MANILA, Philippines — Every woman of child-bearing age goes through the menstrual cycle. It is a monthly shedding of blood that occurs when her egg cell is not fertilized by a sperm and therefore no pregnancy happens.
Some women experience a very smooth menstrual period; others suffer from stomach cramps ranging from mild to severe. Normally, menstruation happens on a monthly basis, with a 28- to 30-day interval, but there are those who suffer from irregular menstruation, meaning that the menstruation takes place at an undetermined interval. Some experience light blood shedding, while with others, the flow can be very strong and frequent.
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The Dysmenorrhea experience is really cut out to be different and unique for each woman.
The problem is whether the Dysmenorrhea that a woman experiences is plain Dysmenorrhea or is it a sign of a worse condition, such as Endometriosis?
What is Endometriosis?
Almost 60% of women with Dysmenorrhea have Endometriosis, an illness that causes severe pain, damages reproductive organs, and increases the risk for cancer.
Menstrual cramps, known clinically as Dysmenorrhea, is so common among women that it is often taken for granted, especially since it usually goes away once the menstrual period is over. For some women, however, Dysmenorrhea could be a sign of something more serious, like Endometriosis.
Endometriosis is a condition where endometrial tissue grows outside the uterus. The endometrium is the tissue that lines the inside of a woman's uterus. During a woman's menstrual cycle, as her body is getting ready to release an egg or ovum (to be fertilized by the male's sperm), the endometrium starts thickening inside the uterus.
Besides thickening, the endometrium also starts increasing the size and number of its blood vessels and glands in the uterus. It thus becomes a blood-rich, glandular layer of thick tissue. Why? It’s because the endometrium functions to prepare the uterus for the implantation of the fertilized ovum, and the development of the placenta as well as the fetus. In short, the endometrium's job is to create an environment inside the uterus that would be favorable to the development of a human fetus.
However, if the released egg or ovum is not fertilized, then the endometrium starts shedding the blood and extra tissue that it had prepared. These sheddings of blood and tissue are what flow out of the woman during menstruation.
Risk factors
The thickening and shedding of endometrial tissue is a normal cycle for all women of child-bearing age. However, for reasons that are still unclear, in some women, endometrial tissue begins growing outside of the uterus. This is what's called Endometriosis. When this occurs, some women experience mild to severe pain that may get worse over time.
So what happens? Why and how does endometrial tissue begin growing outside the uterus?
“Current theories suggest that Endometriosis might be caused by several factors acting together, instead of just one. In general, there appears to be a greater risk of Endometriosis when a woman has early menarche (starts menstruation before age 11).
“Other risk factors include shorter monthly cycles (less than 27 days) and heavy menstrual flows lasting more than seven days. The risk is also related to changes in a woman's estrogen level, and a family history of Endometriosis, among others,” said Dr. Maynila Domingo, Obstetrician-Gynecologist of ManilaMed.
Symptoms
Endometrial tissues that grow outside the uterus may attach to the ovaries, fallopian tubes, and even pelvic lining. These tissues continue to act like they would when inside the uterus — they still thicken, then break down and bleed every menstrual cycle. Since they are not inside the uterus, they are not expelled from the body and become trapped. This causes inflammation and irritation in the surrounding organs — the ovaries and fallopian tubes — and pelvic tissues.
“The most common symptoms of Endometriosis are chronic pelvic pain and Dysmenorrhea. Depending on the individual, pain can be mild to severe. Symptoms may include heavy menstrual bleeding, painful ovulation, pain during or after sexual intercourse, fatigue, and infertility. These symptoms may also impact on a woman's general physical, mental, and social well-being,” Dr. Domingo said.
Complications that may arise
Untreated Endometriosis can lead to other, more serious conditions. It can damage the ovaries and fallopian tubes, or other surrounding tissues, and this may lead to low fertility or infertility.
“The exact mechanism behind infertility from Endometriosis is not yet fully known, but it may be related to distorted pelvic anatomy, endocrine and ovulatory abnormalities, altered peritoneal function, and altered hormonal and cell-mediated functions in the endometrium,” Dr. Domingo explained.
Women who have Endometriosis may still have children if their cases are not severe. It is advisable for them to bear children earlier since Endometriosis may worsen over time.
“The other, more serious complication of Endometriosis is cancer. There are some studies showing a link between Endometriosis and certain cancers, especially ovarian cancer. However, the association is not definitive; it does not mean that if you have Endometriosis, you will eventually get cancer. Nevertheless, early treatment of Endometriosis is recommended to prevent or reduce the risk of both infertility and cancer,” the doctor said.
Treatment options
Management and treatment of Endometriosis is different for each individual, depending on the patient's symptoms, the severity of the disease, and other related concerns.
“Endometriosis may be treated with medicine or surgery, or both. The goals of treatment include pain control, preservation of fertility, cancer prevention, and reduction of the risks of recurrence,” Dr. Domingo said.
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