Endometriosis in the brain: Symptoms and treatment

Endometriosis, which affects millions of women, is a health condition in which cells similar to the lining of the uterus grow outside of it. This chronic condition can lead to menstrual irregularities and pelvic pain. It mostly affects the reproductive system, but it can also have an impact on the brain. Endometriosis in the brain or cerebral endometriosis is a rare condition where a tissue similar to the one lining the uterus is found in the brain. This can lead to headaches, seizures, and anxiety. Medications can help to manage the pain or surgery may be recommended.

What is endometriosis?

Endometriosis is a chronic and often painful medical condition where tissue similar to the lining of the uterus (the endometrium) grows outside the uterus. “This misplaced tissue can develop on the ovaries, fallopian tubes, and other organs within the pelvic region,” says obstetrician and gynaecologist Dr Madhu Juneja. It affects about 190 million women in the reproductive phase across the globe, according to the World Health Organization. In rare cases, it may also spread beyond the pelvic organs.

“The exact cause remains unclear, but it may be due to genes, immune system disorders or retrograde menstruation where period blood flows backward through the fallopian tubes into the pelvic cavity,” says the expert.

Cerebral endometriosis: Know how endometriosis affects the brain

Endometriosis primarily affects the reproductive system, but it can also have implications for the brain, and lead to a condition known as cerebral endometriosis. Involvement of the central nervous system, which includes the brain, in endometriosis is rare, according to research published in the Journal Of Clinical Medicine in 2022.

Here’s how it may influence brain function and health:

1. Chronic pain and its effects

It is associated with chronic pain, which can change the way the brain processes signals of pain. “This may lead to heightened sensitivity to any kind of pain, known as central sensitisation, where normal stimuli are perceived as painful,” says Dr Juneja.

2. Inflammation

Endometriosis is associated with increased levels of inflammatory cytokines (signaling proteins that help control inflammation) and markers, which can affect the brain. If there is inflammation in the body, it can influence the way the brain functions.

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3. Hormonal influence

This condition often involves hormonal imbalances, particularly with estrogen. Estrogen affects brain function, influencing mood, cognition, and emotional well-being. Fluctuating hormone levels can lead to mood swings, anxiety, and depression in people with endometriosis.

4. Anxiety and depression

The chronic pain and stress associated with this condition can affect mental health, and contribute to the development of anxiety and depression. During a 2018 study published in the Biology Of Reproduction journal, researchers found that anxiety and depression were induced by endometriosis.

What are the symptoms of endometriosis in the brain?

Here are the potential symptoms associated with this condition:

• Headaches: Women may experience severe headaches, which can be similar to migraine or tension headaches. “They may be chronic and persistent, often worsening during menstruation or hormonal changes,” says the expert.
• Seizures: Seizures can occur if endometrial tissue is located in areas of the brain that affect electrical activity. This can include focal seizures that affect a specific portion of the brain. They may also experience generalised seizures that leave an impact on the entire brain.
• Focal neurological deficits: Women may feel weakness or paralysis in certain areas of the body, depending on the location of the lesions in the brain. Altered sensation or numbness in different body parts is also possible. They may also face difficulties in speaking or understanding language, depending on the affected brain region.
• Cognitive changes: “Problems with memory retention or recall, often described as brain fog, is another symptom,” says the expert. Women may also have trouble focusing on tasks or maintaining attention, which can be exacerbated by chronic pain and fatigue.
• Emotional changes: Increased anxiety, depression, or mood swings due to the combination of chronic illness and neurological symptoms is possible. “They may also have heightened emotional responses or they may get irritated very easily,” says the expert.

What are the causes of endometriosis in the brain?

The cause of endometriosis in the brain is still unclear, but may be due to –

• Endometrial-like cells may travel via the bloodstream or lymphatic system and implant in brain tissue.
• Estrogen, which stimulates the growth of endometrial tissue, could play a role, especially in cases where brain tissue shows estrogen receptor activity.
• Similar to pelvic endometriosis, genetic predisposition and immune system dysfunction may increase susceptibility to distant endometrial-like growths.

How is endometriosis in the brain diagnosed?

“Diagnosing it can be challenging since it is rare and its symptoms can overlap with other neurological conditions,” says the expert. The diagnostic process typically involves these steps –

• A doctor will review the patient’s medical history, including any history of endometriosis, menstrual irregularities, and neurological symptoms.
• A thorough neurological exam may be performed to evaluate reflexes, muscle strength, coordination, and sensory function.
• Magnetic Resonance Imaging (MRI) is the most effective imaging technique for visualising soft tissues in the brain. It can help detect the presence of endometrial-like lesions, cysts, or other abnormalities in the brain.
• CT Scan (Computed Tomography) may be used in certain cases to assess brain structure.

How to treat endometriosis in the brain?

When it comes to its treatment, the focus will be on managing the symptoms.

• Hormonal therapy: Hormone-based treatments like GnRH (gonadotropin-releasing hormone) agonists may help reduce endometrial tissue growth.
• Surgery: If endometrial-like tissue in the brain is accessible and causing severe symptoms, surgery to remove the tissue may be an option.
• Pain management: Medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) and sometimes antidepressants or anticonvulsants, can help manage pain and neurological symptoms.
• Anti-seizure medications: If seizures occur, anti-seizure drugs may be necessary.
• Supportive therapies: Cognitive-behavioral therapy, dietary adjustments, and physical therapy may support pain management and improve overall well-being.

Endometriosis in the brain is not a common condition. Early diagnosis and treatment plans following that can help manage the symptoms like anxiety, mood swings, and headaches.