Endometriosis

Endometriosis is a painful condition in which the tissue that normally lines the inside of the uterus – known as the endometrium – grows outside your uterus. An endometrial tissue that is found outside the pelvic area is known as an implant. The endometrial implants are often found in the ovaries, bowels, and pelvic lining. 

The endometrium lines the inside of the uterus. During the menstrual cycle, it thickens and breaks down due to changes in hormone levels. The endometrial implants thicken and break down as well, explaining why endometriosis is worse when you are on your period.

Endometrial implants expand significantly, thus backing into organs or tissues and causing pain. If left untreated, the affected tissues become irritated and form scar tissue around the implants. This results in the formation of adhesions, which cause the organs to stick together. Such adhesions can cause severe complications, such as infertility.

The main symptom of endometriosis is severe pelvic pain that is often associated with discomfort during the menstrual cycle. However, endometriosis pain is much worse than pain associated with menstrual cramps. This type of pain even tends to worsen over time. 

The main symptom of endometriosis is severe pelvic pain that is often associated with discomfort during the menstrual cycle. However, endometriosis pain is much worse than pain associated with menstrual cramps. This type of pain even tends to worsen over time.

The other signs and symptoms associated with endometriosis include:

• Dysmenorrhea – Dysmenorrhea, or menstrual cramps, often start several days before and extend several days into your period. They are also accompanied by lower back pain and abdominal pain.
• Painful bowel movements or painful urination - If you are experiencing severe pain during regular bowel movement or while you are urinating, it is important to go in for a check-up. You may even need to consult with a doctor to see if you are suffering from a case of endometriosis.
• Heavy menstrual bleeding – One of the indications of endometriosis is heavy bleeding, which is often mistaken for a menstrual cycle. If you have been experiencing heavy menstrual bleeding, then you need to speak with your doctor right away to see if you are suffering from a case of endometriosis.
• Abnormal bleeding – If you are experiencing abnormal bleeding during your period, pay a visit to your doctor to see if you are suffering from endometriosis. Since abnormal bleeding or excessive bleeding occurs around your period, it is often mistaken for heavy menstrual bleeding. In any case, make an appointment with your gynecologist and get yourself checked out right away.
• Painful intercourse – If you are experiencing severe pain during intercourse, this could be on account of endometriosis and the endometrial implants. Since the implants are pushed back against the other organs, this can cause you to experience severe pain during and shortly after intercourse. Consult with your doctor and get yourself treated for endometriosis right away.
• Infertility – Endometriosis is known to cause infertility. If you find yourself experiencing heavy bleeding during your periods and difficulties getting pregnant, then chances are that you may be suffering from endometriosis. Consult with a doctor or a specialist immediately. They can help you choose from a range of reproductive therapies (along with medication) to help you become more fertile.
• Having fatigue, diarrhea, bloating, constipation, nausea, and vomiting that worsens during periods - If you feel extremely weak (more so than usual during your period) and you experiencing heavy menstrual bleeding, you could be suffering from endometriosis. Similarly, if you find yourself experiencing nausea, constipation, and even diarrhea during your periods, then you need to consult with your doctor right away and see if you are indeed suffering from this condition. An accurate and timely diagnosis can help alleviate all these symptoms. For this reason, it is important that you get your condition treated right away since endometriosis has a proclivity to spread to other areas of the body, including the major organs.

Pain is not a reliable symptom or measure of severity for endometriosis. Some women with mild cases may experience severe pain, while others with advanced endometriosis may experience little or no discomfort.

There are several medical conditions with symptoms similar to endometriosis. These include irritable bowel syndrome, pelvic inflammatory disease, and ovarian cysts. This is why making an accurate diagnosis is extremely difficult for both the patient and the doctor.

You need to see a doctor immediately if you are experiencing any of the above signs and symptoms. Early diagnosis and treatment are key to preventing pain and complications. It is essential that you inform your doctor about your medical history and whether you have any genetic predispositions to endometriosis.

The exact cause of endometriosis is unknown. Below are a few possible causes:

• Retained menses inside the uterus or retrograde menstruation – At times, instead of going out of the vaginal opening, the menses go out of the fallopian tubes and end up in the pelvic cavity. The endometrial cells still present in the retained menses react to the hormones, thus causing implants and endometriosis.
• Hysterectomy and C-section - Such surgical procedures may cause tiny bits of endometrial tissue to attach to incisions. If you have undergone either of these two surgeries in the past and you continue to experience heavy menstrual bleeding, chances are that you may end up experiencing endometriosis. Check with your doctor to see if he or she can confirm the condition and provide you with effective treatment options.
• Human embryogenesis - The cells inside the abdomen and pelvic cavity come from embryonic cells. Sometimes, the small sections of the abdominal lining turns into endometrial tissue, thus causing the formation of implants. This is why you need to get yourself checked out regularly, and if endometriosis is confirmed, then get the same treated right away. If left untreated, this condition can lead to severe health complications, including ovarian cancer.
• Transportation of endometrial cells through blood or lymph vessels - This type of transportation causes implants in other parts of the body. An early diagnosis is important because it can enable you to get yourself treated for endometriosis before it spreads to other parts of your body, including some of the major organs.
• Immune system disorders - It is thought that the immune system is capable of recognizing and destroying endometrial tissue outside the uterus. However, if the immune system is under attack, it might cause the endometrial tissue to grow - leading to the growth of implants. So if you are already suffering from a weakened immune system or your immune system has already been comprised due to other health disorders and treatments, then you need to be extremely careful. You could end up suffering from any of the above listed symptoms of endometriosis. With a weakened immune system, endometriosis can easily spread to other parts of your body, resulting in severe health complications.

If you are experiencing symptoms of endometriosis, you may be referred to a general practitioner or gynecologist to receive an accurate diagnosis. If you have fertility problems, you might be referred to a reproductive endocrinologist, which is a doctor who specializes in treating hormonal issues that cause infertility.

Here are a few ways in which you can prepare for your appointment:

• Make a list of all your symptoms and any medications, supplements or vitamins you are currently taking - It is important that you are able to give your doctor all the information they need in regards to your condition. It can impact the treatment option your doctor may wish to prescribe you.
• Be prepared to take notes - Take a notepad or a mobile device with you during your appointment. This should help you to review all the information and suggestions prescribed by your doctor. Additionally, this can help you to understand your condition better, as well as the medication you are prescribed - including the associated side effects of the treatment in question.
• Have family members or a loved one come with you during your scheduled appointments - It is important that you share all the information regarding your health with your family or loved one. Since you are about to seek out treatment for a very severe medical condition, having support is invaluable. Facing this type of health issue on your own can be quite overwhelming, so it is always recommended to have a family member or loved one with you when you visit your doctor. They can help reassure you regarding treatment and various therapies.

You should also prepare a list of questions to ask your doctor. Feel free to ask away.

Here are some good questions to ask:

• How is endometriosis diagnosed?
• What are the available treatment options for endometriosis?
• What kinds of medications are typically prescribed for endometriosis? Will they improve my symptoms?
• What are the side effects of the medications?
• Do I need to have surgery for endometriosis?
• Will endometriosis pose any problems if I plan on getting pregnant?
• Will treating endometriosis improve my chances of getting pregnant?

During the appointment, the doctor will discuss your symptoms with you. It is essential that you answer any questions you are asked honestly and provide exact details in order to obtain an accurate diagnosis.

The doctor may also ask you if you have any problems or abnormalities with your menstrual cycle, such as missed / irregular periods or abnormal bleeding during periods.

Depending on its severity, endometriosis is generally treated with medications and surgery. However, doctors tend to opt for conservative approaches first, especially if you still plan on having children.

You may be prescribed ibuprofen (Advil, Motrin IB) or naproxen (Aleve) for symptoms such as pain. These drugs are known as non-steroidal anti-inflammatory drugs (NSAIDS) and may even be prescribed for symptoms such as dysmenorrhea. If these medications fail to provide any relief, your doctor may explore other alternatives for your condition.

Hormone therapy may also work for endometriosis. Hormone medications help stop the rise and fall of hormones in the menstrual cycle, which slows down and prevents the growth of new implants. However, endometriosis may recur if these medications are stopped abruptly.

Here are a few common types of hormone medications used to treat endometriosis:

• Birth control pills, patches, and vaginal rings – These methods may work for mild to moderate endometriosis. They are a solid choice because they work to stop the hormones responsible for the menstrual cycle and they help lighten menstrual flow.
• Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists – These are a class of drugs used to prevent the production of hormones that stimulate the ovaries. They lower estrogen levels and prevent menses, which typically cause endometrial implants to shrink. These medications may suppress the growth of endometrial implants for months or years, but they typically cause a ‘mini-menopause’. Your doctor may start you off with a low-dose of estrogen or progestin to reduce symptoms such as hot flashes, vaginal dryness, and bone loss. You must only consume these medications during the prescribed period. Afterwards, your chances of getting pregnant may increase.
• Depo-Provera (Medroxyprogesterone) – This manufactured hormone of progesterone works by preventing menses and the growth of implants that cause endometriosis. It can relieve symptoms; however, it may also cause weight gain, reduced calcium in the bones, and depression.
• Danazol - This medication suppresses the growth of implants by blocking hormones that stimulate the ovaries. It prevents menses and alleviates the symptoms associated with endometriosis; however, it also presents severe side effects. Should you decide to get pregnant, danazol can be harmful to your developing fetus.

Surgery for endometriosis may be conservative or it may require complete removal of the uterus. Conservative surgery involves removing the visible implants, all the while being careful not to cause any damage to the uterus and ovaries.

Your doctor may suggest laparoscopy (use of a thin, lightened instrument through a small incision in the stomach) or a traditional open-abdominal surgery. This type of surgery may be appropriate for very painful endometriosis, however, there is a possibility that the implants and severe pain may return. Make sure that you consult with your doctor and opt for surgery as a last resort. Usually, they will not recommend surgery unless it is absolutely necessary. So make it a point to talk to them about all of the risks involved with the surgery, the post-operative care, and the medications you will be prescribed - before and after surgery.

If you plan on getting pregnant, your doctor might recommend undergoing assisted reproductive technologies (ART), such as in-vitro fertilization.

For cases of repeated endometriosis (and if you do not plan on getting pregnant), your doctor may recommend a hysterectomy. Hysterectomy is a major surgical procedure that involves removal of the uterus (including the cervix and the ovaries). This type of procedure is typically considered as a last resort treatment for endometriosis. Undergoing hysterectomy means that you cannot get pregnant, but it will stop the production of hormones that cause the endometrial implants to grow. Typically, your doctor will not recommend a hysterectomy unless your condition is getting worse and they want to prevent the growth and spread of the endometriosis.

You should take the time to think about whether a total hysterectomy is the right treatment option for you, especially if you are still in your reproductive years. Consider a second opinion before starting any other treatment.

Aside from taking NSAID medications, you can also try these alternative remedies to relieve pain caused by endometriosis:

• Try taking warm baths or using a heating pad to relieve cramps and pain. Make sure that the water is lukewarm or just slightly hot enough so that it can help soothe the affected areas, as well as the pain and associated cramps.
• Exercise or move around to relieve symptoms of endometriosis. While moving around might be difficult, some patients find that exercise relieves their symptoms.

There are several risks and complications associated with endometriosis. They include the following:

• Having a family history of endometriosis. This increases your chances of suffering from the same condition. Make sure to give your doctor all the information regarding your family’s past and present medical history.
• Having a medical condition that is blocking the flow of menses.
• Having a personal history of infections in the pelvic area. If you have developed infections in the pelvic area in the past, then your chances of developing endometriosis are also high. Consult with your doctor and get yourself completely checked out. It is vital that you share all the information with them so that he or she can provide you with a timely diagnosis and effective treatment.
• Having uterine abnormalities
• Having never given birth before

Endometriosis tends to start developing several years after the first menses (menarche). Pregnancy temporarily stops endometriosis since the body halts production of the hormones that affect the implants. Menopause also stops endometriosis, unless you have undergone estrogen replacement therapies.

The main complication of untreated endometriosis is infertility. A significant number of patients with endometriosis have difficulties getting pregnant. Endometrial implants may block the fallopian tubes and prevent sperm cells from reaching the egg.

Women with endometriosis can still get pregnant and carry a pregnancy to term. Since endometriosis worsens over time, doctors often advise patients not to delay having children.

Endometriosis may slightly increase the risk of ovarian cancer. A significant numbers of patients with ovarian cancer have personal or family histories of endometriosis. This condition may also increase the risk of developing another type of cancer known as endometriosis-associated adenocarcinoma.