Talk to your Doctor: Endometriosis
Debilitating cramps. Heavy bleeding. Pelvic pain. Nausea. Does this sound like your period? These could be symptoms of endometriosis. Endometriosis is a common chronic condition estimated to affect 10% of women during their reproductive years. Still, many don’t know the signs and symptoms, while others have been misinformed. At Women’s Health CT, our OB/GYNs can help determine if you have this disease and devise a treatment plan that’s right for you.
What is Endometriosis?
In non-pregnant women, the tissue lining the inside of the uterus, called the endometrium, builds up and is shed each month during menstruation. With endometriosis, this tissue develops outside the uterus. It usually forms on the ovaries, fallopian tubes, outer surface or surrounding tissues of the uterus, but can appear on other organs as well. Most cases are reported among women in their 30s and 40s.
This misplaced endometrial tissue acts as if it is inside the uterus. At the end of every cycle, when hormones cause the uterus to shed its endometrial lining, endometrial tissue growing outside the uterus also breaks apart and bleeds. However, unlike menstrual fluid from the uterus, blood from the misplaced tissue has no place to go. Tissues surrounding the areas of misplaced tissue may become inflamed or swollen and produce cysts or scar tissue, called adhesions. These adhesions can cause organs to stick together and be very painful.
The most common symptom of endometriosis is pain, especially during menstruation. This can include excessive menstrual cramping, long-term lower back and pelvic pain, pain during or after sex, intestinal pain, and painful bowel movements or urination during menstruation. Endometrial patches may be tender to touch or pressure. The amount of pain is not always related to the severity of the disease − some women with severe endometriosis have no symptoms, while others with just a few small growths have incapacitating pain.
Heavy menstrual bleeding, spotting or bleeding between menstrual periods, digestive problems, and infertility may be indications of the disease as well.
Endometriosis is considered one of the three major causes of female infertility, and approximately 50% of women with infertility have endometriosis. Unsuspected or mild endometriosis is a common finding among infertile women, but how this type of endometriosis affects fertility is still not clear. Compared to the general population, pregnancy rates for those who suffer from endometriosis remain lower. However, many women with the condition get pregnant – it just may not happen as quickly.
The cause of endometriosis is still unknown. One theory is that during menstruation some of the menstrual tissue backs up through the fallopian tubes into the abdomen, where it implants and grows. Another theory suggests that endometriosis may be a genetic condition or that certain families may have predisposing factors to endometriosis. Endometriosis may also be caused by an excess of the hormone estrogen in a woman’s body or a weakened immune system.
Diagnosis of endometriosis begins with a gynecologist evaluating your medical history. A complete physical exam, including a pelvic examination, is also necessary. Your OB/GYN may have an ultrasound or magnetic resonance imaging (MRI) test performed to check for ovarian cysts from endometriosis. However, diagnosis of endometriosis is complete only when proven by a laparoscopy where the surgeon checks the abdominal organs for endometrial implants.
The laparoscopy can show the locations, extent, and size of the growths and will help the patient and her doctor make better-informed decisions about treatment. A small amount of tissue may be removed through a biopsy during this process as well.
Treatment plans for endometriosis are developed based on symptoms and desire for pregnancy. For younger patients with mild endometriosis who wish to become pregnant, the best course of action is to have a trial period of unprotected intercourse for six months to one year. If pregnancy does not occur within that time, then further treatment may be needed. Your OB/GYN may also recommend a gonadotropin-releasing hormone (GnRH) agonist. This medicine prevents the body from producing the hormones responsible for ovulation, menstruation, and the growth of endometriosis. After you stop taking this medication for a period of time, you may have an increased chance of conceiving.
For patients not seeking pregnancy with milder cases, the first step is often a course of hormonal birth control. For more severe symptoms, surgical treatment to remove the endometrial implants also may be considered, whether pregnancy is desired or not. Immediate pain management is also addressed once diagnosis is confirmed.
There are many solutions to ease the symptoms of endometriosis, but there is no known cure yet. Fortunately, most women experience the joy of childbirth and an improved quality of life after treatment. The first step is to talk to your doctor if you are experiencing any of the above symptoms. If you’re not comfortable talking with your doctor, find a new one! With over 200 providers in the Women’s Health Connecticut network, you can find the right OB/GYN for you. Request an appointment with a Women’s Health Connecticut provider in your area today.