The Causes of Endometriosis

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Learn about the causes of endometriosis right here.


Motherhood speaks to Associate Professor Fong Yoke Fai, head and senior consultant, Division of Benign Gynaecology, Department of Obstetrics & Gynaecology, National University Hospital and Dr Kelly Loi, Health and Fertility Centre for Women at Paragon Medical Centre, about endometriosis and how it affects a woman’s fertility.


What Is Endometriosis?

Endometriosis is a condition in which cells from the endometrium (the lining of the womb) are found outside the womb in the pelvis and around the ovaries and fallopian tubes where they attach and form cysts as well as lesions.

Dr Loi elaborates, “Endometriosis can also take hold almost anywhere on, behind or around the womb, in the peritoneum which is the tissue that lines the abdominal wall and surrounds most of the organs in the abdomen, on the bowel and the bladder. It can also develop deep within the muscle wall of the uterus where it is called adenomyosis.”



Dr Fong emphasises that both endometriosis and adenomyosis are

abnormal situations and can cause severe symptoms such as painful

menses, heavy or abnormal menstrual bleeding, infertility,

painful sex, ovarian cysts and backaches.



What Causes Endometriosis?

The most likely and popular explanation of its cause is the “backflow of menses” which allows the endometrial cells to drop back and implant into the pelvis (lower part of the abdomen). Dr Loi adds that once in the pelvic area, the cells attach themselves to other organs and begin to grow. With each period, more cells from the endometrium enter the pelvic area while those already present are stimulated to grow by the hormonal fluctuations of the menstrual cycle. 

Both Dr Fong and Dr Loi also observe in the patients they treat that endometriosis runs in the family.


Does Having Fewer Babies and Conceiving Later in Life Cause Endometriosis?

Endometriosis is dependent on the cyclicity of the menstrual cycle.



Dr Loi explains that besides having more babies and conceiving

them earlier in life, women two to three generations ago also

mainly breastfed their babies.



“While pregnant and breastfeeding, their menstruation cycles were temporarily put on hold and they had no periods. This meant there was less opportunity for a back flow of menstrual blood to cause endometriosis. Today many women put off babies until their thirties so they may have 15 or 20 years with an uninterrupted menstrual cycle which increases their exposure to the risk of back flow of menstrual blood and developing endometriosis,” says Dr Loi.

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