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What is Endometriosis?

Your Questions About Endometriosis Answered!

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ENDOMETRIOSIS EXPLAINED

It is a very difficult disease to explain to people without a medical background.

It is important to remember that the menstrual fluid contains all the elements necessary to construct an endomtrium. It contains the surface epithelium cells, the glands and blood vessels. To see an explanation of the microscopic structure of the endometrium ( simplified off course) click here .

Due to some still unknown reasons , the endometrial elements in the menstrual fluid will start growing in areas that came into contact with the menstrual fluid. (Ovaries, tubes, the peritoneum in the pouch, on the utero sacral ligaments etc.). This will only happens in some individuals. We are still uncertain why only in some.

These abnormal endometrial tissue will continuously increase in size and also invade the deeper laying tissues. All the monthly changes that occur in the normal endometrium ( see normal menstruation ) , also occur in the abnormal endometrium.

Here is short graphic explanation of how endometriosis developes.

ONE

A drop of menstrual fluid drips from the fimbrial opening of the tube. (retrograde menstruation)

TWO

The menstrual fluid comes into contact with the peritoneum.

THREE

The endometrial components in the fluid start forming a new endometrium.

FOUR

The new endometrium is in a foreign site . It cannot establish contact with the muscle layer of the womb (uterus) and the edges curl inwards.

FIVE

A endometrioma ( endometrial lesion ) forms.

SIX

It menstruates monthly and grows larger and it also invades the the deeper layers of the peritoneum.

SEVEN

Pressure inside the lesion increases over months due to the continuous menstruation. Some of the lesions might rupture (burst open) and there contents might spread to form new lesions.

EIGHT

The ruptured lesions forms rough areas to which other organs ( bowel, fallopian tubes) might adhere to , forming adhesions.

NINE

Longstanding adhesions between endometriosis and bowel.

Further Graphic Explanations of Endometriosis

The next drawings are a further attempt to explain this in a simple manner. To understand these drawings , it is important to have an idea about the peritoneal cavity and the peritoneum CLICK HERE for more information.

Bleeding through the fallopian tubes spills blood into the peritoneal cavity . The endometrial tissue present in the blood start invading the peritoneal membrane and spread along it. Probably due to it presence in a foreign site the endometrial tissue behaves differently. It does not spread to cover a surface but instead it curls and forms small sphere like structures. A type of menstruation will occur inside these spheres. They will gradually grow larger and eventually some will rupture. When they rupture, endometrial building blocks are released into the peritoneal cavity and this also helps the disease to spread. The ruptured endometrial nodules also cause adhesions. REFER TO ADHESIONS EXPLAINED

The next drawing illustrates the intact uterus and ovaries. The vagina is removed. The blue layer surrounding the uterus is the peritoneum. The peritoneum covering most of the uterus is densely adherent to the muscle and therefore represent buy a different color.

The previous drawing should be used as a guide to understand the next one better. The next drawing shows the purple nodules representing endometriosis occurring on the peritoneum next to the uterus , on the tubes and on the ovaries.

The abnormal endometrium is also under hormonal control and the same changes that occur in the normal endometrium occur in the abnormal endometrium. The next illustrations show a nodule in the different stages of menstruation. This nodule is situated on peritoneum as illustrated in the next drawing.

The next drawing shows a cross section through this nodule just after a menstruation.

The purple line represents the endometrial epithelium cells and the blue line the peritoneum. Because the endometrium is in a foreign region and not in contact with the muscle of the uterus (womb), the epithelium curls at the edges. The edges meet and a spherical structure is formed. If endometrium

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The next drawing shows a cross section through the lesion at the time of ovulation

The endometrium is thick and resembles the normal menstruation just before ovulation occurs.

The next drawing shows a cross section through a lesion just before the onset of menstruation.

The abnormal endometrial tissue resembles the normal normal premenstrual endometrium with increased blood flow, spiral arteries and increased glandular secretions.

The next drawing shows a cross section through a menstruating lesion.

Menstruation occurs in the abnormal endometrium in the same way and at the same time when it occurs in the uterus.

The menstrual cycle will repeat over and over and as it does the lesions grow bigger . It is obvious that tissue damage with subsequent pain and other symptoms will follow.

The only reliable way to diagnose this disease is to see the lesions and to take biopsies ( tissue samples). This is usually done by doing a laparoscopy.

A detailed discussion of the treatment is beyond the scope of this site. The treatment depends on two methods namely surgical destruction of the lesions and medical suppression of female hormonal activity. The latter causes the endometrium to become atrophic ( very thin and inactive) this allowing the body to destroy the abnormal endometrium. A combination of both methods is often used.

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