What is endometriosis?
The lining of the uterus, called the endometrium, is made up of cells that combine into endometrial tissue. Endometriosis occurs when this endometrial tissue grows elsewhere in the body. The misplaced tissue implants itself onto the surface of the tissue or organ where it has been deposited and begins to grow and function. This endometrial tissue looks and acts like tissue in the uterus and most often appears in places within the pelvis or the abdomen such as the:
- bladder and ureters
- fallopian tubes
- the space behind the uterus (cul-de-sac)
- the outer surface of the uterus
What causes endometriosis?
Researchers do not yet know the exact causes of endometriosis, but several theories currently exist. The hormone estrogen (highest during childbearing years), is likely to contribute to endometriosis, for example. Other possible causes of endometriosis include:
Blood and lymph systems – Endometrial cells may travel via the bloodstream or lymphatic system to distant places such as the brain and other places far from the pelvis.
Ceolomic metaplasia – The areas lining the pelvic organs have certain cells that can grow into other forms of tissue such as endometrial cells.
Immune system problems – Problems in the immune system may prevent the body from recognizing and destroying cells or tissue that are growing where they should not. Autoimmune endometriosis occurs when the immune system fights off an infection and at the same time attacks healthy cells in the endometrium.
Retrograde menstruation – Menstrual flow that backs up into the fallopian tubes and abdominal cavity can deposit endometrial tissue to strange locations.
Surgery – Endometrial tissues may be directly transferred outside the uterus during surgeries such as episiotomy or Cesarean section.
There are certain risk factors that make it more likely that a woman may develop endometriosis. For example, endometriosis occurs more often in women who have never had children. Women with a mother, sister, or daughter who have had endometriosis also are more likely to be diagnosed with the condition, as are about three quarters of women with chronic pelvic pain.
Common symptoms of endometriosis
Commonly a woman experiencing endometriosis will experience a gradual and steady increase of pain during the menstrual cycle. This symptom is the first in a gradual decline in general health and the health of the reproductive system. The most common symptoms of endometriosis to look for include:
Bowel problems – Endometriosis can lead to painful bowel movements, diarrhea, constipation, nausea and other intestinal upsets. Endometriosis on the bowel may cause swelling of your lower abdomen, pain during bowel movement or blood in your faeces during a period.
Heavy or irregular menstrual bleeding – Endometriosis can cause more frequent, irregular, prolonged and/or heavy periods.
Fatigue – Feeling tired, exhausted or sluggish much of the time can be a symptom of endometriosis.
Infertility – Women diagnosed with endometriosis have problems getting pregnant between ages 30-40. Infertility is more common as the disease progresses. Infertility may be the result of the endometriosis interfering with the ovaries and the fallopian tubes.
Painful intercourse (dyspareunia) – Women with endometriosis may experience persistent or recurrent pain just before, during and/or after sexual intercourse. Penetration can produce pain in a tender nodule or implant.
Painful menstrual periods (dysmenorrhea) – Severe pain and cramps can manifest right before and during a woman’s period. Pain can also occur at other times throughout the menstrual cycle and can be described as a sharp, knife-like or twisting pain in the pelvis.
Painful urination – Endometriosis on the bladder can cause pain when you urinate or blood in your urine during a period.
Other symptoms – Other symptoms commonly associated with endometriosis include:
- hypoglycemia (low blood sugar)
- low grade fevers
- susceptibility to allergies
- susceptibility to infections
Finding expert help early can help prevent inadequate treatment, frustration, stress, and wasted effort. Keep in mind that even after you locate an expert, that doesn’t mean you’ll be pain free. Even the best endometriosis doctors struggle with the treatment of endometriosis. The treatment goals for endometriosis may be to:
- Improve and reduce symptoms of endometriosis
- Eliminate or slow the growth of endometrial tissue / endometriotic implants
- Maximize or restore fertility
The choice of preferred treatment depends on your age, the severity of your symptoms, where the endometrial tissue is growing, how large the growths are, and your desire for pregnancy. Several factors and patient-specific indications / contraindications need to be thoroughly discussed and considered prior to treatment selection. Feel free to talk to your doctor about the advantages and disadvantages as well as the risks and benefits of different treatment options before making a choice. The choice of treatment will depend on several factors such as:
- fertility status (and whether you want to keep the option of becoming pregnant)
- prior treatments (if any) and treatment response and side effects (if any)
- severity of symptoms
- stage of the disease
Medical treatments and/or surgery usually help patients manage or ease symptoms of endometriosis. However, the disease often comes back, despite good treatment. Remember, if one therapy does not work, another can be tried.
Hormone replacement therapy
Many types of hormones that can be prescribed by your doctor to slow the growth of endometriosis and may be given up to 6 months at a time. This type of treatment may prevent pregnancy after the first month of treatment. It should be noted that women with a history of endometriosis that take hormone replacement therapy (HRT) during menopause may reactivate the condition.
If a patient with endometriosis still cannot get pregnant after other types of treatment have been tried, she may consider other options. These may include a form of assisted reproduction, such as in vitro fertilization (IVF), or adoption.
Drugs can also be given for pain relief. These may or may not require a prescription. It is important that you ask about all of the side effects of any endometriosis medication. For example, medication that simulates menopause can cause bones to weaken. So be sure to consider the long-term effects of any medications.
Birth control – Birth control hormones, in the form of pills, the birth control injection called Depo-Provera, a skin patch or a vaginal ring are one of the most widely used treatments for endometriosis
Treatment via surgery can usually relieve symptoms of pain, but symptoms of endometrial growth may return. Your doctor may have to decide what type of procedure is best during the surgery iteself. Sometimes what is observed during surgery may be very different from what was expected. If surgery is needed, talk with your doctor before the operation. Be sure that you understand fully what is involved.
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