Thoracic endometriosis: Symptoms to watch out for, causes and treatment

Thoracic endometriosis is a rare condition that may cause chest pain and shortness of breath around the time of your period. All you want to know.

Thoracic endometriosis, a rare condition in which endometrial tissues grow around lungs, can cause coughing, shortness of breath, chest pain around the time of one's menstrual cycle. It is different from endometriosis, which is more common, and where cells similar to the lining of the uterus grow outside the uterus in lower abdomen and pelvic area. The condition can be diagnosed using Chest X-ray, Chest CT and Chest MRI. When endometriosis patches grow around the lungs, they can have life threatening complications. Thoracic endometriosis is the most common type of extragenital endometriosis. (Also read: Tips to protect your lungs during the festive season)

What is thoracic endometriosis

"Thoracic endometriosis is a rare condition that may cause chest pain and shortness of breath around the time of your period. This condition develops when endometrial tissue grows inside your chest cavity, in or around your lungs," says Dr Nisha Kapoor, Director & HOD, Department of Obstetrics Gynaecology & Advanced Gynae Laparoscopy, Marengo QRG Hospital, Faridabad.

What is endometriosis

Endometriosis is a common condition in which cells similar to the lining of the uterus (endometrium) grow outside the uterus. It affects approximately 6%–10% of reproductive-aged women.

What is extragenital endometriosis

Around 12% of those who suffer from endometriosis are estimated to experience endometriosis of nonreproductive organs, referred to as extragenital endometriosis. The most common site of endometriosis outside abdominopelvic cavity is within the thoracic cavity.

Causes of thoracic endometriosis

"Many theories have been proposed but the exact cause for endometriosis is unknown. Most commonly accepted theory is retrograde flow of menstrual blood in which menstrual blood doesn’t come out of the uterus via cervix, but instead spreads into the abdominal cavity via spill through tubes. The route to the lungs is possibly due to fragments of endometrial tissue going to the lungs via bloodstream due to manipulation of pelvic organs, especially during pelvic surgeries for endometriosis," says Dr Kapoor.

Symptoms of thoracic endometriosis

"This endometrial tissue responds to hormones during the menstrual cycle. Most symptoms are catamenial (cyclical, during periods every month) and can come up as chest pain, cough, shortness of breath, cyclical haemoptysis (blood in sputum) and also chronic fatigue. It may cause life threatening complications like a collapsed lung too," says Dr Kapoor.

Diagnosis of thoracic endometriosis

This condition can be diagnosed using chest X-ray, chest CT and chest MRI. Although, direct visualisation of the endometriosis tissue via bronchoscopy and its biopsy is confirmatory.

How to manage thoracic endometriosis

"First line of management includes medicines to suppress ovarian hormone production, like OCPs (birth control pills), GnRH agonists etc. Condition can be surgically managed by VATS which is Video Assisted Thoracoscopic Surgery (gold standard treatment) which is a modality to clear the pleural cavity of endometriotic tissue. Another important aspect of treatment is the pain relief by analgesics especially during periods.

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