“Doctor, I have extremely painful periods. There is pain while using the washroom, nausea, vomiting, bloating, constipation, diarrhoea, and fatigue, and it is difficult to work and lead a normal life during my menstruation. Moreover, I am having fertility issues. Can you prescribe me some medicines?” Shreya asked.

The doctor replied, “Why not? Here are some multivitamins. Do not worry, you will be all right. These are normal symptoms during menstruation. Many women have the same.”

Shreya returned home hoping to feel better, but unfortunately, her symptoms persisted for years. It was only after years she learned her symptoms were indicative of endometriosis, a painful disorder that affects one in ten women.

Just like Shreya, endometriosis is often misinterpreted as common menstrual symptoms, leading many women to remain untreated or receive delayed treatment. In endometriosis, endometrial tissues, that normally lines the inside of your uterus grow outside your uterus. The tissues act the way they do inside the uterus even when they are outside the uterus. They thicken, break down and bleed with each menstrual cycle. But the blood has nowhere to go. It gets accumulated in the surrounding organs and makes them inflamed or swollen making menstruation an excruciating condition. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. However, recent studies say that it affects the other organs too.

According to the World Health Organization (WHO), endometriosis affects around 190 million trusted. Source People — Some 10% of people who menstruate worldwide.

Endometriosis symptoms can be like menstrual discomfort, including back pain, severe menstrual cramps, and pain during bowel movements or urination, particularly during menstruation. Additional signs include heavy or unusual menstrual bleeding, blood in urine or stool, constipation or diarrhoea, painful intercourse, persistent fatigue, and difficulty conceiving. However, the symptoms can vary significantly among women. While some may experience mild symptoms, others can have moderate to severe symptoms, and the severity of the pain does not necessarily indicate the degree or stage of the condition. It is possible to have a mild form of the disease yet experience excruciating pain, while others may have a severe form and little discomfort.

Endometriosis is a chronic condition that has no known cure, but there are treatments available to help manage its symptoms and improve quality of life.

Surgery can be used to remove endometrial tissue, cysts, and adhesions, which can help reduce pain and improve fertility in some cases. In more severe cases, a hysterectomy (removal of the uterus) may be recommended.

Pain relievers and Hormonal Therapies can be used to manage symptoms of endometriosis. As per Medical News Today, up to 80% of women experience symptoms again within 2 years of surgery. After surgery, many also go back on hormone treatments to maintain their condition and symptoms.

Endometriosis, a condition affecting women, is associated with higher production of prostaglandins compared to women without the condition. To alleviate menstrual pain, many women are prescribed NSAIDs such as Ibuprofen, Voltarol, and Ponstan (mefenamic acid), which prevent the body from producing prostaglandins. However, NSAIDs have common side effects such as nausea, vomiting, diarrhoea, stomach upsets, and ulcers, and are not considered a permanent cure for endometriosis.

• Gonadotropin-releasing hormone (GnRH) is a hormone that blocks the production of oestrogen, which stimulates the ovaries. This can reduce bleeding and inflammation and prevent scarring and cyst formation. GnRH agonists like Lupron Depot are injected, while GnRH antagonists like Elagolix are taken orally.
• Progestin is another hormone that inhibits oestrogen and prevents the growth of the endometrium (the lining of the uterus). Oral progestin pills are often more effective than birth control pills at relieving endometriosis symptoms.
• Danazol is a hormone derived from testosterone that can be amazingly effective at reducing endometriosis. However, because it mimics male hormones, it may cause unwanted side effects like hair growth or acne.

Endometriosis is a female disorder that has been overlooked and less discussed due to a lack of research studies. However, a clinical trial is currently being conducted to determine whether dichloroacetate (DCA) could be an effective non-contraceptive treatment for endometriosis. Recent research published in PLOS Genetics in 2020 revealed that individuals with endometriosis have specific chemical modifications to their DNA through the process of DNA methylation, which can alter gene activity. These changes were found to vary depending on the severity of endometriosis and may provide a way to diagnose endometriosis without surgery in the future.

Furthermore, a study conducted in 2020 investigated the effects of cannabis or cannabinoids on endometriosis symptoms and found that 59% of women who used cannabis reported being able to stop using pain medication, including opioids, entirely.

There is also evidence suggesting that environmental factors could contribute to the development or severity of endometriosis. A large study published in Human Reproduction in 2018 found that chronic sexual and physical abuse of various forms increased the risk of an endometriosis diagnosis by 79%. Researchers are also exploring possible links between endometriosis and other health conditions such as fibromyalgia, chronic fatigue syndrome, allergies, chemical sensitivities, and asthma.

Despite this research and studies, we still have a long way to go. Neunco aims to contribute to the development of Endometriosis drugs by providing necessary resources such as APIs, excipients, and RLD comparators. For more information connect to Neunco today!