Endometriosis is the third leading cause of infertility in women of childbearing age. This disease affects 1 in 10 females from the ages of 15 to 44. It impacts more than 11% of women in the U.S. alone and is often times not diagnosed until a woman is in her 30’s or 40’s, so they may have it and not even know.
What is Endometriosis?
The inside of your uterus (womb) has a lining of tissue called the endometrium. This is similar to that thin layer of skin-type material attached to the shell you sometimes see when you peel a hard-boiled egg.
When you have a normal menstrual cycle, this uterine lining thickens to get your uterus ready to house a baby. Its purpose, if fertilization occurs, is to keep an embryo latched on to itself for nine weeks, providing nourishment until the mother’s blood supply through the placenta can take over the job.
If pregnancy doesn’t happen that month, menstrual blood sloughs away that barrier and your body begins to rebuild a new one in preparation for the possibility of pregnancy the next time.
With endometriosis, endometrial tissue grows and attaches itself in different places outside of your uterus where it doesn’t belong. Like the one in your womb, this tissue is stimulated during the menstrual cycle, but it doesn’t break down. Instead, it remains, causing pain, irritation, and possible scarring which can eventually lead to adhesions, a type of scarring that can cause different organs to fuse together.
Endometrial tissue can be found in:
- The pelvic cavity lining
- Fallopian tubes
- Uterine support structures
- Outer uterine surface
- Cul-de-sac (a space that is located behind the uterus)
- Outer uterine surface
In very rare cases, it has even been found on skin, and in the lungs and brain.
What are the Symptoms of Endometriosis?
Many women have none. Others may suffer a little discomfort, while yet others may experience extreme, debilitating effects. Symptoms include:
- Moderate to crippling pain during menstrual cycles that worsens over time
- Sexual discomfort felt deep in the pelvic area both during and after intercourse
- Lasting, chronic pain in pelvis and lower back
- Intestinal pain
- Digestive problems, especially during menstruation
What Are the Heath Risks of Endometriosis?
Although endometriosis is neither contagious nor cancerous, left alone it can continue to expand in places where growths should not appear. Unchecked, this may lead to the following problems:
- Swelling and pain: Because these implants of endometriosis are appearing internally where they don’t belong they cannot be expelled from the body. They can cause tenderness, inflammation, swelling, irritation, and even excruciating pain depending on their location.
- Infertility: Adhesions or scar tissue involving the fallopian tubes may block access to eggs, or damage both the sperm and egg during ovulation. Adhesions that have formed may also make pregnancy difficult or impossible.
- Cysts: If endometrial tissue grows in the ovaries and traps blood, painful, blood filled sacs called cysts may develop.
- Intestinal and bladder problems: Continual, unchecked growths in these areas can result in major health issues.
Who Can Get Endometriosis?
Any female who has begun to menstruate can get endometriosis. In the past, women were often not diagnosed until 30 or 40 years old. Now, doctors know to be on the lookout much earlier, starting in the teens to 20’s. Although endometriosis is not overly picky about which woman’s body it chooses to inhabit, you have a greater likelihood of suffering from it if you have:
- Had short menstrual cycles of 27 days or less
- Breast or ovarian cancer
- Never had children
- Difficulties or health problems preventing you from expelling regular menstrual flow
- Sensitivity to certain chemicals
- A female relative diagnosed with endometriosis
- Prolonged periods that exceed one week.
- An autoimmune disease like lupus, multiple sclerosis, hypothyroidism etc.
- Chronic fatigue syndrome
What Causes Endometriosis?
No one really knows although research is intense and ongoing. Some theories include:
- Genetics: Women in the same family are often diagnosed with the disease, so it is assumed that genetics play a role.
- Hormones: Estrogen spurs endometrial tissue production, so there is a hormonal link.
- Menstrual flow problems: Referred to as ‘retrograde menstrual flow’, this means that, since tissue is expelled through the fallopian tubes into the pelvis, it can end up in other parts of the body. This is the most popular theory
- Compromised immune systems: A weakened immune system may not be able to perceive or fight off the growth of endometrial tissue. Endometriosis has been found in that many women with certain cancers and lowered immunities.
- Invasive surgery: Transfer of endometrial tissue during certain abdominal surgeries is a possibility.
- Transportation of cells: Some experts think that endometrial cells ‘hitchhike’ with tissue fluids and blood cells to other parts of the body.
How is Endometriosis Diagnosed?
The only way endometriosis is diagnosed is that it must be seen at the time of surgery. When someone presents with symptoms of endometriosis, initial workup may entail:
- Complaints you are experiencing
- Family and your own medical history
- Evaluating all medications, herbs and supplements you are taking
- Blood and urine tests if needed
- A pelvic exam
Surgery is then performed as necessary.
Is There a Cure for Endometriosis?
There is no cure, but endometriosis can be treated and managed. Options depend on your particular issues and symptoms, and whether you still want to become pregnant. They range from medication to surgery.
What Are the Treatments?
Your doctor will most likely try the following:
- If pain is your major complaint, over the counter anti-inflammatory medications might work, or stronger prescriptive medication may be dispensed if needed. If you are averse to those, meditation, acupuncture, chiropractic help, and certain supplements may be beneficial.
- If you are not trying to get pregnant, you may be prescribed a birth control pill minimizing menstrual occurrence or eliminating periods altogether. Another option is insertion of a long-term intrauterine device (IUD) to prevent pregnancy for up to five years. It may not, however, reduce bleeding and endometrial pain for its complete duration.
- If you want to get pregnant, there are medications that may help. They stop the hormones that prod the body into ovulating, putting your body into a temporary state of menopause for a few months to control endometriosis growth. When this medication is stopped, menstruation resumes, allowing you a better chance of success for pregnancy.
- If a possible fallopian tube blockage is suspected, a test called a hysterosalpingogram (HSG) may be performed to confirm obstruction. Surgery may follow to correct the problem, or another bypass method to achieve pregnancy, such as insemination or in vitro fertilization (IVF) may be recommended.
- Laparoscopy is the mainstay of treatment. When the implants of endometriosis are found, they are treated or removed so that they no longer are active.
- As a last resort for unbearable pain and extensive growth, a hysterectomy may be performed, removing the uterus and ovaries entirely, along with all visible endometrial tissue. Hormone therapy is then started immediately to stave off additional formation. There is still a chance that endometrial development may continue, but this usually solves the problem.
How Can I Make Sure I Don’t Get Endometriosis?
There is no way to prevent endometriosis, but there is a possibility of reducing your odds by using estrogen-lowering birth control, limiting caffeine and alcohol which raise estrogen, exercising regularly, and maintaining ideal body weight.
How Can Cherokee Women’s Health Specialists Help Me?
Our entire practice focuses solely on women and their unique biology. We are trained in every aspect of women’s health care and have three board–certified, doubly accredited urogynecologists holding certification in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). This means that we can diagnose, understand, and treat all feminine problems with the most up-to-date knowledge and innovations known to modern medicine.
To book an appointment to further discuss endometriosis, call 770.720.7733.