Uterine Endometriosis: What It Is, Causes, and Manifestations

Endometriosis is a condition in which cells resembling the inner lining of the uterus grow outside it. It is not your fault: the exact causes are unknown, and the manifestations can be kept under control together with a doctor. Below — about the mechanism, symptoms, and the boundaries of normal.

Uterine endometriosis and genital endometriosis: what kind of disease this is

The uterus is lined on the inside with the endometrium. In endometriosis, tissue similar to it appears in other places — such areas are called foci, nodules, or implants. Most often they are found on the ovaries, fallopian tubes, behind the uterus, on the tissues that hold the uterus in place, on the intestines and bladder; less often — in the lungs. The foci undergo the same cyclical changes as the endometrium, including microbleeding: hence inflammation, pain, enlargement of the organ, and difficulty conceiving.

Genital endometriosis is within the reproductive organs, extragenital is outside them, for example in the umbilical area or in the intestines. Genital is divided into external (ovaries, pelvic peritoneum) and internal — adenomyosis, when the endometrium grows into the myometrium. It occurs in everyone who has or has had a uterus, from the onset of menstruation to menopause; the average age of patients is 25–30 years. There are four stages:

• I — single superficial foci;
• II — several deeper foci;
• III — multiple deep foci, small endometrioid cysts of one or both ovaries, thin peritoneal adhesions;
• IV — large bilateral cysts, dense adhesions of organs, invasion of the vagina or rectum.

Why endometriosis occurs

The cause has not been definitively established by official medicine; the involvement of cellular enzymes, hormone receptors, and gene mutations is discussed. One mechanism is the reflux of menstrual blood into the abdominal cavity through the fallopian tubes: endometrial cells take hold and grow; in the internal variant, they grow into the muscular layer of the uterus. A link with an imbalance of the vaginal microbiome is also discussed: immune surveillance fails, and the level of pro-inflammatory cytokines rises.

The probability is higher if endometriosis is present in the mother, sister, or daughter, if menstruation began before age 11, the cycle is shorter than 27 days, and periods last longer than 7 days. It is lower in those who have been pregnant, whose menstruation began later, and who breastfed.

Discharge in endometriosis and changes in periods

Changes should be discussed with a gynecologist if a pad or tampon has to be changed every 1–2 hours, blood leaks onto clothing, or bleeding has become longer and heavier than before. There may be spotting or bleeding between periods. Pain during intercourse, during defecation and urination, a pulling pain in the lower abdomen and back, pronounced fatigue, low mood or anxiety, and difficulty conceiving are also part of the picture. Pain that prevents you from working or getting out of bed is not considered normal.

Endometrioid cyst and uterine size in endometriosis

An endometrioid cyst is a fluid-filled sac in the ovary that has arisen due to endometriosis. Small cysts of one or both ovaries are classified as stage III, large bilateral ones as stage IV. In adenomyosis, the uterus becomes round or spherical and may enlarge to the size typical of 5–6 weeks of pregnancy; it is often combined with uterine fibroids.

What happens to endometriosis during menopause

Symptoms usually stop after menopause, although sometimes they persist after it as well. In postmenopause, the disease occurs less often, but cases have been described in older women. If manifestations continue, this is a reason to return to the gynecologist and discuss monitoring.

When to see a gynecologist

You should make an appointment if you suspect endometriosis, if symptoms interfere with life, work, and relationships, and if the prescribed treatment does not help. The diagnosis is not made immediately: the picture resembles adenomyosis, fibroids, inflammatory diseases of the pelvic organs, and irritable bowel syndrome. The doctor will ask about symptoms and cases of endometriosis in relatives, perform an examination, including an internal vaginal one, and may order blood tests. Next, ultrasound, MRI, and laparoscopy are possible — the gold standard: a camera is inserted through a small incision near the navel and the foci are assessed. A negative ultrasound does not mean that endometriosis is absent: most nodules are not visible on it.

Endometriosis by itself is not a reason to call an ambulance. 103 or 112 — if hemoptysis or chest pain with shortness of breath appears: foci are sometimes located in the chest cavity.

It is impossible to get rid of endometriosis completely, but the manifestations can be corrected, and the doctor discusses the options and their risks with you individually. The material is for reference and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer