During the month of March, thousands of women around the world come together to raise awareness about endometriosis. Endometriosis is a painful, chronic disease that affects at least 6.3 million women and girls in the U.S., 1 million in Canada, and millions more worldwide.
Endometriosis occurs when endometrial tissue which normally lines the uterus is found outside the uterus. The tissue can be found on abdomen on the ovaries, fallopian tubes, and ligaments that support the uterus; the area between the vagina and rectum; the outer surface of the uterus; and the lining of the pelvic cavity. Other sites for these endometrial growths may include the bladder, bowel, vagina, cervix, vulva, and in abdominal surgical scars. Less commonly they are found in the lung, arm, thigh, and other locations.
This misplaced endometrial tissue develops into growths or lesions which respond to the menstrual cycle in the same way that the tissue of the uterine lining does: each month the tissue builds up, breaks down, and sheds. Menstrual blood flows from the uterus and out of the body through the vagina, but the blood and tissue shed from endometrial growths has no way of leaving the body. This results in internal bleeding, breakdown of the blood and tissue from the lesions, and inflammation can cause pain, infertility, scar tissue formation, adhesions, and bowel problems.
What are the Symptoms of Endometriosis?
Many women with endometriosis will experience pain just before, during, or after menstruation, which is the most common symptom. Some women will also experience pain during or after sex, during bowel movements or urination. Other symptoms include: ongoing pain in the pelvis lower back pain, fatigue, infertility and other gastrointestinal upsets such: as diarrhea, constipation, nausea. While some women with endometriosis have no symptoms at all.
The severity and frequency of symptoms may be related to the location of the growths. Complications of endometriosis include: internal scarring, adhesions, pelvic cysts, cyst of ovaries, ruptured cysts, and bowel and ureteral obstruction resulting from pelvic adhesions. Endometriosis-associated infertility can be related to scar formation and anatomical distortions due to the endometriosis.
What Causes Endometriosis?
Although the exact cause of endometriosis is not certain, several possible explanations include:
- Retrograde menstruation. This is the most likely explanation for
endometriosis. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
- Embryonic cell growth. The cells lining the abdominal and pelvic
cavities come from embryonic cells. When one or more small areas of the abdominal lining turn into endometrial tissue, endometriosis can develop.
- Surgical scar implantation. After a surgery, such as a hysterectomy or
C-section, endometrial cells may attach to a surgical incision.
- Immune system disorder. It is possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that’s growing outside the uterus.
Who Is at Risk?
There is no definite way to determine who will have endometriosis, but research shows that the condition is more common in women who:
- Are in their 30s and 40s
- Have not had children
- Have periods longer than 7 days
- Have cycles shorter than 28 days
- Started their period before age 12
- Have a mother or sister who had endometriosis
To diagnose endometriosis, your doctor will 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 test to diagnosis endometriosis include:
- Pelvic Exam. During a pelvic exam, your doctor manually feels (palpates areas) in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus. Often it’s not possible to feel small areas of endometriosis, unless they have caused a cyst to form.
- Ultrasound. This test uses high-frequency sound waves to create images of the inside of your body. To capture the images, a device called a transducer is either pressed against your abdominal skin or inserted into your vagina (transvaginal ultrasound). Both types of ultrasound may be done to get the best view of your reproductive organs. Ultrasound imaging will not definitively tell your doctor whether you have endometriosis, but it can identify cysts associated with endometriosis (endometriomas).
- Laparoscopy. Medical management is usually tried first. But to be certain you have endometriosis, your doctor may refer you to a surgeon to look inside your abdomen for signs of endometriosis using a surgical procedure called laparoscopy. While you are under general anesthesia, your surgeon makes a tiny incision near your navel and inserts a slender viewing instrument (laparoscope), looking for endometrial tissue outside the uterus. He or she may take samples of tissue (biopsy). Laparoscopy can provide information about the location, extent and size of the endometrial implants to help determine the best treatment options.
Treatment for endometriosis is usually with medications or surgery. The approach you and your doctor choose will depend on the severity of your signs and symptoms and whether you hope to become pregnant. Options include: pain medication, hormone therapy, hysterectomy, and alternative therapy including acupuncture. If your pain persists or if finding a treatment that works takes some time, you can try measures at home to relieve your discomfort.
- Warm baths and a heating pad can help relax pelvic muscles, reducing
cramping and pain.
- Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others), can help
ease painful menstrual cramps.
- Getting regular exercise may help improve symptoms.
For more information about endometriosis, contact your local physician.