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There is no specific factor that will make it trigger. I think retrograde menstruation and many cycles whereby part of the menstrual flow goes back into the pelvis is likely to be a contributing factor to advancing the stage of endometriosis. Hence why the clinical management which entails others going on the pill (so stopping having regular menstrual cycles) or taking some injections to stop the menstrual cycle per se are likely to improve the endometriosis and the symptoms of this disease. This is also been seen in women that conceive when they pregnant and for the nine months of pregnancy, they will not be producing the environments that normally cause a flare-up of the endometriosis and also they will not be having periods and and some studies have shown that pregnancy or at least have speculated that pregnancy will put the endometriosis to rest although for a short period of time.
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When patients get periods every month and they have got some genetic tendency or autoimmune problem then obviously the disease can proceed and any exposure to estrogen because the disease is dependent on estrogen hormone and ovarian hormones. So, any exposure of estrogen could potentially stimulate the endometriotic deposits and can make the symptoms worse and the disease could progress. If a patient has got infertility and she is not achieving pregnancy, that can also be a contributory factor. Pregnancy could be one thing which could stop the progression or using medical treatment in the form of oral contraceptive pills or some injections could also stop the progression of the disease and possibly reverse the deposits as well.
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Endometriosis is strongly related to stressful moments in life. The periods in life when somebody goes through a rough period, it is more likely that endometriosis will be stronger, more painful and everything. If it is only the anatomical problem, some things move there, I think it should happen all the time but it does not happen all the time – it happens at a very specific period of the life and all the women (because I am discussing those things)can tell you about this thing.
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What can affect the endometriosis and lead it to flare if we are doing IUI (Intrauterine Insemination) or if we are doing ovarian stimulation which is a common practice nowadays. After the surgery, instead of going to have IVF directly so you will try ovulation stimulation and they will start giving medication then you will have disruptions, you will have the symptoms exaggerated again and this is the way you feel that the symptoms are worse – if we are given a stimulation or we are doing IUI (Intrauterine Insemination) where we are inserting the semen or sperm into the womb by injection not taking these eggs from outside like what we are doing in IVF.
Answer from:
Good question. I think we probably don’t know the answer to that. Certainly some individuals who have endometriosis, their symptoms seem to get better by themselves and others symptoms are unchanged and others the symptoms get worse and that can be despite medical intervention, surgeries, treatments. We talk about the natural history of the disease and this is a real area of research interest trying to understand how it starts and how and if it indeed progresses to more severe stages or whether people may suddenly develop a very severe version of the condition. Lots of unanswered questions there.
