Endometriosis and its Psychological Impact

Endometriosis is a gynecologic condition caused by abnormal growth of endometrial tissue, the innermost lining of the uterus, in other places in the pelvic cavity. This ectopic tissue behaves just like the normal endometrial lining throughout the menstrual cycle. As the blood and tissue produced has no way of leaving the body, it causes inflammation, adhesions, and cysts in surrounding tissues leading to the symptoms. 

Endometriosis impacts about 10 - 15% of women within the reproductive age group. 70% of chronic pelvic pain, pelvic pain that lasts for six months or longer, is attributed to this condition.

Symptoms

Pain during menstruation is the typical complaint of women with endometriosis. Menstrual cramps in these women, dubbed ‘killer cramps’ by some, can be quite severe, leaving the person unable to function. Pain during intercourse is also common.

Infertility is another major symptom of endometriosis occurring in 30% - 50% of people. This is caused by different mechanisms, including the change in the quality of eggs, blockage of the fallopian tube, and problems with implantation.

Diagnosis

The diagnosis of endometriosis is quite tricky. Its symptoms overlap with the symptoms of many other gynecological disorders. In addition to that, blood tests, examinations, and imaging cannot definitively diagnose or exclude endometriosis. The only method to confirm its diagnosis is through laparoscopy, a surgical procedure on the abdomen or pelvis using a small incision. These problems delay its diagnosis. A study¹ found that the average time between women seeing a doctor with their symptoms and getting a final diagnosis is 7.5 years.

The pain due to endometriosis is caused by cyclic changes in the ectopic endometrial tissue during the menstrual cycle. It can be managed using medication that inhibits ovulation and menstruation. These include combined oral contraceptives and other hormonal treatments. There is no definitive treatment of endometriosis currently. Surgical removal of the lesion can alleviate symptoms and help with infertility; however, this is not a cure as the symptoms tend to come back after some time. Surgery is only recommended for cases with severe pain, failure of medication, and fertility problems.                                                                                                                     

Psychological Impact

This chronic condition affects a person’s life in different dimensions. Due to this, it is associated with an increased risk of depression and anxiety.

The pain due to endometriosis can lead to low energy and feelings of anger and stress. This can impact relationships with family and friends. Pain associated with intercourse is among the commonest symptoms of endometriosis. The pain can last for days; hence women frequently avoid sexual intercourse, which may cause relationship problems.

Pain can also significantly affect the daily functioning of individuals. This can mean decreased work and school attendance. A study found that, on average, women miss nineteen workdays per year because of symptoms of endometriosis. The delay in diagnosis causes difficulties in getting sick leaves in school and workplaces. The difficulties in diagnosing endometriosis have deleterious effects on a person’s mental well-being. The repeated medical visits and multiple diagnoses to no avail can take their toll on a person.

The fact that it doesn’t have definitive treatment is another issue. When the symptoms of endometriosis come back even after surgery, women become frustrated. Problems with pregnancy and possible infertility are also sources of distress.

Many agree that there is a paucity of research and funding towards this condition that affects so many. There should be more effort to find ways to diagnose it sooner and treat it more effectively. In the meantime, society taught to acknowledge the daily struggles of women with endometriosis, policies should be in place to make schools and workplaces more accommodating to them.   

Written by: Selam Temesgen, M.D.