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What Causes Endometriosis

Introduction

While there is so much we don’t know about how and why so many women get endometriosis (and why so many others don’t). There is a growing body of evidence that forms a compelling trail of breadcrumbs leading to some potentially meaningful and fruitful ways of approaching endometriosis. These breadcrumbs often lead us to view endometriosis less as a disease to be cut out (although that has its place) and more towards it being a condition that relates holistically to the global well-being of the individual sufferer.

Endometriosis Caused by Genetics 

Genetic predisposition plays a significant role in the development of endometriosis, with individuals having a family history of the condition being at a higher risk of developing it themselves. Causes of endometriosis remain largely unknown, but the condition has an estimated heritability of 50% with 26% estimated due to common genetic variation. Recent research suggests that certain genetic variations may influence a person’s susceptibility to endometriosis, affecting their immune response, hormonal regulation, and tissue repair mechanisms. 

Additionally, genetic factors may contribute to the severity of endometriosis symptoms and the likelihood of complications such as infertility. While genetics alone do not determine the development of endometriosis, they can interact with environmental and hormonal factors to increase the risk of the condition. 

Endometriosis Caused by Retrograde Menstruation

Retrograde menstruation occurs when menstrual blood containing endometrial cells flows backward through the fallopian tubes into the pelvic cavity during menstruation. Instead of being expelled from the body, these displaced endometrial cells implant and grow on pelvic organs like the ovaries, fallopian tubes, and pelvic lining. Over time, this can lead to the formation of endometriosis lesions, causing symptoms such as pelvic pain, infertility, and menstrual irregularities. While retrograde menstruation is common, those with endometriosis may have a defect in their immune system, allowing the implanted cells to thrive and grow, exacerbating the condition’s severity.

Endometriosis Caused by Environmental Factors

Exposure to environmental toxins, chemicals, and pollutants may increase the risk of developing endometriosis or exacerbate existing symptoms. Endocrine-disrupting chemicals (EDCs), such as bisphenol A (BPA), phthalates, and polychlorinated biphenyls (PCBs), can disrupt hormonal balance and interfere with reproductive function, potentially contributing to the development and progression of endometriosis. A recent study was used to observe the presence of heavy metals in specific earth moving sectors (industrial, transportation, and waste management), among these metals, cadmium (Cd) has received attention due to its ability to bind to hormone receptors. A case-control study relying on self-reported data for endometriosis diagnosis found higher Cd blood levels in 61 patients with endometriosis. 

Furthermore, environmental factors such as diet, lifestyle choices, and occupational hazards may influence the risk of endometriosis through their effects on inflammation, immune function, and hormonal regulation.

Endometriosis Caused by Hormonal Factors 

Hormones play a crucial role in regulating many different processes in the body including appetite and metabolism, sleep cycles, reproductive cycles and sexual function, body temperature and mood. An imbalance occurs when there is too much or too little of a hormone. Hormonal imbalances, particularly involving oestrogen, play a significant role in the development and progression of endometriosis. Oestrogen, a hormone responsible for regulating the menstrual cycle and promoting the growth of the uterine lining, can stimulate the proliferation of endometrial tissue outside the uterus. Elevated levels of oestrogen can lead to the excessive growth of endometrial cells in the pelvic cavity, contributing to the formation of endometriotic lesions. Fluctuations in hormone levels throughout the menstrual cycle can exacerbate symptoms such as pelvic pain, cramping, and heavy menstrual bleeding, further impacting the quality of life for individuals with endometriosis. 

Endometriosis Caused by Immune System Disorders

Immune system disorders, also known as immunological disorders, refer to conditions in which the body’s immune system malfunctions, leading to abnormal responses to substances or tissues within the body. Dysfunctions in the immune system can play a role in the development and progression of endometriosis. 

Normally, the immune system helps identify and eliminate foreign substances and abnormal cells, including endometrial tissue outside the uterus. However, in individuals with endometriosis, the immune system may fail to recognize and destroy ectopic endometrial cells, allowing them to implant and grow on pelvic organs. Additionally, immune system abnormalities such as inflammation and altered immune cell activity may contribute to the chronic pain associated with endometriosis. 

Endometriosis Caused by Surgical Scars

Surgical scars from procedures such as hysterectomy, caesarean section (C-section), or pelvic surgery may provide sites for the implantation and growth of endometrial tissue outside the uterus. During surgery, endometrial cells may inadvertently adhere to incision sites or surgical instruments and subsequently proliferate, forming endometriotic lesions. 

Scar tissue resulting from previous surgeries can create a conducive environment for the development of endometriosis, exacerbating symptoms such as pelvic pain, infertility, and menstrual irregularities. While surgical intervention is often necessary to address certain gynaecological conditions, careful consideration of the risk of endometriosis recurrence and appropriate management strategies is essential to minimise its impact on patients quality of life. 

Endometriosis Caused by Metaplasia 

Metaplasia refers to the transformation of normal pelvic tissue into endometrial-like tissue, potentially contributing to the development of endometriosis. Under certain conditions, specialised cells in the pelvic cavity may undergo a change in phenotype, acquiring characteristics similar to endometrial cells. 

This process can occur in response to hormonal fluctuations, inflammation, or tissue injury, creating an environment conducive to the growth of endometriotic lesions. Metaplastic changes may occur in various pelvic structures, including the peritoneum, ovaries, and fallopian tubes, leading to the formation of ectopic endometrial tissue and the subsequent development of endometriosis. 

Endometriosis Stress & Emotional Trauma

A rapidly growing number of women are waking up to the fact that ‘the body keeps the score’ and that many of our stubborn health issues are caused (or at least badly exacerbated) by the impacts of stress and cortisol on the body. Many of these women are those with endometriosis. And studies like this one are in the process of proving these links exists even though our doctors rarely talk to us about them.

It is a sad fact that even the stressors of the past can make us sick in the present. Let alone the things we deal with in the present day. You only have to look at the rates of chronic pain and sickness in war veterans to know that our bodies have a strong tendency to carry thing things that happened to us in the past.

The happy news within the sad news is that if it is, in fact, true that our emotional stresses and trauma are whats is our endometriosis, there are many more opportunities to heal than we might have expected. At least for those who prefer to ‘heal’ themselves rather than be cut open as a solution to their health challenges.

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