Endometriosis (pronounced ‘end–oh–me–tree–OH–sis’) is a condition that occurs when tissue, similar to that which is found inside the uterus, is found growing outside the uterus in areas such as the ovaries, fallopian tubes and bowel. These pieces of misplaced tissue are called endometrial implants.
In most cases these implants do not migrate very far outside of the pelvic and lower abdominal regions, however, there have been some rare cases of endometriosis being found on the diaphragm, lungs and even the brain.
As hormones change during the menstrual cycle, this tissue responds much like the endometrium, building up, breaking down and shedding. However, unlike the endometrium, this blood and tissue has no way of leaving the body and so may cause inflammation, painful scar tissue and adhesions.What are the symptoms of Endometriosis?
Endometriosis is a complex disease and some women with the disease at its most severe may be asymptomatic while the majority of women present with the following symptoms.
- Pelvic pain before and during menstruation.
- Painful sex.
- Painful bowel movements.
- Lower back pain.
- Pain during urination.
- Heavy or prolonged menstrual cycles.
Most women have some mild cramping or pain along with their menstrual period and may find relief with over-the-counter pain medications. If the pain is unbearable, keeps you from participating in your normal activities or remains after your period, then it is a good idea to speak with your doctor. Do not let anyone tell you that being in severe pain during menstruation is normal.What Causes Endometriosis?
Although there are many theories, the exact cause of endometriosis is still unknown.Endometriosis and Infertility
Sometimes the first – or only -symptom of endometriosis is trouble conceiving. Fertility may be affected by scarring, adhesions, distortion of pelvic organs, inflammation, reduced egg quality, blocked fallopian tubes, hormonal imbalances and damage to ovaries. The good news is that medical treatments such as laparoscopic surgery and IVF can help those who are struggling with infertility.Who Is at Risk? The condition is more common in women who:
- Have periods longer than 7 days.
- Have cycles shorter than 28 days.
- Started their period before age 12.
- Have a mother or sister who has endometriosis.
- When the pain happens.
- How bad it is.
- How long it lasts.
- A change or worsening of pain.
- Pain that limits your activities.
- Pain during sex, bowel movements, or urination.
Your doctor will do a pelvic exam to check your ovaries, uterus, and cervix for anything unusual. An exam can sometimes reveal an ovarian cyst or internal scarring that may be due to endometriosis. The doctor also looks for other pelvic conditions that could cause symptoms similar to endometriosis.Pelvic Scans
Although it isn’t possible to confirm endometriosis with scanning techniques alone, your doctor may order an ultrasound, CT scan, or MRI to help with diagnosis. These may be able to detect larger endometrial growths or cysts. The scans use sound waves, X-rays, or magnetic fields with radiofrequency pulses to create the images.Laparoscopy
Laparoscopy is the only sure way to determine if you have endometriosis. A surgeon inflates the abdomen with gas through a small incision in the navel. A laparoscope is a viewing instrument that’s inserted through the incision. The surgeon can take small pieces of tissue for a lab to examine — called a biopsy — to confirm the diagnosis.Treatment: Pain Medicine
Pain medications and nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen, often help relieve the pain and cramping that comes with endometriosis. But these drugs only treat the symptoms and not the underlying endometriosis.Birth Control Pills
Oral contraceptives manage levels of estrogen and progestin, which make your menstrual periods shorter and lighter. That often eases the pain of endometriosis. Your doctor may prescribe pills to be taken continuously, with no breaks for a menstrual period, or progestin-only therapy. Progestin-only therapy can also be given by injection. Endometriosis symptoms may return after you stop taking the pills.Other Hormone Therapies
These drugs mimic menopause, eliminating periods along with endometriosis symptoms. GnRH agonists, such as Lupron, Synarel, and Zoladex, block female hormones from being made. They can cause hot flashes, vaginal dryness, fatigue, mood changes, and bone loss. Danocrine works mainly by lowering estrogen. Side effects can include weight gain, smaller breasts, acne, facial hair, voice and mood changes, and birth defects.Excision
During a laparoscopy, the surgeon may remove visible endometrial growths or adhesions. Most women have immediate pain relief. A year after the surgery, though, a reported 45% of women will have a return of symptoms. The likelihood of symptoms returning rises over time. Hormone therapy after surgery may improve the outcome.Open Surgery
Severe cases of endometriosis may require laparotomy, or open abdominal surgery, to remove growths, or a hysterectomy — removal of the uterus and possibly all or part of the ovaries. Although this treatment has a high success rate, endometriosis still recurs for about 15% of women who had their uterus and ovaries removed.Coping With Endometriosis
Although there is no way to prevent endometriosis, you can make lifestyle choices that will help you feel better. Regular exercise may help relieve pain by improving your blood flow and boosting endorphins, the body’s natural pain relievers. Acupuncture, yoga, massage, and meditation also may help ease symptoms.Suspect you have Endometriosis?
- Seek professional medical care by a qualified doctor.
- Do the necessary research and educate yourself.
- Keep a diary of symptoms and pain.
- Be specific and assertive when dealing with your doctor.
- Many women suffer needlessly for years before receiving an official diagnosis.