Endometriosis

Endometriosis

The lining of the uterus is called the endometrium. Sometimes, tissue similar to that which normally lines the uterus grows elsewhere in the body. When this happens it is called endometriosis.

Endometriosis can cause pain, especially during the menstrual period. For some women, the pain is mild. For others, it can be severe. Endometriosis may also cause infertility.

The Endometrium

• About day 5, the hormone estrogen signals the endometrium to grow and thicken to prepare for a possible pregnancy.
• About day 14, an egg is released from the ovary. This is called ovulation. during this time, a woman can get pregnant. The egg moves into one of the two fallopian tubes connected to the uterus, where it can be fertilized by a man’s sperm. If fertilized, the egg then moves into the uterus and begins to grow. A woman does not have a menstrual period while she is pregnant.
• About day 28, if an egg is not fertilized, hormone levels decrease, and the endometrium is shed with some bleeding (menstruation).
• The process of growth and thickening of the endometrium then starts again in the next cycle.

The Menstrual Cycle

What is Endometriosis?

In endometriosis, tissue similar to the endometrium is found in other areas in the body and acts like tissue in the uterus. It most often appears in places within the pelvis, including the:

• Ovaries
• Fallopian tubes
• Outside of the uterus
• Cul-de-sac (the space behind the uterus)
• Bowel
• Bladder
• Rectum

Endometrial tissue may attach to organs in the pelvis or to the peritoneum. It may also be found in other parts of the body, although this is very rare. Endometrial tissue outside the uterus responds to monthly changes in hormones the same way it does inside the uterus It also breaks down and bleeds This bleeding can cause pain especially during your period The breakdown and bleeding of this tissue each month can Rectum cause scar tissue, called adhesions. Sometimes adhesions bind organs together. Adhesions can also cause pain. If blood is trapped in the ovary because of adhesions, it can form an endometrioma (also known as a cyst). No one is certain of the cause of endometriosis. One theory is that blood sometimes backs up and carries tissue from inside the uterus into the fallopian tubes during your period. The tissue then travels out of the tubes and attaches to other places. Another theory is that endometrial cells are transported through blood and lymph vessels.

About 7% of women of childbearing age in the United States have endometriosis. It is most common in women in their 30s and 40s, but it can occur anytime in women who menstruate. Endometriosis occurs more often in women who have never had children. Women whose mother, sister, or daughter has had endometriosis are more likely to have it. The symptoms of endometriosis often get worse over time. It will progress in more than half of women who are not treated and in 20% of women who are treated. Treatment may help keep the condition from getting worse.

Symptoms

Symptoms of endometriosis include pelvic pain. Such pain may occur with intercourse, during bowel movements or urination, or just before a menstrual cycle. Endometriosis may also cause spotting or infertility. Although these symptoms may be a sign of endometriosis, they could also be signs of other problems. If you have any of these symptoms, see your doctor.

The amount of pain does not tell you how severe your condition is. For example, some women with slight pain may have a severe case, whereas others who have a lot of pain may have a mild case.

Some women with endometriosis have no symptoms. In fact, they may first find out that they have endometriosis if they are unable to get pregnant. Endometriosis is found in about one third of infertile women. Women often find that symptoms are relieved while they are pregnant. In fact, many of the products used to relieve endometriosis are based on the hormonal effects of pregnancy.

Diagnosis

Your doctor may suspect something is abnormal while performing a pelvic exam. The only way to confirm a diagnosis of endometriosis is to look directly inside the body. This is usually done by laparoscopy. Laparoscopy is often done with general anesthesia. The doctor makes a small cut near your navel. A thin lighted scope, a laparoscope, is then inserted into your abdomen. The laparoscope allows the doctor to view the pelvic organs. The doctor can then better tell the extent of the endometriosis. Sometimes a small amount of tissue is removed during the procedure. This is called a biopsy. Studying the tissue in a laboratory helps confirm the diagnosis. Endometriosis can also be treated with laparoscopy. If endometrial tissue is found during the laparoscopy, your doctor may decide to remove it right away, if possible.

Laparoscopy

Treatment

Treatment for endometriosis depends on your symptoms and whether you want to have children. It may be treated with medication, surgery, or both. Although symptoms of endometriosis may come back, therapy can relieve pain for a time.

Medications

Hormones may be used to relieve pain. The hormones may help slow the growth of the endometrial tissue. The most commonly prescribed hormones include oral contraceptives, gonadotropin-releasing hormone (GnRH) agonists, progestin, and danazol. Not all women, however, get pain relief from medications. Medication does not reduce adhesions or scar tissue, which may be the cause of pain. These medications are not for all women. As with most medications, there are some side effects linked to hormone treatment. Some women, however, may find the relief of pain is worth the discomfort of the side effects.

Oral contraceptives

Birth control pills are often prescribed for symptoms of endometriosis. The hormone in them helps keep the menstrual period regular, lighter, and shorter and can relieve pain. There is no evidence that birth control pills shrink endometriosis or increase fertility. Your doctor may prescribe the pill in a way that prevents you from having periods.

GnRH agonists

GnRH is a hormone that helps control the menstrual cycle. GnRH agonists are drugs that are similar to human GnRH but many times more potent than the natural substance. GnRH agonists lower estrogen levels by turning off the ovaries. This produces a temporary condition similar to menopause. GnRH agonists can be given as a shot, an implant, or nasal spray. Usually, patches of endometriosis shrink and pain is relieved. GnRH may help relieve pain during sex. Women taking GnRH may have hot flushes (hot flashes), headaches, and vaginal dryness. Treatment with GnRH usually lasts up to 6 months. After stopping GnRH, you will have periods again in about 6-10 weeks. Symptoms of endometriosis will recur in at least half of women who take GnRH, especially if symptoms are severe.