Endometriosis

Endometriosis is a medical disorder in women. It happens in the lining of your uterus, which is called the endometrium.When you have endometriosis, the endometrium grows outside of your uterus.

Endometriosis occurs when the endometrium grows on your ovaries, bowel, and tissues lining your pelvis. It’s unusual for endometrial tissue to spread beyond your pelvic region, but it’s not impossible. Endometrial tissue growing outside of your uterus is known as an endometrial implant.

The hormonal changes of your menstrual cycle affect the misplaced endometrial tissue. These changes cause the area to become inflamed and painful. This means the tissue will grow, thicken, and break down. Over time, the tissue that has broken down has nowhere to go and becomes trapped in your pelvis.

This tissue trapped in your pelvis can cause:

• irritation
• scar formation
• adhesions, in which tissue binds your pelvic organs together
• severe pelvic pain during your periods
• fertility problems

Endometriosis is a common gynecological condition. It affects up to 10 percent of women. You’re not alone if you have this disorder.

Causes of Endometriosis

During a regular menstrual cycle, your body sheds the lining of your uterus. This allows menstrual blood to flow from your uterus through the small opening in the cervix and out through your vagina.

The exact cause of endometriosis isn’t known. One of the oldest theories is that endometriosis occurs due to a process called retrograde menstruation. This happens when menstrual blood flows back through your fallopian tubes into your pelvic cavity instead of leaving your body through the vagina.

Another theory is that hormones transform the cells outside the uterus into cells similar to those lining the inside of the uterus, known as endometrial cells. Others believe the condition may occur if small areas of your abdomen change into endometrial tissue. This may happen because cells in your abdomen grow from embryonic cells, which can change shape and act like endometrial cells. It’s not known why this occurs.

These displaced endometrial cells may be on your pelvic walls and the surfaces of your pelvic organs, such as your bladder, ovaries, and rectum. They continue to grow, thicken, and bleed over the course of your menstrual cycle in response to the hormones of your cycle.

It’s also possible for the menstrual blood to leak into the pelvic cavity through a surgical scar, such as after a cesarean delivery. Another theory is that the endometrial cells are transported out of the uterus through the lymphatic system. Still another theory says it may be due to a faulty immune system that isn’t destroying errant endometrial cells.

Some researchers believe endometriosis might start when you’re still in the womb, with misplaced cell tissue that begins to respond to the hormones of puberty. This is often called Mullerian theory.

Endometriosis might also develop because of genetics or even environmental toxins.

Stages of Endometriosis

Endometriosis has four stages or types. It can be any of the following:

• minimal
• mild
• moderate
• severe

Different factors determine the stage of the disorder. These factors can include the location, number, size, and depth of endometrial implants.

Stage 1: Minimal

In minimal endometriosis, there are small lesions or wounds and shallow endometrial implants on your ovary. There may also be inflammation in or around your pelvic cavity.

Stage 2: Mild

Mild endometriosis involves light lesions and shallow implants on an ovary and the pelvic lining.

Stage 3: Moderate

Moderate endometriosis involves deep implants on your ovary and pelvic lining. There can also be more lesions.

Stage 4: Severe

The most severe stage of endometriosis involves deep implants on your pelvic lining and ovaries. There may also be lesions on your fallopian tubes and bowels.

Diagnosis

The symptoms of endometriosis can be similar to the symptoms of other conditions, such as ovarian cysts and pelvic inflammatory disease. Treating your pain requires an accurate diagnosis.

Your doctor will perform one or more of the following tests:

• Detailed history — Your doctor will note your symptoms and personal or family history of endometriosis. A general health assessment may also be performed to determine if there are any other signs of a long-term disorder.
• Physical exam — During a pelvic exam, your doctor will manually feel your abdomen for cysts or scars behind the uterus.
• Ultrasound — Your doctor may use a transvaginal ultrasound or an abdominal ultrasound. In a transvaginal ultrasound, a transducer is inserted into your vagina. Both types of ultrasound provide images of your reproductive organs. They can help your doctor identify cysts associated with endometriosis, but they aren’t effective in ruling out the disease.
• Laparoscopy — The only certain method for identifying endometriosis is by viewing it directly. This is done by a minor surgical procedure known as a laparoscopy. Once diagnosed, the tissue can be removed in the same procedure.

Complications

Having issues with fertility is the most serious complication. Women with milder forms of endometriosis may be able to conceive and carry a baby to term. According to the Mayo Clinic, about one-third to one-half of women with endometriosis have trouble getting pregnant.

Medications don’t improve fertility. Some women have been able to conceive after having endometrial tissue surgically removed. If this doesn’t work in your case, you may want to consider fertility treatments or in vitro fertilization to help improve your chances of having a baby.

You might want to consider having children sooner rather than later if you’ve been diagnosed with endometriosis and you want children. Your symptoms may worsen over time, which can make it difficult to conceive on your own. You’ll need to be assessed by your doctor before and during pregnancy. Talk to your doctor to understand your options.

Risk Factors

About 2 to 10 percent of childbearing women in the United States have endometriosis. It usually develops years after the start of your menstrual cycle. This condition can be painful, but understanding the risk factors can help you determine whether you’re susceptible to this condition and when you should talk to your doctor.

• Age — Women of all ages are at risk for endometriosis. It usually affects women between the ages of 25 and 40, but symptoms can begin at puberty.
• Family history — Talk to your doctor if you have a family member who has endometriosis. You may have a higher risk of developing the disease.
• Pregnancy history — Pregnancy seems to protect women against endometriosis progressing. Women who haven’t had children run a greater risk of developing the disorder. However, endometriosis can still occur in women who’ve had children. This supports the understanding that hormones influence the development and progress of the condition. You’ll be encouraged to have your babies earlier, rather than later in life. Pregnancy doesn’t cure endometriosis, but there may be fewer symptoms afterward.
• Menstrual history — Talk to your doctor if you have problems regarding your period. These issues can include shorter cycles, heavier and longer periods, or menstruation that starts at a young age. These factors may place you at higher risk.

Prognosis

Endometriosis is a chronic condition with no cure. But this doesn’t mean the condition has to impact your daily life. Effective treatments are available to manage pain and fertility issues, such as medications, hormone therapy, and surgery. The symptoms of endometriosis usually improve after menopause.

The symptoms of endometriosis vary. Some women experience mild symptoms, but others can have moderate to severe symptoms. The severity of your pain doesn’t indicate the degree or stage of the condition. You may have a mild form of the disease, yet experience agonizing pain. It’s also possible to have a severe form and have very little discomfort.

Symptoms

Pelvic pain is the most common symptom of endometriosis. You may also have the following symptoms:

• painful periods
• pain in the lower abdomen before and during menstruation
• cramps one or two weeks around menstruation
• heavy menstrual bleeding or bleeding between periods
• infertility
• pain following sexual intercourse
• discomfort with bowel movements
• lower back pain that may occur at any time during your menstrual cycle

You may also have no symptoms. It’s important that you get regular gynecological exams, which will allow your gynecologist to monitor any changes. This is particularly important if you have two or more symptoms.

Endometriosis Treatment

Understandably, you want quick relief from pain and other symptoms of endometriosis. Left untreated, this condition can disrupt your life. Endometriosis has no cure, but its symptoms can be managed.

Medical and surgical options are available to help reduce your symptoms and manage any potential complications. Your doctor may first try conservative treatments. They may then recommend surgery if your condition doesn’t improve.

Everyone reacts differently to these treatment options. Your doctor will help you find the one that works best for you.

It may be frustrating to get diagnosis and treatment options early in the disease. Because of the fertility issues, pain, and fear that there is no relief, this disease can be difficult to handle mentally. Consider finding a support group or educating yourself more on the condition. Treatment options include:

Pain Medications

You can try over-the-counter pain medications such as ibuprofen (Advil), but these aren’t effective in all cases.

Hormonal Therapy

Taking supplemental hormones can sometimes relieve pain and stop its progression. This therapy helps your body to regulate the monthly changes in hormones that promote the tissue growth that occurs when you have endometriosis.

Hormonal Contraceptives

Hormonal contraceptives decrease fertility by preventing the monthly growth and buildup of endometrial tissue. Birth control pills, patches, and vaginal rings can reduce or even eliminate the pain in less-severe endometriosis.

Medroxyprogesterone (Depo-Provera) Injection

This is also effective in stopping menstruation. It stops the growth of endometrial implants. It relieves pain and other symptoms. This may not be your first choice, however, because of the risk of decreased bone production, weight gain, and increase in the incidence of depression in some cases.

Gonadotropin-Releasing Hormone (GRNH) Agonists and Antagonists

Women take what are called gonadotropin-releasing hormone (GnRH) agonists and antagonists to block the production of estrogens that stimulate the ovary. Estrogen is the hormone that’s mainly responsible for the development of female sexual characteristics. This prevents menstruation and creates an artificial menopause. The therapy has side effects like vaginal dryness and hot flashes. Taking small doses of estrogen and progesterone at the same time can help to limit or prevent these symptoms.

Danazol

Danazol is another medication used to stop menstruation and reduce symptoms. While taking danazol, the disease may continue to progress. Danazol can have side effects including acne and hirsutism, which is abnormal hair growth on your face and body. Other drugs are being studied that may improve symptoms and slow disease progress.

Conservative Surgery

Conservative surgery is for women who want to get pregnant or experience severe pain and for whom hormonal treatments aren’t working. The goal of conservative surgery is to remove or destroy endometrial growths without damaging your reproductive organs.

Laparoscopy

This minimally invasive surgery is used to both visualize, diagnose, and remove the endometrial tissue. Your surgeon will make small incisions in your abdomen to remove the growths surgically or to burn or vaporize them. Today, surgeons commonly use lasers as a way destroy this “out of place” tissue.

Last-Resort Surgery (Hysterectomy)

Rarely, your doctor may recommend a total hysterectomy as a last resort if your condition doesn’t improve with other treatments. During a total hysterectomy, your surgeon will remove your uterus and cervix. Your doctor will also remove your ovaries because they make estrogen, and estrogen causes the growth of endometrial tissue. They will also remove visible implant lesions.

This radical approach to treatment is used only when other treatment approaches have failed, and the pain and inflammation are interfering with quality of life. This procedure will stop the cycle of menstruation, and symptoms of endometriosis should reduce. There is no guarantee that all pain will go away, however.

You’ll be unable to get pregnant after a hysterectomy. Get a second opinion before agreeing to surgery if you’re thinking about starting a family.

Schedule an appointment with your doctor if you have signs or symptoms that may indicate endometriosis or pelvic adhesive disease.