Endometriosis part I - Definition, Stages, Symptoms, Causes and Affects Of Endometriosis

I. Definition
During the last stage of the menstrual cycle, normally a layer of endometriosis lining on the inside of the uterus is expelled, known as menstruation blood which instead some of the endometriosis tissues grows somewhere in the body causing endometriosis. They also react to hormone signals of the monthly menstrual cycle, builds up tissue, breaks it and eliminates it through menstrual period.

II. Stages
Endometriosis is estimated to affect:
a) About 20% of reproductive age women with endometriosis present but without symptoms.
b) About 55% of women who have developed the new onset of severe menstrual cramps
c) About 25% of women with sub-fertility (less fertile than a normal couple)
Since they grow in somewhere other than in the uterus, when they break there is no way for the period blood to exit causing blood attaching to the organs or lining of the abdomen resulting in scars or adheresion as well as weakening the normal function of organs.
Most of the time, the endometriosis tissues do not travel far. It is commonly found within the pelvic region, on the lining of peritoneum, in the ovaries, and on the surface of the uterus's outside wall, but they can be anywhere in the body such as well as fallopian tubes, the cervix, the vagina, and even the vulva.
Endometriosis can vary in appearance. It may be clear or white, reddish, brown or blue black, and cysts. They can be classified according to stage of severity:
a) Minimal stage:
Top surface, few in number. Commonly they are found in the inside wall of uterus, ligaments and ovary.
b) Mild stage:
Deeper implants, greater numbers are presented. Commonly found in the same area as minimal stage.
c) Moderate stage:
Many implants, endometrial cysts present, affecting ovary function, causing scar tissues and adhesion is also present.
d) Severe stage:
Intensive peritoneal implants, large endometromas present and dense adhesion.
Each women experiences differently to endometriosis. Some women may have extensive endometrial tissues in their body but feel little or no pain at all, while other women may only be in the early stage of endometriosis but have excessive pain.

III. Symptoms
1. Severe period pain
It normally happens with over-production of prostaglandins and leukotrient causing the cervix to contract resulting in no escape for the menstrual period.

2. Difficult to get pregnant
If the cyst is presented in the ovary, it will respond to hormone changes in the menstrual cycle causing the cysts to get large every month blocking the normal function of ovaries resulting in infertility

3. Pain during sex
If endometrosis occurs at the region that is stimulated during sex it may cause excessive pain such as uterosacral ligament and cervic region.

4. Pain elevate to ward the end of period.
Endometriosis located somewhere other than in the uterus rupturing during menstruation. Since the blood cannot escape, it retents in our body causing damage to the organs or any part of the body hosting the endometriosis resulting in severe pain toward the end of the period.

5. Constipation
Constipation is caused by endometrial implants or adhesion attaching to the organ of excretion. It makes it extremely painful to urinate and defecate.

6. Premenstrual symptoms
Premenstrual symptom is defined to have menstrual cramps before and during menstrual cycle. If the pain is more severe than before than it may be caused by endometrial implants or adhesion to more sensitive areas.

7. Heavy period
Heavy period is either caused by menorrhagia or endometriosis. Any women who has never experience heavy period before, the sudden change of heavy period may be caused by the rupturing of the endometrial lining embedded on the inner wall of the uterus.

8. Irritable bowel syndrome
Women with endometriosis in the bowel region frequently have abdominal and bowel symptoms, specially during the menstrual cycle. Bowel symptoms may be attributed to irritable bowel symptoms or caused by intestinal involvement from endometriosis.

9. Pain in one side of pelvic
Pain on one side of the pelvic during menstrual cycle may be caused by endometrial implants or adhesion to that side of the pelvic.

IV. Causes

1. Retrograde menstruation
The retrograde menstruation theory suggests that during menstruation the blood flows backward instead of outward causing menstrual blood to go through the fallopian tubes to the pelvic and abdominal cavity, resulting in blood embedding on the outside of the uterus into other tissues and organs causing endometriosis.

2. Weakening of immune system
Normally, the immune will destroy endometrial cells which are located outside the uterus. If the immune system is weakened and no longer functions normally, it will allow the endometrial cells that shed to attach and grow elsewhere in the body.

3. Stress and emotion
During stress and emotion, the adrenal glands produce cortisol which affects the function of the body to cleanse toxins resulting in stimulating the growth of endometriosis.

4. Embryonic theory
This theory suggests during the embryonic stage, some endometrial cells which normally grow in the womb instead develops in the abdomen.

5. Hormone imbalance
Endometriosis happens during reproductive years of women when estrogen and progesterone are most active. In each stage of the menstrual cycle, estrogen and progesterone must be balanced for women to conceive. Any imbalance of hormones during the menstrual cycle causes conversion of estrogen into bad estrogen and over-production of prostaglandin causing the cervix to contract resulting in no escaping of the menstrual period, causing menstrual cramps and endometriosis. Nutritional deficiency is also one of the causes of hormone imbalance.

6. Hereditary
Endometriosis may be genetics passing through from generation to generation or it may result from genetic errors, causing some women to become more likely than others to develop the condition. Study shows that women are 5 times more likely to develop endometriosis if her sister has it. It is wise for these women to have children in their early reproductive years.

7. Toxic environment
Study shows that exposing our body to toxins found in pesticides and some harmful waste products may have some hormonal and chemical influence causing activation of endometriosis at the time of menstrual cycle resulting in proliferating of endo-tissues to the abnormal area in our body.

8. Xenoestrogen
Interaction of our body with certain chemicals causes a disruption of the body's hormones as resulting of over-production of estrogen converting to xenoestrogen to stimulate the growth of endometriosis.

9. Sex during menstruation.
Sexual intercourse during menstruation causes the endometriosis tissue to travel into the fallopian tubes then into the ovary resulting in developing ovarian endometriosis.

IV. Affects
A. Women's life

1. Difficulties at work
Women with endometriosis in certain regions of the body suffer from pain at least several days in a month just before and during menstruation causing the loss of productive activity as well as reducing the chance of advancement. Co-workers who have to cover her work without understanding the symptoms of endometriosis will likely feel resentment resulting in emotional depression. Study shows that endometriosis causes 41% of women to give up or lose their jobs due to illness.

2. Difficulties in personal relationship
Women suffering from endometriosis may feel extensive pain during sexual intercourse. If the disease is not diagnosed, she may be accused of being frigid or neurotic causing difficulty in personal relationship leading to destruction of marriage as well as increasing the risk of depression and other diseases.

3. Infertility
In general, women with endometriosis find it harder to become pregnant than other women. Women with moderate to severe stage of endometriosis tend to have more difficulty conceiving than women with minimal to mild stage of endometriosis. If the woman is living in a culture where she is defined by her ability to produce children, it can lead to social stigma.

4. Interference in social life
Women with severe pain as a result of endometriosis may interference with social life, such as family events, social events, and traveling just before and during menstruation.

5. Emotional depression
Woman with endometriosis who cannot control her symptoms may cause misunderstanding in the family and work place leading to depression. With no support from family and friends she may experience feelings of isolation as well.

6. Frustration
Not understanding endometriosis may cause feelings of confusion and embarrassment about the condition leading to irritation.

B. Reproductive System
1. Infertility
Infertility is always difficult for women with endometriosis. In fact depending on the stage of endometroisis and where endometriosis implants in the body, some women may not even get pregnant at all if they are on the last stage of endometroisis and the cysts is located in the fallopian tubes, ovaries, and uterus because of the enlarged endometrosis cysts not only causing inflammation but also interfering with each stage of the menstrual cycle. In general, women with endometriosis find it harder to become pregnant than other women.

2. Miscarriage
Some physicians in the infertility field do feel there is an increase in the risk of miscarriage with endometriosis. Some feel there is no increase in the miscarriage rate. One of the studies looked at the miscarriage rates in patients prior to treatment of endometriosis and compared to the miscarriage rates in the same patients after treatment of endometriosis. In these studies patients had lower miscarriage rates after treatment. Women pregnant with endometriosis should be wise to seek help from specialists for treatment that not only nourishes the fetus but also controls the progression of endometriosis.

3. Ectopic pregnancy
An ectopic pregnancy is a complication of pregnancy in which the fertilized ovum is implanted in any tissue other than the uterine wall, caused by blockage of endometroisis of the fallopian tubes leading to an ectopic pregnancy. In fact, the fetus produces enzymes that allow it to implant in varied types of tissues, and thus an embryo implanted elsewhere than the uterus can cause great tissue damage in its efforts to reach a sufficient supply of blood, sometime it is life threatening to the mother.

4. Dyspareunia
Dyspareunia is painful sexual intercourse. When pain occurs, the woman experiencing it may be distracted from feeling pleasure and excitement. Women with endometriosis suffer from dyspareunia if endometriosis is located in the major ligaments of the uterus. Endometriosis-related dyspareunia is usually positional and most intense upon deep penetration. It is most intense prior to menstruation.

C. Abdominal and Pelvic Pain
1. Chronic pelvic pain
Normal chronic pelvic pain refers to any pain in your pelvic region (the area below your bellybutton and between your hips) lasting more than six months. In case of endometriosis at the final stage of the menstrual cycle period, endometrial tissue swells and bleeds, just like the lining of your uterus causing pain and scar tissue, and adhesion forming in your pelvic area resulting in the tissue and organ near the endometrosis being covered. Any movement of these constricted organs can cause severe pain.

2. Locally pelvic pain
Some women experience locally pelvic pain beginning or/and during menstrual cycle caused by pre-menstrual syndrome as a result of over-production of prostaglandins increasing the contraction within the uterus lining. In case of endometriosis, the pain continues throughout menstruation, caused by inflammation of rupturing of endometrial cysts that attach to some pelvic regions as a result of over-production of certain hormones elevating the pain in that area.

3. Lower pelvic pain
Normally lower pelvic pain is caused by infection of the bladder or inflammation of the collecting system of one or both kidneys, or dysmenorrhea. In case of endometrosis, the pain continues and becomes severe just before and during menstruation caused by scars and adhesion attached to the organs in the lower pelvic regions, such as the kidneys, bladder, and/or ovary.

4. Severe abdominal cramps
Severe abdominal cramps before or during the menstrual cycle is likely caused by dysmenorrhea or premenstrual syndrome, if the pain is prolonged or just before, or during menstruation, then it may be caused by endometrial cells and rupturing of endometrial cysts resulting in over-production of prostaglandins in one area of the back, or travelling down the legs. If you experience back pain with continual dull abdominal pain just before and during menstruation it may caused by scar tissue or adhesion attached to the vertebra area.

Remember any severe pain JUST BEFORE AND DURING menstruation in any region may be a good indication of endometriosis.

D. Irregular menstruation
1. Variable amounts of bleeding either heavy or scanty
Variable amounts of bleeding either heavy or scanty is normal for menarche and perimenopause as the menstrual cycle is initiated and during a woman 's forties until menopause accordingly because of imbalance of estrogen and progesterone. In endometriosis, heavy and scanty bleeding are caused by over-production of certain hormones in the prostaglandins hormonal family that controls the aggregation or disaggregation of platelets.

2. Menstrual spotting
Menstrual spotting in the middle of the menstrual cycle may be caused by polyp growth in the uterus. Polyps within the uterus may prevent pregnancy or interfere with implantation of embryo as well as miscarriage. Polyps also cause heavy bleeding as a resulting of rupture of polyps in the uterus during menstruation. Luckily most polyps exit in uterus tend to be benign growth.

3. Prolong bleeding
Prolong bleeding may be caused by endometriosis cysts or fibroid located in the uterus wall as a result of imbalanced hormones of the prostaglandins family caused by excessive estrogen in the body if one type of prostaglandins hormone that helps to stop platelets from clumping together.

4. Long menstrual cycle
An irregular menstrual pattern of long menstrual cycles may be an indication of ovulation problems and can be a major factor in infertility caused by endometriosis ovulation problems resulting in ovulation delay or immature eggs in the follicular phase. Sometimes, the follicle develops but the egg is not expelled from the ovary, caused by low levels of progesterone.

5. Blood clots
Because of irregular menstruation causing imbalance hormone, blood clots usually happen during menstruation if one of the hormones of the prostaglandins family that helps to regulate blood clots is over-produced. In this case over-production of such hormones cause more platelets clumping together and fails to dilate blood vessels resulting in blood clots.

E. Digestive System
1. Constipation or difficult defecation
Defecation is the final act of digestion by which organisms eliminate waste material from the digestive tract via the anus. Constipation is caused by endometriosis implants or adhesion thst are attached to organs of excretion resulting in painful urination, as well as defecation.

2. Bloating
Bloating may have several causes, the most common being accumulation of liquids and intestinal gas. In endometriosis, bloating is caused by ovarian cysts, endometrial implants, or adhesion in the intestines that promote collection of fluid within an ovary causing swelling in the abdominal region and swelling in the digestive system as resulting of lack of regular ovulation and excessive amounts of androgenic hormones.

3. Rectal bleeding
Constipation normally is the main cause of rectal bleeding. In endometriosis, endometrial implants or adhesion in large intestine resulting in rectal bleeding as waste passing through. It also causes rectal bleeding just before and during menstruation as endometrial bleeding.

4. Diarrhea
Sudden bouts of diarrhea may be caused by bacterial infection. In woman with endometriosis, deficiency of vitamin A and B are common, causing low level of enzymes that allow food to pass through the intestine undigested.

5. Fluid retention
Fluid retention may be caused by endometrial cysts located other than in the reproductive system. Endometrial lining bleeding during menstruation causes blood to have nowhere to escape causing fluid retention in some parts of the body.

6. Sugar craving
Sugar craving is the symptom of premenstrual syndrome. Women with endometriosis also have premenstrual syndrome. Unlike other woman, they also have a high level of abnormal tolerance curves because of low levels of progesterone resulting in an over-production of adrenaline causing sugar craving.

7. Loss of appetite
Woman with intestinal endometriosis may have loss of appetite present only at the time of the menstrual period or they may be present all month long and worsen at the time of the period.

F. Urination

1. Irregular urination
Normally irregular urination in adults is caused by pressure of a fetus on the bladder of a pregnant woman or losing muscle of the badder causing the feeling to use the bathroom. In woman with endometriosis, it is caused by endometrial implants or adhesion in the badder region, which increases the pressure to the urinary system resulting in irregular urination.

2. Lower abdominal pain on urination
Lower abdominal pain may be caused by endometrial implants, adhesion or cysts in the pelvic region or by over-production of prostaglandins which increases the tension of muscle spam in the bowel and the uterus. Lower abdominal pain on urination is caused by over-production of prostaglandins which stimulate the contraction of the ovaries and uterus muscles or endometrial implants and adhesion in the lower abdominal area causing pressure and pain on urination.

3. Blood in urine
Blood in urine is a common cause of women with endometrial implants or cysts attached to the bladder area as resulting of bleeding of the endometriosis. It worsens just before and during menstruation.

4. Kidney tenderness
Kidney tenderness may be caused by the weakened immune system of woman with endometrial adhesion attached to the kidney causing abnormal function of the kidney and kidney fluid retention. It may be caused by cysts in the pelvic region which increases pressure of the bladder and urinary tract resulting in mounting pressure to the kidney, causing kidney tenderness. It worsens at the beginning and during period.

G. Emotional state
1. Depression
Depression is a illness that not only affects woman with endometriosis but also their family, work or school life, sleeping and eating habits, and general health. It is caused by lower levels of good estrogen and high levels of progesterone, and the symptom get worse before and during menstruation. Being misunderstood by co-workers, family, and friends may trigger the feeling of worthlessness and loss of interest in daily activity such as hobbies and sex.

2. Apathy and fatigue
Apathy and fatigue may be caused by thyroid problem or hormone imbalance. Apathy and fatigue in endometriosis is caused by the pressure of coping with any sort of pain that returns relentlessly every month, affecting her physical and emotional state.

3. Loss of concentration and memory
Many women with endometrosis also suffer from anemia caused by heavy blood flow leading to deficiency of iron, folate aid, and vitamin B12 which are necessary for reproduction of red blood cells and to increase transportation of oxygen to brain cells, causing loss of concentration and memory.

4. Irritability
Irritation besides being caused by hormonal imbalance in the women with endometriosis during the menstrual cycle. Stress and confusion for woman with endometriosis is understandable. It is best to cope with the stress and try understand the disease and how to treat it. Denial of any of this not only causes more emotional pressure but also irritates any suggestion and help.

5. Loss of self confidence
It is hard for woman to perform daily activities with menstrual cramps on her back. It not only affects her work but also causes absence due to sickness every month in the work place. Without understanding by her boss and family, women with endometriosis may lose self confidence in her job as well as at home.

6. Insomnia
Insomnia is common among women with endometriosis because it is caused by the pain keeping them awake during the night.

H. Hormonal symptoms
1. Hot flashes
Hot flashes also known as hot flushes, is a feeling of intense heat with sweating and rapid heartbeat, and may typically last from two to thirty minutes for each occurrence, normally happening only to women in the menopause stage. Woman with endometriosis may also experience some sources of hot flashes caused by hormone imbalance and tends to occur only during times of menstruation as resulting of more progesterone produced by the purity gland and low levels of good estrogen in the body. Intake of soy rich foods will help to reduce symptoms of hot flashes.

2. Tender breast
Tender breast normally happens to women during the 7th to 14th days prior to their period such as discomfort, tenderness and swelling of the breasts. It also happens to women 1-2 weeks after conception. In case of endometriosis, it causes interfere of endometriosis implants or adhesion against normal ovarian functions of the menstrual cycle as resulting of over-production of estrogen or progesterone. These symptoms may worsen due to a decline in your normal ovarian function. It is said that intake of vitamin B6 and primrose oil will help. Be sure to talk to your doctor before taking any supplements or over-the-counter medication.

3. Premenstrual syndrome
Premenstrual syndrome is a condition that happens between ovulation and the start of the period. Women who have endometriosis also have PMS mostly caused by hormone imbalance such as imbalance of estrogen and progesterone, serotonin or excessive androgen. In case of endometriosis pre-menstrual symptom is caused by imbalance of prostaglandins and leucotrienes produced by endometrium that interferes with normal muscle contraction and the local blood flow resulting in abdominal pain.

4. Prolong and heavy bleeding
Normally abnormal uterine bleeding happens to women in menarche or perimenopause stages. It may also happen to women with hypothyroidism or polycystic ovarian syndrome. If the bleeding is heavy and over six months, then it is caused by endometrial implants or adhesion that interferes with the ability of the blood vessels to contract to stop bleeding after the normal menstrual sloughing.

I. Cardiovascular Symptoms
1. Breathlessness
Women with endometriosis may experience breathlessness caused by heavy blood flow that depletes the storage of iron and other necessary substances, resulting in less oxygen and nutrition needed to re-nourish the body's cells as the heart has to work harder to pump blood. Intake of food with rich sources of iron such as spinach and broccoli during menstrual cycle is said to help, reduce, or get rid of this symptom.

2. Palpitation
Endometrial implants or adhesion on the liver caused by malfunction of the liver as it no longer secretes enough bile to the intestine as a result of high levels of bad cholesterol in the blood stream. As this problem progresses, cholesterol builds up on the arterial wall causing the heart to over-work, resulting in heart palpitations. Intake of flax seed oil is said to restore balance of omega 3 and 6 fatty acids and reduce cholesterol as well as helping restore the normal function of the liver.

3. Giddiness and confusion
Giddiness is defined to have a reeling, lightheaded sensation, or dizziness. Women with endometriosis may experience dizziness due to insufficiency of oxygen levels in the blood stream that are vital for brain cells. Without enough oxygen to nourish its cells, the brain cannot function causing confusion as well as giddiness. It also caused by endometriosis that attach to the lung which interferes with lung function to absorb oxygen.

4. Hypertension
High blood pressure is always associated with heart disease. In case of women with endometriosis, it is caused by abnormal function of the liver which has been damaged by endometrial implants or adhesion. The damaged liver now cannot produce enough bile to help the digestive system to get rid of bad cholesterol from our body resulting in cholesterol building up as well as high blood pressure.

Since endometriosis is treatable and manageable by natural remedies and self help, if you have endometroisis, please look at the bright side.
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