Endometriosis Showing A Threefold Increase In Heart Disease Risk

Signs and symptoms of endometriosis

The main symptom of endometriosis is pelvic pain which is most often associated with the patient's menstrual period. This pain is described as being worse in nature when compared to the menstrual cramps and pain that the patient is used to.

The common signs and symptoms of endometriosis include the following:

• Dysmennorhoea (extremely painful menstrual pain) - pelvic pain and cramping can start before menstruation and then carry on for a few days after the menstruation ends. Abdominal and lower back pain can also be involved.
• Dyspareunia, which is pain with intercourse.
• Pain with urination or bowel movements, which occurs during menstruation.
• Excessive bleeding - there may be occasional heavy periods (menorrhagia) or bleeding in-between periods (menometrorrhagia).
• Infertility occurs in endometriosis.
• Other symptoms such as diarrhoea, constipation, fatigue, nausea or bloating during menstrual periods can also be experienced.

Causes

The exact cause of endometriosis is not known, but there are a few possible explanations. They are as follows:

• Retrograde menstruation is the most likely cause of endometriosis. Here, endometrial cell containing menstrual blood flows back up the fallopian tubes and into the pelvic area instead of out of the body. These cells then attach to the above-mentioned areas and cause endometriosis there.
• Embryonic cell growth - the cells which line the abdominal and pelvic regions are derived from embryonic cells, and when one of the small areas of the abdominal lining turns into endometrial tissue, then endometriosis occurs.
• Endometrial cell transport - as with retrograde menstruation, endometrial cells are transported to certain pelvic areas, but in this case, via the bloodstream or lymphatic system.
• Surgical scar implantation - endometrial cells can attach to surgical incisions from operations such as a Caesarian section or hysterectomy.
• Immune system disorder - an issue with the immune system may result in the body not being able to recognize and destroy abnormal endometrial tissue. This then increases the chances of endometriosis.

Risk factors

There are a few factors which increase the risk of developing endometriosis and they include the following:

• Women who haven't given birth.
• Medical conditions which prevent the normal passage of menstrual blood.
• Family history of first-degree relatives (sister, aunt, mother) with endometriosis.
• Uterine abnormalities.
• History of pelvic infections.

Complications

The most common complication of endometriosis is diminished fertility. 30-50% of women with this condition struggle to get pregnant. Endometriosis can obstruct the fallopian tube which then prevents the sperm and egg from uniting. Damage to the sperm and/or egg can also occur as an indirect cause of endometriosis.

READ Endometriosis & Hysterectomy

The risk for ovarian cancer increases in women with endometriosis. Since the overall risk of ovarian cancer in women is low to start off with, the risk of ovarian cancer in patients with endometriosis is still relatively low. 

Endometriosis-associated adenocarcinoma may develop later on in life in these patients, but this is a rare occurrence.

Endometriosis And Heart Disease

This equates to a three-fold increase of having coronary heart disease related conditions such as chest pain or heart attacks which may require treatment such as stenting or bypass of any blocked arteries. 

Treatment of endometriosis, which may entail surgical removal of the ovaries, will result in menopause which in itself can also increase the risk of coronary heart disease by 40%. Other possible causes for the increased risk of coronary heart disease in patients with endometriosis can include increased cholesterol levels, chronic inflammation and increased oxidative stress which results in the exposure to free radicals. These conditions are often associated with patients diagnosed with endometriosis.

Management of endometriosis

The treatment of endometriosis can include oral medications for pain relief and hormonal regulation in order to control the symptoms. Surgical procedures can also be performed if the endometriosis is complicated or not controlling on the oral medication. The prevention or management of heart disease is also very important here.

Oral medication

• Pain medication - these can include paracetamol, ibuprofen, naproxen and sometimes even opioids.
• Hormone therapy - hormonal contraceptives (birth control pills, patches or vaginal rings) help to control the hormones responsible for the accumulation of endometrial tissue. Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists and agonists cause estrogen levels to decrease and this leads to prevention of menstruation. Meproxyprogesterone can also stop menstruation from occurring and reduces the growth of abnormal endometrial tissue. Danazol suppresses the growth of endometrial tissue but it may not be the first choice drug since it can cause serious side-effects.

READ Endometriosis, Fertility And Infertility

Surgery

• Conservative surgery - this is a laparoscopic procedure where as much of the abnormally deposited endometrial tissue is removed. 
• Hysterectomy - complete removal of the uterus and cervix is considered to be done as a last resort procedure which will only be performed in severe cases. The ovaries can also be removed (oophorectomy) in order to reduce the estrogen levels and therefore stop stimulation of the endometrial tissue. 

Other treatments

In-vitro fertilization can be considered as an alternative to conservative surgery, especially for women who are still looking to conceive or if conservative surgery hasn't been effective.