Can endometriosis kill you? Is it life-threatening?

 Key takeaways

• Endometriosis is a condition where the tissues lining the inner layer of the uterus (endometrium) are found in places outside the uterine cavity.
• Endometriosis on its own is not fatal but can cause some complications that may be life-threatening, especially when left untreated or managed poorly.
• Endometriotic tissues can embed in different organs of the body but are commonly seen in the pelvic organs, e.g., the fallopian tube, ovaries, bowel, and bladder. Its complications and severity depend on the organ affected and the extent to which it is affected.

The uterus is made of three layers: the inner layer (endometrium), which lines the cavity; the middle layer (muscular layer); and the outer layer (perimetrium). In endometriosis, the endometrial tissues that line the uterine cavity are seen outside the cavity. They can be seen in some other places, like the perimetrium, fallopian tube, ovaries, bladder, and intestines.

Global statistics have shown that about 10% of people with vaginas in their reproductive years are diagnosed with endometriosis. This is approximately 1 in every 10 women. However, its exact prevalence cannot be ascertained due to the similarities of its symptoms to other conditions and the delay in its diagnosis. 

Symptoms of endometriosis differ from individual to individual, and their manifestation depends on the organ affected. Common symptoms include chronic pain in the pelvic region, severe pain during menstruation, painful sexual intercourse, and heavy and prolonged periods.

 Can endometriosis kill you?

Endometriosis often does not kill, especially if treated. It is not considered a fatal illness, but it can lead to some complications that may be fatal, such as ectopic pregnancy, bowel obstruction, peritonitis, and chronic anemia.

Currently, there's no known cure for endometriosis. However, there are treatment options available to manage the symptoms.

 How endometriosis can cause complications

Because of the similarities between the normal endometrium and endometriotic tissues, endometriotic tissues grow and shed with the endometrium with each menstrual cycle. The hormone responsible for this is the female hormone estrogen. 

As opposed to the endometrium, which sheds and leaves the body via the vagina during periods, endometriotic tissues get trapped in the body because there's no canal through which they'll be expelled. Additionally, endometrioid cyst/ chocolate cyst (a blood-filled sac formed by the presence of endometriotic tissues) can overgrow, burst, and its contents spread to the surrounding organs causing problems.

The body recognizes these trapped tissues as foreign bodies and therefore triggers inflammatory responses in the body leading to inflammation in the affected area. This results in the pain felt by people with endometriosis. 

With time, scar tissues may also form in those areas, leading to obstruction and possible abnormal bonding between organs. This can lead to reduced functions of the affected organs and might be fatal if not noticed and treated early.

 Fatal complications of endometriosis that can lead to death

Some complications of endometriosis that may lead to death include:

 1. Peritonitis

Peritonitis is inflammation of the peritoneum (a membrane covering the abdominal organs and some pelvic organs). This is often caused by an infection.

When endometriotic tissues get attached to the peritoneum, or there's a rupture of an endometriotic cyst, the body reacts by activating inflammatory responses, which can cause severe dysfunction in the abdominal cavity. Because the peritoneum lines all the abdominal organs and some pelvic organs, an inflammatory event in any region will affect all the other organs. 

 2. Ectopic pregnancy

An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in the fallopian tube. This can result in the rupture of the fallopian tube, which leads to bleeding. Bleeding following a ruptured ectopic pregnancy can result in severe anemia, hypotension, and death, if not treated promptly.

Also, anemia can cause severe dysfunction in vital organs such as the brain and heart.

 3. Bowel obstruction

Inflammation and the formation of scar tissues resulting from the presence of endometriotic tissues in the intestine can cause obstruction in the intestines. This can be partial or complete. The obstruction reduces or blocks peristalsis (the wave-like movement of the intestine that pushes food contents forward), depending on the extent of the obstruction.

Bowel obstruction can also result from peritonitis, and is considered an emergency surgical condition that requires immediate intervention.

 4. Urinary tract obstruction

Obstruction in the urinary tract due to endometriotic scar tissues mostly occurs in the ureters (the tubes through which urine passes from the kidney to the bladder), causing the backflow of urine to the kidney. This may result in the accumulation of urine and possible infection, which might damage the kidney if left untreated. 

Any condition that threatens the kidney is termed an emergency because the kidneys do more than just produce urine; they regulate blood pressure, produce hormones, contribute to the production of blood, and so much more.

When the kidney is damaged, its function is impaired, which may result in chronic kidney failure.

 5. Chronic anemia

Due to the excessive bleeding that occurs in endometriosis—both obvious and internal bleeding—the person is at risk of developing anemia. Chronic anemia can affect vital organs such as the heart, brain, and kidneys.

 What organs can endometriosis affect?

Research shows that endometriotic tissues can be seen in several organs of the body, but they're more commonly seen in some parts than others. 

Organs that endometriosis commonly affects are:

• Fallopian tube
• Ovaries
• Rectum
• Bladder
• Intestines

Organs the condition rarely affects include:

• Lungs
• Brain
• Diaphragm 
• Ureters

 Can endometriosis cause cancer?

Endometriosis is a benign (non-cancerous) growth and therefore does not cause cancer. Nevertheless, research has shown a link between endometriosis and some gynecological cancers, such as ovarian cancer, endometrial cancer, and breast cancer.  

Dr. Sally, a scientist at the Institute of Molecular Bioscience (IMB), discussed, in a YouTube video,  findings from research conducted in their facility on the link between endometriosis and ovarian cancer. She said, 

...We were able to identify that the genetic markers that predispose women to endometriosis also predispose them to epithelial ovarian cancer. We were able to identify nineteen genomic locations in women's DNA that increase their risk of both endometriosis and epithelial ovarian cancer.

This link may be attributed to some factors, such as increased estrogen levels and mutation in a particular gene (the ARID1A gene).

While endometriosis increases the risk of developing other gynecological cancers, the overall risk of endometriosis-associated cancers remains relatively low.

 Does treating endometriosis reduce the risk of death?

Although endometriosis has no known cure, proper management may prevent endometriosis complications and its fatality, thereby reducing the risk of death. This also involves you keeping up with appointment dates and maintaining your prescribed drug regimen. 

 Treatment for endometriosis

The goal of endometriosis treatment is to offset estrogen dominance and reduce pain. The treatment approach your doctor will recommend will depend on your symptoms and their severity. Treatment methods for endometriosis include:

• Use of pain relievers

Drugs like non-steroidal anti-inflammatory Drugs (NSAIDs) eg. ibuprofen, and other pain-relieving drugs, can be used to reduce the pain experienced by people with endometriosis.

• Hormonal therapy

Common hormonal therapies doctors use for treating endometriosis are:

• Use of birth control technique: This can be in the form of pills, injectables, or patches.
• Gonadotropin-Releasing Hormone Agonists (GnRHa): These drugs induce menopause-like effects, thereby reducing estrogen levels.
• Surgery

Surgeries for treating endometriosis may include:

• Deep excision surgery:  The total removal of all the endometriotic lesions.
• Ablation and cauterization: Superficial removal of the lesions. 
• Hysterectomy: This is the removal of the womb. It is mostly done in women who have no intention of getting pregnant again or in those with disabling pain.
• Dietary management

Reducing pain and inflammation is the main goal of dietary management of endometriosis. This involves the intake of foods that reduce inflammation and avoiding those that increase it.

• Exercise

Exercise can help improve your blood circulation. This promotes the delivery of oxygen, blood cells, and nutrients to the affected area as well as every part of the body.

 When to see a doctor

Most people dismiss endometriosis symptoms, especially when it presents with only dysmenorrhea. It is mostly mistaken as normal menstrual cramps which people with vagina experience. However, if you experience severe pain during your period that hinders you from performing activities of daily living and is consistent in every cycle, it's advisable to go see a gynecologist for proper investigation and treatment.

Also, if you experience any of the above-mentioned symptoms, you should as well see your doctor for proper referral and treatment.