The Causes and Risk Factors of Endometriosis
One of the most common and disabling chronic inflammatory diseases that can affect a woman in her fertile stage is endometriosis. Its most characteristic symptom is severe pain during menstruation, which can even affect urination and defecation. Now, what are the causes and risk factors of endometriosis?
As the Office on Women’s Health explains, endometriosis occurs when tissue similar to that which lines the uterus on the inside develops outside the organ. Consequently, it can affect different parts of the reproductive system (ovaries, fallopian tubes, and supporting tissues of the uterus). In less common cases, the abdomen and its peritoneum are affected.
Common causes of endometriosis
The pathogenesis of endometriosis is unknown. However, various hypotheses and explanations have been developed over the years.
According to a recent study published in the journal Legal Medicine of Costa Rica, the causes and risk factors of endometriosis revolve around the following aspects:
- Retrograde menstruation: Menstrual blood isn’t expelled normally, but returns through the fallopian tubes into the pelvic cavity, in the opposite direction to normal. This blood contains endometrial cells that attach to different parts of the reproductive system and then grow.
- Metaplasia of the germinal epithelium: This is the differentiation of mesothelial cells in tissue similar to the endometrium. In other words, the transformation of cells of the peritoneum into cells equal to or similar to those of the endometrium.
- Metastatic spread: This is the journey of cells to the far away.
At the same time, estrogen activity has often been suggested as a possible cause of endometriosis. More specifically, the overproduction of these hormones, prostaglandins, and cytokines in endometrial tissue.
Experts at the Mayo Clinic outline other possible causes of endometriosis:
- The deformation of surgical scars
- Endometrial cell transport by various fluids
- Immune disorders
The role of genetics
Women who have a family history of endometriosis are considered to be at higher risk of developing the disease than those who don’t. Therefore, there’s a possible genetic origin.
Endometriosis risk factors
Some of the risk factors most associated with the development of endometriosis are the following:
- Age: Women of reproductive age are much more prone to endometriosis than menopausal women.
- Infertility: Not having had children.
- Family history: As we clarified in the section on genetics.
- Altered menses: Lasting more than 7 days with bleeding, recurring in less than 27 days between cycles, or starting early (before age 11).
- High estrogen levels or artificial overexposure to them.
Other associated risk factors are obesity and its opposite, low body mass index. There are also hypotheses about the influence of diets high in red meat and trans fats, as well as a sedentary lifestyle.
Exposure to endocrine disruptive substances could favor the migration processes of endometrial cells to abnormal sites. For example, diethylstilbestrol, prescribed to pregnant women in the past, was linked to endometriosis in fetuses of women whose mothers were medicated with the substance.
It’s important to note women don’t have heavy menstruation or problems in the reproductive system in all cases. There have even been cases of asymptomatic patients, which highlights the complexity of this health problem.
When to go to the doctor?
If you’re of reproductive age and your periods are more painful than they should be and the discomfort is so intense that it prevents you from leading a normal life, it’s best to get a gynecological check-up. Keep in mind that, even when the pathogenesis of endometriosis is unknown and there’s no curative treatment, there are treatment options that allow for symptom control.
Both early diagnosis and treatment and adherence to the latter can be very beneficial in the short and long term. For this reason, don’t stop going to your periodic controls. Avoid putting them off, as well as downplaying the discomfort you may experience during menstruation.It might interest you...
- Durón González R, Morera PB. Endometriosis. Med Leg Costa Rica Edición Virtual [Internet]. 2018 [cited 2021 Jul 7];35(1). Available from: https://www.scielo.sa.cr/pdf/mlcr/v35n1/1409-0015-mlcr-35-01-23.pdf
- Endometriosis: MedlinePlus en español [Internet]. [cited 2021 Jul 7]. Available from: https://medlineplus.gov/spanish/endometriosis.html
- Endometriosis [Internet]. Organización Mundial de la Salud. [cited 2021 Jul 7]. Available from: https://www.who.int/es/news-room/fact-sheets/detail/endometriosis
- Endometriosis | Oficina para la Salud de la Mujer [Internet]. [cited 2021 Jul 7]. Available from: https://espanol.womenshealth.gov/a-z-topics/endometriosis
- Emilio Fernández O, Jaime Albornoz V. Endometriosis e infertilidad. Rev Médica Clínica Las Condes [Internet]. 2010 May 1 [cited 2021 Jul 7];21(3):403–8. Available from: https://www.elsevier.es/es-revista-revista-medica-clinica-las-condes-202-articulo-endometriosis-e-infertilidad-S0716864010705514
- ¿Cuáles son los síntomas de la endometriosis? | NICHD Español [Internet]. [cited 2021 Jul 7]. Available from: https://espanol.nichd.nih.gov/salud/temas/endometri/informacion/sintomas
- Ulett Araya NM. Actualización en los puntos clave de la endometriosis. Rev Médica Sinerg [Internet]. 2019 May [cited 2021 Jul 7];4(5):35–43.