As women, we are often exposed to various gynecological conditions that can be confusing to understand in terms of their causes and impact on our health. Three conditions that often create confusion are endometriosis, endometrioma, and endometritis. Are these conditions related? What causes them? In this blog post, we will analyze these conditions to better understand the symptoms, know how to treat them, and know when to seek professional assistance.
Endometriosis
Endometriosis is a chronic gynecologic disease characterized by the presence of endometrial tissue (which normally lines the uterus) outside the uterine cavity. This ectopic tissue consists of endometrial glands and stroma, and it is typically found in areas such as the ovaries, fallopian tubes, uterosacral ligaments, gastrointestinal tract, and occasionally in the pleura, pericardium, or central nervous system.
Symptoms of Endometriosis
While the presentation of symptoms differs in women, some typical symptoms can be found.
- Dyspareunia (painful sexual intercourse)
- Dysmenorrhea (pelvic pain during menstruation)
- Dyschezia (Painful defecation)
- Dysuria (Painful urination)
- Infertility
The pain can be described as chronic and progressive over time.
Causes of Endometriosis
The exact cause of endometriosis is not fully understood. Several theories have been proposed to explain its development. Researchers are currently working hard to understand the cause of this condition and, with the cause, be able to develop better treatments.
Sampson’s theory
Retrograde menstruation, where menstrual blood flows backward into the pelvic cavity, allows the implantation and growth of endometrial cells outside the uterus.
Coelomic metaplastic theory
The transformation of peritoneal cells into endometrial-like tissue under certain factors.
Müllerian remnant theory
Atypical migration or differentiation of remnants from the female reproductive system leads to endometriotic tissue in the pelvic floor.
Vascular and lymphatic metastasis theory
Endometrial tissue infiltrates the lymphatic and vascular systems, allowing it to spread to distant sites.
The Incidence of Endometriosis
Endometriosis affects 10–15% of women of reproductive age globally and 30% of infertile women [3]. 1 in 9 women of reproductive age has endometriosis in the United States [4]. In the U.S., according to a more recent survey of the National Hospital Discharge Survey, 11.2% of all women between 18 and 45 years old hospitalized for genitourinary causes were diagnosed with endometriosis, and approximately 10.3% of the women who have undergone gynecologic surgeries have endometriosis [1].
Diagnosis of Endometriosis
Diagnosing endometriosis can be challenging and typically involves a combination of the following approaches:
Medical history
Evaluation of symptoms such as pelvic pain, abnormal menstrual bleeding, and infertility.
Laparoscopy
The gold standard for diagnosing endometriosis involves a surgical procedure called laparoscopy, where a thin tube with a camera is inserted into the abdomen to visualize and biopsy suspicious tissue.
Treatment of Endometriosis
The management of endometriosis depends on various factors, including the severity of symptoms, the desire for fertility, and the patient’s overall health. Treatment options include:
Pain medication
Over-the-counter pain relievers or prescribed medications may help manage the pain associated with endometriosis.
Hormonal therapy
Hormonal medications (such as birth control pills, progestins, or GnRH agonists) can help regulate the menstrual cycle and reduce the growth of endometrial tissue.
Surgery
Laparoscopic surgery can be performed to remove endometriotic lesions, alleviate pain, and improve fertility.
Assisted reproductive technologies (ART):
In cases of infertility, techniques such as in vitro fertilization (IVF) may be recommended.
Complementary therapies
Some individuals may find relief from symptoms through complementary approaches such as acupuncture, dietary changes, or stress reduction techniques.
Endometritis
Endometritis is defined as an inflammation and infection of the endometrium, which is the innermost layer of the uterus. It can affect all layers of the uterus. The condition can be acute or chronic and may be related to or unrelated to pregnancy. Endometritis is usually caused by the migration of microbes from the cervix and vagina into the uterine cavity, leading to inflammation and infection. Common symptoms of endometritis include fever and abdominal/pelvic pain.
Symptoms of Endometritis
While symptoms can differ depending on the severity of the condition, some common symptoms of acute endometritis are:
- Abrupt onset of pelvic pain
- Dyspareunia (painful sexual intercourse)
- Vaginal discharge
Incidence of Endometritis
Acute endometritis often occurs in patients with pelvic inflammatory disease, with an approximate incidence of 8% in the United States.
The incidence of post-partum endometritis ranges from 1% to 3% in patients without risk factors after normal spontaneous vaginal delivery, increasing to about 5% to 6% with risk factors. Cesarean delivery is associated with a 5- to 20-fold increase in the risk of endometritis [5].
Diagnosis of Endometritis
Diagnosis of endometritis typically involves a combination of clinical evaluation, medical history, physical examination, and laboratory tests. Chronic endometritis is often asymptomatic and typically requires histologic confirmation [5].
Treatment of Endometritis
Treatment of endometritis typically involves a combination of antibiotics to target the infection and supportive measures. The specific treatment regimen may vary depending on the severity of the infection, the causative organism, and other individual factors.
Severe cases of endometritis or cases occurring in postpartum women may require hospitalization for intravenous administration of antibiotics and monitoring. In rare cases, if the infection does not respond to antibiotics or if there are complications like abscess formation, surgical intervention may be necessary to drain the abscess or remove infected tissue.
Endometrioma
An endometrioma is a cystic lesion that develops as a result of endometriosis. It is most commonly found in the ovaries and is filled with dark brown endometrial fluid, which gives it the name “chocolate cyst.” Endometriomas indicate a more severe stage of endometriosis.
Symptoms of Endometrioma
Endometriomas can cause severe pain. While symptoms differ in women, some of the most common are:
- Pelvic pain
- Heavy and painful menses
- Back pain
- Dyspareunia (painful sexual intercourse)
- Dyschezia (painful defecation)
- Dysuria (painful urination)
- Urinary frequency
- Nausea/vomiting
- Bloating [6]
Incidence of Endometrioma
It is estimated that 17 to 44% of women with endometriosis experience an endometrioma, and 28% of these women will have bilateral endometriomas. In the specific subfertility population, approximately 17% of these women are found to have endometriomas [6].
Diagnosis of Endometrioma
The diagnosis of endometrioma is typically made through surgical means, specifically by direct visualization and obtaining tissue samples. The biopsy should contain both endometrial glands and stroma to confirm the presence of endometriosis.
The exact cause of endometriomas is not fully understood, but it is believed to occur when ectopic endometrial tissue attaches to the ovary and bleeds, resulting in the formation of a cyst.
Treatment of Endometrioma
The treatment of endometriomas may involve a combination of medical and surgical approaches. The management options include:
Pain medication
Over-the-counter pain relievers or nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pelvic pain associated with endometriomas.
Hormonal therapy
Hormonal medications such as birth control pills, progestins, gonadotropin-releasing hormone (GnRH) agonists, and aromatase inhibitors may be prescribed to suppress endometriosis growth and reduce symptoms.
Laparoscopic surgery
This minimally invasive procedure is commonly used to remove endometriomas and any adhesions or implants present. It aims to improve symptoms, preserve fertility, and restore normal pelvic anatomy.
Laparotomy
In severe cases or when laparoscopic surgery is not feasible, a larger abdominal incision may be necessary for the complete removal of endometriomas and associated endometriotic lesions.
Conclusion
Even though the names of the discussed conditions are similar, they are not all interconnected. While endometritis is associated with inflammation and infection of the endometrium, the exact causes of endometriosis and endometrioma remain unknown. However, both conditions, endometriosis and endometrioma, involve the abnormal growth of endometrial tissue outside the uterus.
If you suspect you may be experiencing any of these conditions, it is highly recommended that you seek medical attention from your doctor or gynecologist, as they are the healthcare professionals who can provide a proper diagnosis and treatment for these diseases.
Bibliography
[1] Tsamantioti ES, Mahdy H. Endometriosis. [Updated 2023 Jan 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK567777/
[2] Buck, L.G.M., Hediger, M.L., Peterson, C.M., Croughan, M., Sundaram, R., Stanford, J., Chen, Z., et al. (2011). Incidence of endometriosis by study population and diagnostic method: the ENDO study. Fertility and Sterility; 96(2): 360-5.
[3] Cela V, Daniele S, Obino MER, Ruggiero M, Zappelli E, Ceccarelli L, Papini F, Marzi I, Scarfò G, Tosi F, Franzoni F, Martini C, Artini PG. Endometrial Dysbiosis Is Related to Inflammatory Factors in Women with Repeated Implantation Failure: A Pilot Study. J Clin Med. 2022 Apr 28;11(9):2481. doi: 10.3390/jcm11092481. PMID: 35566605; PMCID: PMC9101226.
[4] Ellis K, Munro D, Clarke J. Endometriosis Is Undervalued: A Call to Action. Front Glob Womens Health. 2022 May 10;3:902371. doi: 10.3389/fgwh.2022.902371. PMID: 35620300; PMCID: PMC9127440.
[5] Taylor M, Jenkins SM, Pillarisetty LS. Endometritis. [Updated 2023 Feb 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553124/
[6] Hoyle AT, Puckett Y. Endometrioma. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559230/
sur180therapeutics.com 