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What is Endometriosis? Living with Endometriosis

What is Endometriosis?Endometriosis is a disease known to affect adolescents and reproductive-aged women. It is characterized by the presence of endometrial tissue outside the uterine cavity and commonly associated with chronic pelvic pain and infertility.

The endometrium is the innermost lining of the uterus. It has a basal layer and a functional layer. During the menstrual cycle, the functional layer thickens, breaks down, bleeds and is shed. In patients with endometriosis, the thickened tissue grows outside of the uterus. It may then get attached to the ovaries, fallopian tubes and the tissue lining the pelvis. Very rarely it might spread beyond the pelvic organs. As the hormonal changes happen during the menstrual cycle, this tissue may breakdown and there may be pain, swelling, and inflammation in the affected region, leading to scar tissue formation and adhesions.

PrevalenceEndometriosis is a multifactorial disorder affecting up to 15% of women of reproductive age. About 176 million women suffer from the condition globally. The prevalence in India is 26
Million.

Ages Affected

Ages Group
0-15 years
15-45 years
45-55 years
55-95 years
Prevalence
Very Rare
Very Common
Common
Rare

Clinical Picture
• Abdominal cramps and back pain during menstruation
• Pain while passing urine and stools during periods
• Abnormal and heavy bleeding during periods

• Severe menstrual cramps
• Pain during sexual intercourse
• History of infertility

Endometriosis Causes
The exact cause and pathogenesis of endometriosis are not known. Immunological or hormonal dysfunction may be a possible cause, as also a genetic predisposition. Endometriosis may present more commonly in women with a family history (first-degree relatives) of endometriosis. Other risk factors are defects in the uterus and fallopian tubes, early age of menarche, short menstrual cycles (less than 27 days), heavy menstrual bleeding, delayed childbearing, iron deficiency, etc.

Although the exact cause of endometriosis is unknown some possible explanations have been put forward like – retrograde menstruation – in which some menstrual blood flows backward through the fallopian tubes, transformation of peritoneal cells, embryonic cell transformation, surgical scar implantation, endometrial cell transport, and immune system disorder.

The ovary is the most common site for endometriosis. The size of the lesion can range from a few millimeters to large endometriomas. Ovarian endometrioma is known as the chocolate cyst of the ovary, a classic lesion. The chocolate colour comes from old menstrual blood and tissue. A chocolate cyst can affect one or both ovaries; it may occur in multiples or singularly. If the cyst ruptures, it causes severe abdominal pain, which is typically associated with endometriosis exacerbations.

Is Endometriosis related to Genetics?
Research shows multiple candidate genes may be involved in the disorder. The chances of a person getting diagnosed with endometriosis increases when the woman’s mother is diagnosed with Endometriosis.

Diagnosis
Diagnostic tests, such as radiological studies ultrasound, CT scan, and MRI, are recommended. A definitive diagnosis can be made only through laparoscopy following which treatment is started. Patients with infertility should undergo a thorough basic evaluation for other causes of infertility before diagnostic laparoscopy for endometriosis is performed.

Treatment
In women with milder disease, initial medication includes oral contraceptives or progestins along with symptomatic treatment for pain relief. Danazol and GnRH Agonists (leuprolide and goserelin) are useful for relieving pain. These drugs provide short term relief and are not curative. Surgical excision of lesions may be used before IVF to enhance the chances of fertility. However, surgical excision is associated with the risk of reducing ovarian reserve as it reduces the number of healthy tissues. Recurrence is common and surgery cannot be performed repeatedly. Although hysterectomy is recommended, it is not the solution as it has many other adverse effects and not possible when patients want to conceive.

Innovative disease management using evidence-based nutraceuticals are gaining steady acceptance world over as they are not only safe, but also complement the action of conventional treatment strategies. This makes it an attractive option in comparison to the traditional management. Such approaches are extremely useful for endometriosis diagnosed with milder disease conditions or adolescent endometriosis, where hormonal manipulations is considered as the last option. Endometriosis treatment management including curcumin, resveratrol, N-acetylcysteine, vitamin D offer new hope as they are backed with well-designed and validated clinical studies.

Key novel ingredients that can help relieve Endometriosis symptoms:
Curcumin:
The key ingredient of turmeric is a potent compound with antioxidant and anti-inflammatory properties. Studies have confirmed the anti-inflammatory properties of Curcumin. One study shows that curcumin reduces estradiol production in the body. Estradiol is known to aggravate inflammation, growth and the pain associated with endometriosis. Other studies also suggest that curcumin suppresses tissue migration of the lining of the uterus. Although, if curcumin has to be effective then it needs to have better absorption and bioavailability. Most turmeric as well as curcumin have poor bioavailability. To address this problem of poor bioavailability, new technologies are being developed such as the Ultrasol technology. Ultrasol is a patented technology that enhances the bioavailability of curcumin by 46 times in comparison to standard curcumin.

Resveratrol:
Resveratrol is a naturally occurring plant-based compound which has demonstrated to counteract several theorized molecular mechanisms of endometriosis. It has proven apoptosis-inducing activities. Its natural anti-inflammatory properties are directly correlated to the prevention of endometriosis. Resveratrol may also reduce the dimensions and quantity of endometriosis lesions through inhibition of prostaglandin synthesis, activation of activated immune cells. . Studies have also showcased the anti-angiogenic properties of Resveratrol that inhibit the development of endometriotic lesions.

N-acetyl-cysteine:
A useful antioxidant and detoxifier, it eases oxidative stress and may also help to keep the liver detoxified. N-acetyl-cysteine is reported to have the potential to reduce endometriosis and improve fertility too.