predicting endometriosis’s impact on fertility.
Endometriosis has a wide symptom range, and needs to be diagnosed by a doctor; the gold standard for diagnosis is laparoscopy (minimally invasive surgery), although nonsurgical diagnostic tools are being investigated. In terms of imaging, MRI is showing the most positive results, although more studies are needed before it can replace surgical diagnosis. Transvaginal ultrasound may also be useful for endometriosis involving the rectum and sigmoid colon.[4] Blood markers could also be used for diagnosis in the future, although the appropriate marker hasn’t yet been found. Anti-endometrial autoantibodies, interleukin 6 (IL-6), and cancer antigen 125 (CA 125) have been considered, but are not accurate enough to replace the current diagnostic standard.[5]
No. Endometriosis growths aren’t cancer, and endometriosis is a benign condition. It is associated with an increased risk of ovarian cancer, but the majority of people with endometriosis won’t develop ovarian cancer.[6] Rarely, people who have had endometriosis can later develop endometriosis-associated adenocarcinoma.
The three grading systems of endometriotic severity chiefly reflect the extent of the endometriotic growths. However, the severity of the symptoms experienced by a person with endometriosis isn’t always correlated with this. People with extensive growths may experience few symptoms, and people with relatively less endometriotic tissue may experience severe pain.
Endometriosis is a chronic condition requiring long-term treatment which focuses on symptom management. Symptoms can be managed medically through surgery to remove endometriotic tissues, and through long-term medication for hormonal management. Hormone treatment, in the form of tablets, skin patches or implants, may effectively reduce pain symptoms, but may not be appropriate in patients with infertility, or in women who are trying to become pregnant. Endometriosis-impaired fertility can be addressed by assisted reproduction techniques, such as in vitro fertilization (IVF).[6] Although surgery isn’t considered a cure (because endometriotic tissue may return after surgery), it can reduce painful symptoms in the short term, and hormonal treatment can delay the tissue’s regrowth.[7]
Several vitamins and supplements have been studied, including vitamin D,[8] melatonin,[9] and vitamins E and C. Vitamin E, with or without vitamin C, seems to improve pain symptoms. Vitamin D also improves pain symptoms to a lesser extent. Both effects are small, but given their good safety profiles, these supplements are worth considering in conjunction with other medical interventions.[10] Melatonin has limited evidence to support its use, but it might improve pain symptoms, sleep quality, and mood symptoms in people with endometriosis.[11]
Multiple studies have investigated the relationship between diet and endometriosis. There is weak evidence that a healthy diet, with reduced alcohol intake and increased physical activity, is associated with a lower risk of getting endometriosis.[12] A diet high in fruit, particularly citrus fruit, might lower the risk for endometriosis.[13]
Some people may find that some of their symptoms of endometriosis, such as painful menstruation, can be non-medically managed. Some people with endometriosis develop chronic pelvic pain, which may be manageable with pelvic physiotherapy and myofascial trigger point dry needling.[6]
The endometrium is the lining of the uterus. Endometriosis is caused by endometrium-like cells growing outside the uterus, usually accompanied by inflammation.[12] Researchers haven’t yet pinned down exactly why this happens.[14]
Update History
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References
- ^Saunders PTK, Horne AWEndometriosis: Etiology, pathobiology, and therapeutic prospects.Cell.(2021-May-27)
- ^Alexandre Vallée, Yves LecarpentierCurcumin and EndometriosisInt J Mol Sci.(2020 Mar 31)
- ^James H. LiuEndometriosis(2022-09)
- ^Nisenblat V, Bossuyt PM, Farquhar C, Johnson N, Hull MLImaging modalities for the non-invasive diagnosis of endometriosis.Cochrane Database Syst Rev.(2016-Feb-26)
- ^Yeh MC, Shiue YS, Lin HH, Yu TY, Hu TC, Hong JJIron(II) Halide Promoted Cyclization of Cyclic 2-Enynamides: Stereoselective Synthesis of Halogenated Bicyclic γ-Lactams.Org Lett.(2016-May-20)
- ^Tommaso Falcone, Rebecca FlycktClinical Management of EndometriosisObstet Gynecol.(2018 Mar)
- ^FAQ 046: Dysmenorrhea: Painful PeriodsAmerican College of Obstetricians and Gynecologists.(2015)
- ^Pierluigi Giampaolino, Luigi Della Corte, Virginia Foreste, Giuseppe BifulcoIs there a Relationship Between Vitamin D and Endometriosis? An Overview of the LiteratureCurr Pharm Des.(2019)
- ^André Schwertner, Claudia C Conceição Dos Santos, Gislene Dalferth Costa, Alícia Deitos, Andressa de Souza, Izabel Cristina Custodio de Souza, Iraci L S Torres, João Sabino L da Cunha Filho, Wolnei CaumoEfficacy of melatonin in the treatment of endometriosis: a phase II, randomized, double-blind, placebo-controlled trialPain.(2013 Jun)
- ^Nalini Santanam, Nino Kavtaradze, Ana Murphy, Celia Dominguez, Sampath ParthasarathyAntioxidant supplementation reduces endometriosis-related pelvic pain in humansTransl Res.(2013 Mar)
- ^Söderman L, Böttiger Y, Edlund M, Järnbert-Pettersson H, Marions LAdjuvant use of melatonin for pain management in endometriosis-associated pelvic pain-A randomized double-blinded, placebo-controlled trial.PLoS One.(2023)
- ^members of the Endometriosis Guideline Core Group, Christian M Becker, Attila Bokor, Oskari Heikinheimo, Andrew Horne, Femke Jansen, Ludwig Kiesel, Kathleen King, Marina Kvaskoff, Annemiek Nap, Katrine Petersen, Ertan Saridogan, Carla Tomassetti, Nehalennia van Hanegem, Nicolas Vulliemoz, Nathalie Vermeulen, ESHRE Endometriosis Guideline GroupESHRE guideline: endometriosisHum Reprod Open.(2022 Feb 26)
- ^Harris HR, Eke AC, Chavarro JE, Missmer SAFruit and vegetable consumption and risk of endometriosis.Hum Reprod.(2018-Apr-01)
- ^Beata Smolarz, Krzysztof Szyłło, Hanna RomanowiczEndometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature)Int J Mol Sci.(2021 Sep 29)
- ^Bulletti C, Coccia ME, Battistoni S, Borini AEndometriosis and infertility.J Assist Reprod Genet.(2010-Aug)
- ^Li W, Lin A, Qi L, Lv X, Yan S, Xue J, Mu NImmunotherapy: A promising novel endometriosis therapy.Front Immunol.(2023)
- ^Who is Sampson, and what does he have to do with Endometriosis?
- ^Signorile PG, Viceconte R, Baldi ANew Insights in Pathogenesis of Endometriosis.Front Med (Lausanne).(2022)
- ^Kristjansdottir A, Rafnsson V, Geirsson RTComprehensive evaluation of the incidence and prevalence of surgically diagnosed pelvic endometriosis in a complete population.Acta Obstet Gynecol Scand.(2023-Oct)
- ^Revised American Society for Reproductive Medicine classification of endometriosis: 1996.Fertil Steril.(1997 May)
- ^Adamson GD, Pasta DJEndometriosis fertility index: the new, validated endometriosis staging system.Fertil Steril.(2010-Oct)
- ^Tuttlies F, Keckstein J, Ulrich U, Possover M, Schweppe KW, Wustlich M, Buchweitz O, Greb R, Kandolf O, Mangold R, Masetti W, Neis K, Rauter G, Reeka N, Richter O, Schindler AE, Sillem M, Terruhn V, Tinneberg HRENZIAN-score, a classification of deep infiltrating endometriosis.Zentralbl Gynakol.(2005-Oct)
- ^Hamouda RK, Arzoun H, Sahib I, Escudero Mendez L, Srinivasan M, Shoukrie SI, Dhanoa RK, Selvaraj R, Malla J, Selvamani TY, Zahra A, Venugopal S, Mohammed LThe Comorbidity of Endometriosis and Systemic Lupus Erythematosus: A Systematic Review.Cureus.(2023-Jul)
- ^Shigesi N, Kvaskoff M, Kirtley S, Feng Q, Fang H, Knight JC, Missmer SA, Rahmioglu N, Zondervan KT, Becker CMThe association between endometriosis and autoimmune diseases: a systematic review and meta-analysis.Hum Reprod Update.(2019-Jul-01)
Examine Database References
- Oxidative Stress Biomarkers - Jennifer Mier-Cabrera, Mercedes Genera-García, Julio De la Jara-Díaz, Otilia Perichart-Perera, Felipe Vadillo-Ortega, Cesar Hernández-GuerreroEffect of vitamins C and E supplementation on peripheral oxidative stress markers and pregnancy rate in women with endometriosisInt J Gynaecol Obstet.(2008 Mar)
- Dysmenorrhea Symptoms - Nalini Santanam, Nino Kavtaradze, Ana Murphy, Celia Dominguez, Sampath ParthasarathyAntioxidant supplementation reduces endometriosis-related pelvic pain in humansTransl Res.(2013 Mar)
- Oxidative Stress Biomarkers - Abolfazl Mehdizadehkashi, Samaneh Rokhgireh, Kobra Tahermanesh, Neda Eslahi, Sara Minaeian, Mansooreh SamimiThe effect of vitamin D supplementation on clinical symptoms and metabolic profiles in patients with endometriosisGynecol Endocrinol.(2021 Jan 29)
- Dysmenorrhea Symptoms - Fariba Almassinokiani, Sepideh Khodaverdi, Masoud Solaymani-Dodaran, Peyman Akbari, Abdolreza PazoukiEffects of Vitamin D on Endometriosis-Related Pain: A Double-Blind Clinical TrialMed Sci Monit.(2016 Dec 17)
- Endometriosis-associated pelvic pain - James L Nodler, Amy D DiVasta, Allison F Vitonis, Sarah Karevicius, Maggie Malsch, Vishnudas Sarda, Ayotunde Fadayomi, Holly R Harris, Stacey A MissmerSupplementation with vitamin D or ω-3 fatty acids in adolescent girls and young women with endometriosis (SAGE): a double-blind, randomized, placebo-controlled trialAm J Clin Nutr.(2020 Jul 1)
- Dyschezia - André Schwertner, Claudia C Conceição Dos Santos, Gislene Dalferth Costa, Alícia Deitos, Andressa de Souza, Izabel Cristina Custodio de Souza, Iraci L S Torres, João Sabino L da Cunha Filho, Wolnei CaumoEfficacy of melatonin in the treatment of endometriosis: a phase II, randomized, double-blind, placebo-controlled trialPain.(2013 Jun)