Endometriosis: The Real Cause of Dysmenorrhea

Women of childbearing age a decade or two ago might not have even heard of the term endometriosis. Fortunately, today the concept of endometriosis has made its way onto social media, and women talk about this condition with some familiarity. At least they know that painful menstruations are not normal, and they can seek medical help and consider whether endometriosis might be among the causes. Various studies agree that at least 10% of women suffer from endometriosis (in Spain, there could be more than two million affected women).

Until not too long ago, most doctors trivialized menstrual pain, known as dysmenorrhea. Many women did the same, often due to the hereditary component of the condition, having their mothers as menstrual references, who would tell them, “pain is normal.” This delayed diagnosis and treatment for years.

“In the last five years, there has been a significant increase in awareness and education about this pathology, both among health professionals and the general population. Previously, endometriosis was often underdiagnosed because its symptoms, being varied, were usually attributed to other conditions. Moreover, the lack of specific research and the stigma associated with menstrual problems contributed to many women not receiving an adequate diagnosis. Today, thanks to awareness campaigns and greater medical knowledge, more women are being correctly diagnosed and treated,” says Dr. Mariel Silva, a specialist in Well-ageing Medicine at SHA.

From a clinical perspective, endometriosis is defined as the presence of tissue similar to the endometrium, which normally lines the inside of the uterus, in other parts of the body, such as the ovaries, fallopian tubes, bladder, and intestines.

“The diagnosis is based on symptom evaluation, physical exams, ultrasounds, and in many cases, laparoscopy, which is a minimally invasive surgery that allows direct visualization of endometrial lesions. Due to the similarity of its symptoms with other conditions, such as irritable bowel syndrome, urinary infections, and other gynecological conditions, it is easy for the diagnosis to be confused if a thorough evaluation is not conducted,” explains Dr. Silva.

The main symptom of endometriosis is pelvic pain associated with menstrual periods. While many people experience cramps during their periods, those living with endometriosis often describe intense, debilitating menstrual pain that limits their lives for two or three days a month. This pain may worsen over time.

Common symptoms of endometriosis include:

Intense and painful periods. Pelvic pain and cramps may appear before the menstrual period and last several days. Pain may also occur in the lower back and stomach.

Pain during sexual intercourse. This is a very common symptom of endometriosis.

Infertility. In some people, endometriosis is diagnosed through fertility studies.

Other symptoms. Fatigue, diarrhea, constipation, bloating, or nausea before or during menstrual periods.

“The exact origin of endometriosis is not completely understood, but several theories attempt to explain it. One of the main theories is retrograde menstruation, which suggests that during menstruation, menstrual flow containing endometrial cells flows backward through the fallopian tubes and deposits in the pelvic cavity. However, retrograde menstruation occurs in many women, but not all develop endometriosis, indicating that other factors are also at play,” explains Dr. Silva.

Another theory is the transformation of peritoneal cells, which proposes that cells lining the abdomen transform into endometrial cells. There is also the lymphatic and vascular dissemination theory to explain endometriosis. This theory suggests that endometrial cells enter the lymphatic or blood vessels and are transported to other parts of the body, which could explain the presence of endometriosis in areas distant from the pelvic region.

“Several studies have shown a higher incidence of endometriosis among first-degree relatives of affected women, suggesting that genetic factors play an important role,” indicates Dr. Silva of SHA.

Immune dysfunction is another theory that attempts to explain the origin of this disease. “It is believed that women with endometriosis have an immune system that fails to recognize and destroy endometrial tissue outside the uterus. Women with endometriosis also have a higher prevalence of other autoimmune diseases, suggesting a possible immunological link,” says the expert.

Lastly, environmental factors could also contribute to the development of endometriosis. Exposure to certain chemicals, endocrine disruptors, and environmental toxins has been suggested as a possible risk factor. “In summary, it is likely that endometriosis results from a combination of several factors, including genetic, immunological, hormonal, and environmental,” states Dr. Silva.

At SHA, endometriosis is approached from diagnosis and treatment with a comprehensive and personalized approach. “In addition to highly specialized clinical care, we provide psychological support and recommend lifestyle changes, such as a balanced diet and regular exercise, to help manage symptoms and improve the quality of life for our patients. We always work closely with each woman to develop a treatment plan tailored to her specific needs,” says Dr. Silva.