Connection Between Endometriosis and Weight Gain

Uterus has three layers perimetrium, myometrium and endometrium. The endometrium usually under goes cyclical changes under the influence of hormones during each menstrual cycle. Presence of functional endometrial tissue outside the uterine mucosa is known as endometriosis. It is usually benign but is locally invasive and disseminates widely. Cyclical hormones stimulates growth but continuous hormones suppress it. The commonest sites of endometriosis are ovary, fallopian tube, pelvic peritoneum, sigmoid colon, pouch of douglas, uterosagral ligament, broad ligament and abdominal scar tissue.
Most common symptoms are painful periods. Pain usually starts few days prior to menstruation and during menstruation and takes time to get relieved. Infertiltiy, abnormal menstruation especially menorrhagia, dyspareunia, chronic abdominal pain are some other symptoms. Sometimes abdominal examination may reveal a mass in the lower abdomen which is most likely due to an enlarged chocolate cyst or tubo – ovarian mass. This is most likely the reason for weight gain due to endometriosis.
Diagnosis is usually made on the basis of clinical findings. Investigations like serum marker CA125 is usually raised. Imaging studies such as transvaginal sonography, MRI, CT scan, and laparoscopy helps in the confirmation of the diagnosis of endometriosis. A certain kind of endometriosis that is also called adenomyosis which is the in growth of the endometrium directly into the myometrium. Symptoms are similar to that of endometriosis. Abdominal examination reveals a mass arising from the pelvis occupying the mid line, mimicking a fourteenth week pregnant uterus and thus it is associated with abnormal weight gain.
Treatment modalities:
• Expectant management with NSAIDS and observation of patients with mild and minimal symptoms.
• Pregnancy usually cures the condition.
Medical management with hormonal therapy:
• Combined estrogen and progesterone pills
• Progestogens
• Levonorgestral releasing IUCD
• Danazol
• GnRH agonist
Surgical management:
• Conservative surgery with laparoscopy in minimal to mild endometriosis to improve fertility outcome.
• Definitive surgery in advance stages where there is no scope for fertility improvement or family is completed –     hysterectomy with bilateral salpingo oophorectomy
• Combined medical and surgical therapy
• Preoperative hormonal therapy reduces the size and vascularity of the lesion to facilitate the surgery.
• Postoperative hormonal therapy destroys the residual lesions and destroys pain.
Endometriosis forms endometrial tissue which develops outside the uterus. This causes chronic abdominal pain, heavy, painful or irregular periods, painful and infertility. There are reports of bloating and weight gain. Sometimes polycystic ovary syndrome (PCOS) can also mimic symptoms of endometriosis.
Bloating and fluid retention are common symptoms of endometriosis. Bloating does not makes the body gain weight but makes the person look and feel heavier. It is noticed that bloating worsens before or during period.
Endometriosis is an estrogen dependent disease because the symptoms get worse with higher estrogen levels. It is many a times believed that estrogen dominance can cause weight gain. This happens only when estrogen in the body outweighs the progesterone.
As endometriosis is painful so it incapacitates the patient from day to day activities and makes them bed ridden. Prolonged PMSing leads to binge eating which leads to excessive gain in weight of the body.

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