It is sharp and usually occurs with cramps. Pain killers cannot hardly reduce the pain.

It occurs before and during every single period. It occurs even between periods.

It happens regularly and is distinct from period pains.

Painful Periods

Sharp, severe, and intense period-pains coupled with weakness. Cramps are often associated with heavy bleeding. There is also lower back and abdominal pain.

Chronic (prolonged) pelvic pain

The endometrial implants get inflamed, causing scar of tissue around them. These scar tissues cause severe pain. There can be severe pain if the implants secrete substances into the blood.

Ovarian cysts

If the implants grow inside the ovaries, they form cavities filled with blood, also called as chocolate cysts. They become large and painful needing surgical removal.

Gastric problems

Painful bowel movements, diarrhea, constipation, and nausea.

Painful urination

There may be pain while urinating and blood in the urine.

Infertility

Endometriosis can cause severe damage to different parts of the uterus responsible for pregnancy; mainly the fallopian tubes, ovaries, or uterus. The scar tissues form ‘adhesions’ (sticking of) and bind these organs together. This interferes with the movement of the fertilized eggs. The implants may produce inflammatory substances which adversely affect ovulation, fertilization, and implantation.

Painful Intercourse

Immense pain experienced during sexual intercourse (due to implants below the uterus).

Hereditary

This disorder can be inherited by the daughter from the mother. So, women are more prone who have family history.

Retrograde Menstruation

Normally, the menstrual blood is shed out of the body. But, in the case of endometriosis, the menstrual blood flows in a reverse direction, e.g., into the fallopian tubes instead of flowing out of the body through the vagina. This blood gets deposited in the pelvic and abdominal cavities onto the surfaces of various organs.

Endometrial cell transport

Some endometrial cells may be accidentally transferred by the blood or other fluids like lymph - present in the tissue system to other parts of the body. This can be a reasonable explanation for endometriosis.

There are other postulations on this subject like …

1. Embryonic cell transformation (cells present in the embryo change shape and act like endometrial cells due to genetic transformation).
2. Surgical Scar implantation (surgery like hysterectomy or C-section; endometrial cells may attach to grow as endometriosis).
3. Immune System Disorder (own immune system becomes self-destructing by mistake)

Physical Examination

The doctor performs a physical examination to feel the nodules /cysts behind the uterus. This does not confirm endometriosis.

Ultrasound

Even USG is not a definitive test; it can only confirm the presence of cysts.

Magnetic Resonance Imaging (MRI)

MRI imaging uses magnetic and radio waves to create deep tissue images; helps surgeons to locate and measure the implants to plan a surgery.

Laparoscopy

Laparoscope is a viewing instrument with a long tube and a tiny hi-res camera. It is inserted via a small incision near the navel under general anesthesia. Thus, the surgeon can directly view the implant and register its location, extent, and shape. They can also take a sample to perform biopsy.

Myth: Endometriosis is nothing but cramps during periods and heavy bleeding

If general bleeding is ignored by Indian women, assuming it as a part of the menstrual cycle. When it is too heavy coupled with severe pain, it needs to be investigated. The pattern of pain of endometriosis is different from period cramps; it is severe and unbearable. In fact, implants keep reacting to hormonal changes every cycle and it affects organs around it. Thus, scar tissues develop, which can entangle organs with each another resulting in severe pain with the slightest movement.¹

Myth: Endometriosis makes you infertile

Though endometriosis poses difficulty to conceive, it does not prevent pregnancy completely. A 2014 review of studies found that 2­10 % of couples living with endometriosis succeeded in becoming pregnant versus 15 - 20 % of couples without endometriosis as a complication².

Myth: Only women in the reproductive age get endometriosis

Endometriosis can affect anyone who gets their periods. Even teens can get the condition if they have a history of endometriosis in the family. In rare cases, menopausal women on estrogenic therapy can also get it³. 'Research studies have indicated that 38% of those with endometriosis have symptoms before the age of 15; yet it takes an astounding average of over nine years to receive a correct diagnosis and treatment. This means that much of a child’s youth may be spent suffering unexplained, often crippling pain which greatly hinders development.³

Myth: Heavy bleeding and pain means it is endometriosis

There can be other causes for heavy bleeding like growth of polyp or fibroids, thyroid problems etc. It should be noted that the pain experienced during endometriosis is severe and occurs in between periods or while having sex.

Myth: Endometriosis is always painful

In many cases there is no pain in the patient with this condition. The condition is diagnosed while investigating reasons for not getting pregnant.

Stage I: Minimal

There are the least number of implants, and they are superficial.

Stage 2: Mild

The number of implants is more than the previous stage and they are deeper.

Stage 3: Moderate

There are many deep implants in the ovaries and pelvic region. There can be cysts in one or both ovaries and the presence of filmy adhesions (band of scar tissues).

Stage 4: Severe

There are deep implants, not only in the pelvic region and ovaries, but also in the fallopian tubes and bowels. There are large cysts in one or both ovaries and many have dense adhesions.

Endometrial cysts

If the endometrial tissue is formed inside the ovaries it develops into a cyst (lump). These cysts can be present in one or both the ovaries. They are small – less than 2 inches in diameter and later grow to around 8 inches. The cysts can cause severe pelvic pain, infertility or even develop into ovarian cancer.

The stage of endometriosis does not necessarily translate to greater pain, infertility, or other symptoms. A woman with stage 4 endometriosis may be asymptomatic while a woman with stage 1 may experience severe pain and other symptoms.

Women between the ages of 25 to 40 are at a greater risk of developing endometriosis.

Women who have a history of the condition in their families are at a higher risk.

Hormones influence the development of endometriosis; pregnancy may decrease the symptoms.

When there is anything unusual about the periods, e.g., shorter period cycles, heavier or longer periods or menstruation starting at a young age, you are at a higher risk of developing endometriosis.

Pain Relief: For relief of the foremost suffering

Usually Nonsteroidal anti-inflammatory drugs (NSAIDs), e.g., ibuprofen, (with or without paracetamol) and naproxen sodium etc. are prescribed; and in some cases, anti-spasmodic medicines like dicyclomine or drotaverine are advised.

Hormonal Therapy to manage periods and slower endometrial build up

Hormones control the menstrual cycle and can slow the process of endometrial build-up or formation of new implants. • Contraceptives: Birth control pills or patches or vaginal rings may reduce or relieve pain in some cases. They create shorter periods by controlling the hormonal build-up. • Gonadotropin releasing hormones, Progestin Therapy and Aromatase inhibitors help to reduce hormones level in the body; may trigger the natural menstruation and thus reduce growth of the implants.

Conservative Surgery

If satisfactory results are not achieved, surgery is usually advised. In majority cases laparoscopy is preferred; else, abdominal surgery. Abdominal surgery is done in severe cases. If pain persists after surgery, hormonal therapy is generally advised.

Hysterectomy and removal of ovaries

The old method of surgical removal of the uterus and ovaries are no longer considered as a viable treatment as it carries many risks. Reduction of symptoms of endometriosis can be achieved due to loss of hormones, but the tissues remain to cause pain. For younger patients < 35 years, removal of uterus affects health for long time. Moreover, menopause is induced early if ovaries are removed, but this poses risk of heart disease, metabolic disease, and even early death.

Supplements and their effect on reducing peritoneal inflammation

“Endometriosis (EMS) is a common gynaecological disorder characterized by the presence of endometrial tissue outside the uterine cavity. It is commonly associated with pelvic pain and infertility. The exact pathogenesis remains unclear and many hypotheses have been suggested. In recent years, accumulating evidence indicates that oxidative stress (OS) plays a role in the development of EMS. The treatment of EMS remains a challenge. Antioxidant therapies for effective management of reactive oxygen species and inflammation have generated considerable research interest. Antioxidant agents such as Vitamins C and E, resveratrol, curcumin, melatonin, epigallocatechin-3-gallate, and others have been studied for the treatment of EMS. This review presents the role of OS in pathophysiology of EMS and the antioxidant therapies in its management”¹