In 1993, a bizarre case of endometriosis was reported, in which the woman had seizures on every first day of her menstrual cycle. Even though catamenial epilepsy (the term for seizure associated with the menstrual cycle) is known to be caused by other mechanisms, biopsy showed the presence of uterine tissue in the woman’s brain, which would proliferate and bleed every month to cause her symptoms. Even though it was an extremely rare case, it accounts for the strange yet intriguing nature of the disease called endometriosis.
Endometriosis is a condition in which the uterine lining is found in other regions of the body, which proliferates in response to estrogen and bleeds every month to cause chronic inflammation and pain. Even though it mainly affects the ovaries and pelvic tissues, it can also affect the bladder, intestines, vagina, rectum, etc, and in rare cases even the lungs and brain. Scar endometriosis is the type of endometriosis that occurs in surgical scars of cesarean surgery. Endometriosis causes severe pain and excessive bleeding during periods.
When the bleeding tissue cannot escape the body as it is not in the uterus where it can be shed through the vagina, it stays there and causes a vicious cycle of inflammation. This eventually causes changes in the pelvic anatomy causing defective picking up of the ovum and is one of the reasons for infertility in endometriosis. The inflammatory fluid is also known to be toxic to embryos, adding fuel to the fire.
Endometriosis is seen in about 10-15% of women in the reproductive age group. A study conducted in 2018 found that 1 in every 100 women suffer from endometriosis. It is estimated that an average of 6.7 years pass before the patient is finally diagnosed, as it is often dismissed as normal menstrual pain due to a lack of awareness of this disease. But it decreases the quality of life of the woman substantially due to disabling pain that prevents her from doing daily activities. Pain occurs during intercourse, and infertility occurs in about 40% of patients, all of which finally leads her to the doctor’s office.
In 1993, the Endometriosis Association began Endometriosis Awareness Month. It is observed worldwide in March through educational activities, fundraising, and marches. It aims to create general awareness in the public; especially in the adolescent age group as catching the disease early is beneficial. There are many such non-government organizations that are actively involved in educating the public and fundraising for research activities.
Every female experiences a little bit of retrograde menstruation, that is, backflow of blood and uterine tissue into fallopian tubes and into the abdominal cavity, during every cycle. This deposits on the ovaries and pelvic cavity and in people with genetic susceptibility and hormonal imbalance, it survives in these locations to cause disease. Another theory suggests these foci are there from birth itself. Many studies have shown the use of hormonal birth control and more pregnancies to be protective in effect.
A suspicion of diagnosis can be confirmed by an ultrasound or by a diagnostic laparoscopy. Hormonal pills and injections can be taken to decrease the growth of endometriotic tissue and regulate cycles, and intrauterine hormone-releasing devices can be left in place for some years to relieve symptoms. Surgery to remove endometriotic tissue from the pelvic cavity is done for severe cases and this can even lead to the removal of the uterus and ovaries. Newer therapeutic models targeting the migration and proliferation of uterine tissue are being studied, which can help in developing more tailored drugs.
Disclaimer: All information in this article is intended for general guidance only and must never be considered a substitute for the advice provided by a doctor, a physical therapist, or other qualified medical professionals.
Ichida M, Gomi A, Hiranouchi N, Fujimoto K, Suzuki K, Yoshida M, Nokubi M, Masuzawa T. A case of cerebral endometriosis causing catamenial epilepsy. Neurology. 1993 Dec;43(12):2708-9. doi: 10.1212/wnl.43.12.2708. PMID: 8255485.
Chauhan S, More A, Chauhan V, Kathane A. Endometriosis: A Review of Clinical Diagnosis, Treatment, and Pathogenesis. Cureus. 2022 Sep 6;14(9):e28864. doi: 10.7759/cureus.28864. PMID: 36225394; PMCID: PMC9537113.
Luna Russo MA, Chalif JN, Falcone T. Clinical management of endometriosis. Minerva Ginecol. 2020 Apr;72(2):106-118. doi: 10.23736/S0026-4784.20.04544-X. PMID: 32403909.
Vercellini P, Somigliana E, Viganò P, Abbiati A, Daguati R, Crosignani PG. Endometriosis: current and future medical therapies. Best Pract Res Clin Obstet Gynaecol. 2008 Apr;22(2):275-306. doi: 10.1016/j.bpobgyn.2007.10.001. Epub 2007 Nov 26. PMID: 18036995.
Parasar P, Ozcan P, Terry KL. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Curr Obstet Gynecol Rep. 2017 Mar;6(1):34-41. doi: 10.1007/s13669-017-0187-1. Epub 2017 Jan 27. PMID: 29276652; PMCID: PMC5737931.
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