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March 20, 2018  |  Login
by James F. Balch, M.D. and Mark Stengler, N.D.

Endometriosis is a painful condition in which uterine tissue from the uterus attaches itself to other organs. The uterine tissue may appear in the fallopian tubes or the ovaries, or it may implant itself on the outer walls of the uterus itself. In rare cases, the tissue travels outside the pelvic region and appears in organs like the bladder, the lungs, and other areas.

These masses of tissue can be painful, in and of themselves, but to make matters worse, they continue to behave as if they're inside the uterus. They continue to fill up with blood over the course of the menstrual cycle, and every month, they shed blood just as the uterus does. Unlike normal menstrual blood, which leaves the body through the vagina, the blood from the abnormal growth has nowhere to go. Instead, it accumulates inside the pelvic cavity, where it often forms cysts. As menstrual cycles repeat themselves and the tissue continues to bleed each month, the cysts may grow so large that they bind organs together. Sometimes a cyst ruptures and leads to agonizing pain. Two out of three women have endometrial growth on the ovaries.

Pain in the pelvis and the lower back is the defining characteristic of endometriosis. The pain usually varies with the menstrual cycle and is at its worst during ovulation, menstruation, or sexual intercourse; sometimes it is so intense as to be incapacitating. A woman with endometriosis may experience heavy or prolonged menstrual bleeding, and this loss of blood can lead to anemia. Digestive problems are common in cases of endometriosis, as is nausea and vomiting. There is a strong connection between endometriosis and infertility, although it is unknown whether the excess tissue actually prevents conception, or if infertility somehow creates conditions hospitable to endometriosis.

No one knows for sure what causes endometrial tissue to leave the uterus and travel to other parts of the body. One prevailing theory is that the disorder is caused by retrograde menstruation, in which menstrual fluid fails to exit the body properly. Instead, some of the endometrial lining that is normally shed during menstruation backs up in the fallopian tubes and enters the pelvic cavity, where the tissue deposits itself and begins to grow. It is also possible that endometrial cells travel to the pelvic cavity via the bloodstream or the lymphatic system.

Others believe that endometriosis is caused when the body is still an embryo. In a normal fetus, the cells that are meant to form the uterus differentiate themselves from others and begin to travel to the appropriate site. But according to this theory, the endometrial cells of some fetuses don't make the trip and end up in the wrong places. It is also thought that environmental estrogens may be a causative factor. These xenoestrogens are endocrine disrupters that have estrogenic effects in the body. This category of environmental estrogens includes plastics, detergents, household cleaners, pesticides, herbicides, and hormones found in meat products.

In addition, studies have shown immune system imbalance to be a factor. Specifically, women with endometriosis have higher levels of antibodies that target their own ovaries and endometrial tissue. They also tend to have lower activity of the natural killer cells that usually keep abnormal cells in check. No matter what the cause, it does appear that all cases of endometriosis are linked to hormonal balance and that elevated estrogen levels are a problem.

It is important that liver function be optimized in women with endometriosis. more

Next: What are the Symptoms of Endometriosis

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