What triggers endometriosis?

There are different causes of endometriosis and some of the causes of endometriosis are known but some are not and what we what we know is that retrograde menstruation which is when the monthly mental flow drains from within the uterus into the pelvis could be a cause of endometriosis. There are also hypotheses that endometriosis could be a consequence of some immune problems. It could be affected by hormones and some types of hormones and could also be associated with some genetic factors. There is a general consensus that the endometriosis per se as a disease may have a degree of familiarity however there are no studies showing a strong link between endometriosis and family history.

This is interestingly called a disease of theories because nobody knows what exactly is the reason behind that. One theory is called “theory of retrograde menstruation” so, as I said, normally, the menstrual flow is outside but somehow in some women, the lining of the womb when it is shed, it’s being shed, some of the deposits and some of the material goes retrogradely and it get deposits within the pelvis – either around the tubes or within the ovaries or in the peritoneum of the pelvis and then it responds every month to ovarian hormones. So, every month there is swelling in that deposit, endometriotic deposit. It swells up, it gets inflamed but because there is no outlet so, the patient gets pain, patient gets irritability and there’s a bit of bleeding inside that deposit which can lead to chocolate cysts within the ovary, outside in the pelvis sometimes. This is the theory but then, endometriotic deposits are seen in lungs or in some other distant sites so, this retrograde menstruation cannot explain that.
Some people believe that there is some genetic component in some women because in some cases, it runs in families as well. So, there might be some genetic tendency which the exact genes people are still studying and the research is going on but definitely, in some cases, there is some genetic component and reacting with some environmental factor which could be any trigger: environmental toxins, something in the beauty products, some chemicals. With genetic interaction, the patients can manifest the symptoms and the disease can progress as well.
One other popular theory is also autoimmune – that the body’s ability to clear those endometriotic retrograde deposits is impaired because they have seen that in some women retrograde menstruation occurs but they do not develop endometriosis so, maybe their body clears those deposits quickly compared to those women who have symptoms and the disease progress. So, they have other autoimmune diseases like: thyroid issue, like diabetes in some cases, it’s a type of autoimmune where the body reacts against its own things or the body’s ability to deal with that endometriotic deposits is impaired as well. There are different theories which explain different cases.

I think that endometriosis is much more present, mainly because our immune system is getting worse and worse with years. We have more stress, we have bad quality food, we have bad quality air to breathe, we have become a little bit more demanding and we get stressed for things that we should never be stressed about. So, imagine that if we stress our body this way, we affect the immune system and more symptoms related to the immune system are coming up: more allergies, more endometriosis, more problems with fertility. I don’t think the age will bring more endometriosis, the changes during the aging will bring the endometriosis and if you have been pregnant, probably you have balanced your immune system a little bit better, so you have less chances to develop endometriosis but this not exclude that even for a women who has been pregnant, had given birth, she would not develop endometriosis later.

Trying to figure out what triggers endometriosis is impossible due to difficulties associated with the selection of an appropriate control group and the exact evaluation of the dose and duration of exposure to the substance of interest. It is also impossible to determine the exact onset of the condition.

The trigger can start very early in the fetus stage if there is exposure to a huge amount of estrogen inside the womb, so she will be very liable to have endometriosis in the future. Also, after birth long exposure to exogenous estrogens from the environment, such as exogenous chemicals in cosmetics, plastics bottles that contain chemical material like bisphenol-A and bisphenol-F, preservatives, and chemical fertilizers on food can lead to endometriosis. Therefore, some may have endometriosis and stay calm, as a silent disease because there is no trigger, others may have just minimal endometriosis with severe symptoms due to continuous exposure to external triggers. This can explain why endometriosis become very common nowadays, not like in the past.

Moreover, a huge study is ongoing now between 14 countries that suggest some genes related to endometriosis; however, what triggers these genes might be different between one country and another country, between races, even between individuals. This means it could be related to genetic-epigenetic factors, as the endometriosis incidence in the general population is 1 in 10 women, and if the first-degree family relative has mild endometriosis, the risk will increase 10 folds more than the general population, and up to 15 folds if it is severe endometriosis.

Currently, the myth that endometriosis is some endometrial tissues outside the uterus that is only responding to the estrogen hormone of your body could be challenged because many studies now suggest how the environmental factors and exogenous estrogen can lead to the development of endometriosis, hence, the regression of the disease, if we can control these factors, even we can reverse the disease very early, which is the new development in endometriosis understanding.

These are basically the pathology, as the real pathology is still not known. We have some hypothesis that probably it’s a retrograde movement of the blood but due to various scenarios which contradict this hypothesis, the most acceptable one the doctor Dr David Redwine in Oregon of Portland, USA has been doing a very pioneering research work recently which is based on the genetic mapping so, when they do the laparoscopic surgery, they do the mapping of the areas and they correlate with that gene receptor expression of that areas probably it does have a genetic connection so, the cause is not known but it affects the body in various like parts of the spectrum and another very intriguing thing about endometriosis is that a mild disease when we grade it clinically so, a very little, very few folk focail of the endometriosis or a very mild disease can have a very very severe symptomatology so, a very grade I endometriosis patient can have a very severe pain or a grade IV with with big ovarian cyst that patient might have no symptom at all so, it is not always related to the symptomatology and this tells us that there is a massive biochemical perspective to this disease.

Good question. We don’t understand why endometriosis happens. We know that it seems to be hereditary so there’s probably a genetic component but we don’t specifically know which gene leads to endometriosis and the likelihood is there is probably a number of genes not one, specific one on its own. There are other factors, theories that have been put forward, for example, changes in the environment in the pelvis, so we think that in some women, the cells lining the walls of the pelvis perhaps produce more of a certain substance which might predispose to endometriosis and there’s a very old theory that endometriosis is due to retrograde menstruation but the problem is that up to 80 -90 percent of women exhibit retrograde menstruation when the menstrual tissue goes back through the fallopian tubes into the cavity, so that doesn’t really explain why it happens. The short answer is: we don’t really know and we need a lot more research in this area.

To be honest, we know that endometriosis it can run in families so, it is not uncommon that in clinic comes and mentions symptoms of endometriosis tell us “by the way my mum suffered from endometriosis” or “my aunt suffered from endometriosis” and also it’s not uncommon that we see sisters in the same family having endometriosis. So, there’s some genetic predisposition for this problem. Nobody understands why but there are some theories which can let us possibly understand why endometriosis happens to certain groups of ethnic backgrounds and doesn’t happen in others. We know that the most acceptable theory is what we call retrograde menstruation, means that, a lady when she minister waits when she has a period a period instead of going out some of the lining of the womb goes up through the fallopian tubes inside the pelvis and of course that lady will have liability for this lining to implant inside the pelvis behind the womb, on the peritoneum which is the layer which covers the inside of the tummy. So, not all ladies of course will have retrograde menstruation and will have endometriosis but there is some genetic predisposition that the ladies level to allow this um lining to implant inside the pelvis. So, there is most probably some genetic disposition in certain families, certain ethnic backgrounds that they will have liability to have endometriosis and of course, delaying childbirth which happens mainly in the western world and that’s why we see a lot of endometriosis at early stage whereas in countries where starting pregnancy at early stage and most of the time without contraception, in those ladies we don’t see the endometriosis that’s common in these societies whereas in the western world is more common.