Diaphragmatic endometriosis is a rare form of endometriosis where tissue that resembles the uterus lining grows on the diaphragm.
The diaphragm is the dome-shaped sheet of skeletal muscle that separates the abdomen from the chest and allows a person to breathe. When endometriosis affects the diaphragm, symptoms may include chest, shoulder, and neck pain.
In this article, we look at an overview of this condition, including its symptoms, complications, and the treatment of diaphragmatic endometriosis.
Diaphragmatic endometriosis is extremely rare. An estimated 0.6 to 1.5 percent of those who undergo surgery for endometriosis have this form. More usually, endometriosis affects the pelvic organs and structures close to the uterus.
Endometriosis is estimated to affect between 6 and 10 percent of women of menstruating age. Estimates are difficult, though, because some women who have no symptoms may never receive a diagnosis. Other women are suspected to have it based on symptoms, but may not have the diagnosis confirmed.
As well as discomfort and stiffness, the condition primarily causes pain, often described as a dull ache. The pain usually becomes worse at certain times of the menstrual cycle.
According to a 2007 study which looked at symptoms in 47 women, diaphragmatic endometriosis occurred only on the right in 66 percent of women, bilateral in 27 percent, and on the left in 6 percent.
- chest pain and stiffness
- shoulder pain and stiffness
- neck pain and stiffness
- difficulty breathing or a bloody cough in severe cases
Symptoms are usually worse during or before menstruation. This may be because the glands producing growth respond to reproductive hormones, meaning they cycle and shed along with normal endometrial tissues.
Symptoms of endometriosis affecting the pelvic organs include:
- pelvic pain
- pain in the lower back and abdomen
- pain during or after sex
- heavy, painful periods
- pain when going to the bathroom
- feeling extremely sick and fatigued
Diaphragmatic endometriosis often occurs with other kinds of endometriosis, which can sometimes result in difficulty becoming pregnant or infertility.
Surgery to remove tissue interfering with pregnancy may help increase the chances of conception.
Hormone therapies can help reduce the symptoms of endometriosis, but they cannot reverse infertility.
There may be a greater chance of pregnancy through in vitro fertilization (IVF), especially after surgery.
One complication of diaphragmatic endometriosis is an inability or difficulty becoming pregnant.
The surgical procedures used to treat endometriosis are associated with health risks, as with all surgeries.
Complications associated with endometriosis surgeries include:
- organ or tissue damage
- regrowth of abnormal tissues
- blood clots in the legs or lungs
Diaphragmatic endometriosis may cause additional complications in very rare cases because of the role the diaphragm plays in breathing.
Additional complications include:
- restricted breathing
- collapsed lung
- fluid, blood, or air in the chest cavity
Endometriosis may also contribute to someone developing depression, as a symptom is a form of chronic pain. In these cases, a doctor may suggest a counselor or support group.
Researchers do not fully understand why endometriosis happens. There are many theories including:
- Retrograde menstruation. This may occur when the lining of the uterus that is shed during menstruation moves upwards instead of out of the body. It may travel through the fallopian tubes and implant on pelvic organs or tissues.
- Abnormal circulation of endometrial cells. This is when the cells that line the uterus enter into circulation through the bloodstream or lymph system, a series of interconnected immune glands.
- Immune conditions. Medical conditions that interfere with the body’s natural defense systems may play a role in excess tissue growth and chronic inflammation.
- Metaplasia. This is when one type of cell randomly transforms into another.
During a pelvic ultrasound, an ultrasound wand is inserted into the vagina to look for cysts on the ovaries and other changes that may be associated with endometriosis.
To make the actual diagnosis, surgery is needed, at which time the tissue specimens that are seen and resemble endometriosis are sent to a pathology lab to confirm the diagnosis.
There is currently no cure for endometriosis, but there are treatments that have been shown to reduce symptoms markedly.
A doctor will determine the best treatment for endometriosis based on:
- severity of symptoms
- severity or extent of the abnormal tissue growth
- age of the individual
- desire to become pregnant
Mild symptoms may not need medical treatment. Minor symptoms may also respond to over-the-counter (OTC) anti-inflammatories.
For severe symptoms, a doctor will often prescribe hormone therapy, either in the form of a pill, injection, or vaginal ring.
Birth control pills, which are commonly used, reduce the number of reproductive hormones released by the ovaries, slowing or stalling ovulation. Slowing ovulation will usually reduce symptoms because the endometriosis tissue is stimulated less with the reduction of hormone fluctuations.
For severe symptoms or symptoms that do not respond to hormone medications, there are surgical procedures that can help.
The most common surgery for endometriosis is laparoscopy. During a laparoscopic procedure, a tube with a light and camera on one end is inserted into a tiny cut in the belly button. A surgeon will be able to see the location of the growths, as well as how large and thick they are.
Most surgeons will collect a biopsy or small piece of the abnormal tissues. If an individual has already given consent to have the tissues removed, a doctor may also remove the growths.
Diaphragmatic endometriosis may require abdominal surgery. This may be used instead of or in addition to laparoscopic surgery.
Surgeons will make cuts in the abdominal wall that allow them to peel back layers of tissue and access the diaphragm. The surgeons will then locate and remove growths.
Because abdominal surgery involves larger cuts, full anesthesia, and impacts a much wider area of the body, it is associated with more serious complications.
Only severe diaphragmatic endometriosis usually requires surgery.
Alternative therapies and lifestyle habits may help decrease symptoms in some patients, though these are not considered first-line treatment options. They include:
Endometriosis is a common condition that results from uterine lining tissue growing outside of the uterus, including on the diaphragm in rare cases.
While diaphragmatic endometriosis may not cause symptoms, severe growths can cause chest, neck, and shoulder pain and can interfere with breathing.
It is best to talk with a doctor about pain in the abdomen and chest, especially if it gets much worse during or before menstruation.