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What Is Stromal Endometriosis?

Stromal endometriosis is a term used to specify the nature of tissue present in endometriosis. A diagnosis featuring this type of cell could mean endometrial lesions are more challenging to spot within your body.

Stromal endometriosis describes endometriosis tissue made primarily of stromal cells. Stromal cells make up the connective infrastructure of all organs in your body.

In the lining of your uterus, the endometrium, stromal cells exist within both the functional layer that sheds during menstruation and the basal layer that triggers regeneration of the functional layer.

Conventional endometriosis consists mainly of glandular cells, the cells that dominate the makeup of your epithelial lining, the topmost layer of the endometrium. In stromal endometriosis, stromal cells are the predominant cell type.

Limited research exists on stromal endometriosis, and its exact prevalence is unknown. Older research from 2009 suggests that while stromal endometriosis is under-recognized, it may be a common presentation of endometriosis, accounting for as many as 44% of people reviewed.

As a tissue variation rather than a subtype, the symptoms of stromal endometriosis are similar to those of conventional endometriosis.

Stromal tissue will respond to hormone fluctuations in your body just as glandular cells do.

Symptoms of endometriosis include:

chronic pelvic pain

pain during penetration

abnormal menstrual bleeding

infertility

Because endometriosis can develop almost anywhere in your body, pain can be specific to lesion sites.

If you have endometriosis on your bladder, for example, you may notice pain when urinating or experience symptoms that feel like a bladder infection.

Some people live with endometriosis but don't experience symptoms.

The causes of endometriosis aren't fully understood, but several theories exist.

The most widely accepted is that of retrograde menstruation, where endometrial tissue backflows through your fallopian tubes into your pelvic cavity, allowing for the endometrial cells to spread.

Another theory involves differentiating certain cell types into endometrial-like tissue due to genetic or hormonal triggers. A third theory is that it's caused by the failure of your immune system to eliminate inappropriate endometrial cells outside of your uterus.

Why stromal endometriosis may develop instead of conventional endometriosis isn't clear. But recent research, such as a review from 2021, suggests stromal cells may spark unique interactions with immune cells.

These distinctive interactions potentially contribute to immune dysfunction and tumor development processes across various conditions.

Surgery is the only way to diagnose any form of endometriosis definitively. Your healthcare professional does this through laparoscopy, or "keyhole" surgery.

Laparoscopy involves making a small incision in your abdomen that's just large enough to insert a specialized viewing tool called a laparoscope. A doctor uses the scope to examine the surface areas of your reproductive organs and other structures inside your abdominal cavity.

Conventional endometriosis almost always has a distinct appearance specific to uterine gland tissue. It appears in varying color shades, involves a spectrum of cellular makeups, and can occur at multiple depths within tissue.

Stromal endometriosis may not have the classic glandular appearance, making it less obvious on visual assessment.

Stromal endometriosis is treated using the same methods as conventional endometriosis. A healthcare professional will recommend treatment based on your symptoms, where the endometriosis has developed, and the presence of any coexisting conditions.

Some cases of endometriosis can be treated with hormone therapy, such as oral contraceptives or the placement of an intrauterine device (IUD). A doctor may recommend this first-line option if your symptoms are mild or endometriosis is in a difficult-to-reach area of your body.

Different hormone therapies are available based on whether or not you're planning on pregnancy.

For moderate to severe endometriosis, or if fertility is trying to be regained, surgery is the primary option. A surgeon can remove endometriosis lesions and adhesions — bands of scar tissue — with the same laparoscopic methods used during diagnosis.

In extreme cases, laparotomy or open surgery may be necessary to remove endometriosis fully.

If you aren't experiencing symptoms, a healthcare professional may recommend monitoring your condition rather than actively starting treatment.

Endometriosis is treatable, though up to 80% of people report a recurrence of pain within 2 years of surgery. Medications and hormone therapy can help extend the time you remain pain free.

Ultimately, endometriosis isn't considered a fatal condition. But if it's left untreated, it can lead to life threatening complications like ectopic pregnancy or small bowel obstruction.

Although considered very rare, older research indicates it's possible for endometriosis to lead to the development of endometrial stromal sarcoma, a type of cancer originating from the stromal cells of your endometrium.

According to the American Cancer Society, the combined 5-year survival rate for any stage of low-grade endometrial stromal sarcoma is 96%. But the high-grade endometrial stromal sarcoma survival rates dip to around 43%.

What are endometrial stromal cells?

Endometrial stromal cells are connective tissue cells found throughout your endometrium, the lining of your uterus.

What are endometrial stromal tumors?

Endometrial stromal tumors are growths originating from stromal cells in your endometrium.

Can endometrial stroma be benign?

The endometrial stroma is the framework of connective tissue found beneath the epithelial lining of your endometrium. It's a natural part of your uterus and is benign.

Tumors that grow within the endometrial stroma may be benign or cancerous.

What's the difference between endometrial stromal tumors and stromal endometriosis?

Endometrial stromal tumors are bundles of excessive cell growth originating within the uterine lining inside your uterus.

Stromal endometriosis develops outside of your uterus and is defined as endometrial-like lesions on pelvic or abdominal structures.

Stromal endometriosis is a descriptive term for the specific cellular makeup of endometriosis tissue. It's not a formal subtype of the disease and is diagnosed and treated in the same ways as conventional endometriosis.

While limited research exists on stromal endometriosis, it may be relatively common but under-recognized. Due to its unique cellular makeup, it might also be less obvious during visual examinations.

The same hormone therapy and surgery used for conventional endometriosis can also treat stromal endometriosis.

What Is Endometriosis?

Endometriosis happens when the tissue that normally grows inside your uterus grows outside of it instead. This misplaced tissue often attaches itself to the ovaries, fallopian tubes, bowel or bladder. It can spread to other internal organs as well.

Just like the lining of the uterus thickens and bleeds each month during menstruation, so does the tissue that forms outside the uterus. But because the bleeding happens in areas where it can't easily leave the body, it causes inflammation and swelling.

Women with severe endometriosis may have heavy and painful menstrual cycles, and sometimes may also have problems getting pregnant. The fallopian tubes can become blocked by endometrial tissue. See a doctor to get a diagnosis and to learn about treatments that can help. ","publisher":"WebMD Video"} ]]>

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Endometriosis happens when the tissue that normally grows inside your uterus grows outside of it instead. This misplaced tissue often attaches itself to the ovaries, fallopian tubes, bowel or bladder. It can spread to other internal organs as well.

Just like the lining of the uterus thickens and bleeds each month during menstruation, so does the tissue that forms outside the uterus. But because the bleeding happens in areas where it can't easily leave the body, it causes inflammation and swelling.

Women with severe endometriosis may have heavy and painful menstrual cycles, and sometimes may also have problems getting pregnant. The fallopian tubes can become blocked by endometrial tissue. See a doctor to get a diagnosis and to learn about treatments that can help.

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Why Are Doctors Still Telling Women With Endometriosis To Become Pregnant?

Hippocrates thought many physical ailments in women were caused by their uteruses moving around their bodies like restless animals, searching for moisture. "The triad of marriage, intercourse, and pregnancy was the ultimate treatment for the semen-hungry womb," author Terri Kapsalis wrote of the thinking at the time. "The uterus was a troublemaker and was best sated when pregnant."

In ancient Greece, magicians prescribed "hysterical" women amulets to heal their wandering wombs. By the 19th century, hysteria (derived from the Greek hysteria, meaning womb) was thought to be a psychological, rather than purely physical, disease. In 1873, a Harvard professor wrote that women should not pursue higher education because they might become "irritable and infertile" if blood travelled to their brains instead of nourishing their uteruses.

Indeed, that 1949 Catholic Weekly article warned that women with careers were more susceptible to the disease. The message lingers in treatment rooms today: if the womb isn't being used for its God-given purpose, it wreaks havoc.

This stubborn sentiment is not only offensive but inadequate. It is astounding that in so many years we don't have decent treatment options for a disease that impacts around 10 per cent of women and girls, according to the World Health Organisation.

I didn't get my diagnosis because my pain was taken seriously but because I was rushed into an emergency surgery for a burst ovarian cyst. While they drained the blood, the doctors noticed the endometriosis creeping beyond my uterus towards my bowel. It takes people an average of eight years to get a diagnosis because of the lack of research and awareness, but also because of the stubborn notion that some level of pain is a prerequisite of owning a uterus.

There is a cruel irony in insisting people procreate to briefly treat a condition that itself can cause devastating infertility.

As Angelina Chapin wrote in The Cut, patients seeking care often have their worst endometriosis symptoms neglected until it comes time to procreate and the disease is taken seriously as an obstacle to conception. "My pain, divorced from the context of motherhood, doesn't seem to matter in a doctor's office," she wrote.

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Endometriosis can bring menstrual pain, pain during sex, pain with bowel movements or urination and pain while doing nothing at all. It can lead to gastrointestinal issues, fatigue, excessive bleeding and bloating. It can create bands of fibrous tissue, which fuse organs together. It can impact your mental health and relationships and destabilise your career. It can leave you with thousands of dollars in medical bills.

Symptoms can be managed, often unsatisfactorily, with surgery, hormonal medications and physiotherapy, but there is currently no known cure for endometriosis.

Sometimes I wonder whether the condition would still upend millions of lives if the uterus, fallopian tubes and ovaries had been researched as thoroughly and dispassionately as other organs have – free from sexist mythology and disconnected from their reproductive capacities.

Authors of the study released last week wrote that doctors needed to provide "evidence-based information" and yet, after 4000 years, we still have a way to go.

Gina Rushton is the author of The Most Important Job In The World (Pan Macmillan).

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