Endometriosis
Endometriosis
What is endometriosis?
- Endometrium: Tissue that forms the lining of the uterus
- Endometrium grows in places in the body other than the uterus.
What are the most common places in the body where…
- Ovaries
- Fallopian tubes
- Surface of the uterus
- Cul-de-sac (the space behind the uterus)
- Bowel
- Bladder and ureters
- Rectum
- Lungs: rarely
- Other parts of the body as well
What are the effects of endometriosis?
- Abnormal bleeding
- Endometrial tissue outside the uterus responds to changes in hormones.
- It breaks down and bleeds like the lining of the uterus during the menstrual cycle.
- Adhesions
- The breakdown and bleeding of this tissue each month can cause scar tissue, called adhesions, to form.
- Adhesions can cause pain.
- Sometimes, adhesions bind organs together.
- Infertility
- Endometriosis may lead to infertility.
Who is at risk of endometriosis?
- Age
- Most common in women in their 30s and 40s,
- It can occur any time in women who menstruate.
- Children
- Endometriosis occurs more often in women who have never had children.
- Family History
- Women with a mother, sister, or daughter who have had endometriosis
What are the symptoms of endometriosis?
- Pelvic pain.
- Pain may occur with sex,
- During bowel movements or urination,
- Just before or during the menstrual cycle.
- Pain severity does not correlate with condition severity
- Some women with slight pain may have a severe case.
- Others who have a lot of pain may have a mild case.
- Menstrual bleeding may occur more than once a month.
- Many women with endometriosis have no symptoms.
- They may first find out that they have endometriosis if they are not able to get pregnant.
- In women who can get pregnant, many often find that symptoms are relieved while they are pregnant.
How is endometriosis diagnosed?
- Physical exam, including a pelvic exam.
- Laparoscopy
- Looking directly inside the body.
- The only sure way to tell if endometriosis is present
- Biopsy
- Sometimes a small amount of tissue is removed during the procedure and studied in a lab.
How is endometriosis treated?
- Options
- Medication
- Surgery
- Both
- Treatment choice depends on
- Extent of the disease
- Your symptoms
- Whether you want to have children.
- Treatment Efficacy
- Treatments may relieve pain and infertility for a time
- Symptoms may come back after treatment.
What medications are used to treat endometriosis?
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- May be used to relieve pain.
- Hormones
- May help slow the growth of the endometrial tissue
- And prevent the growth of new adhesions
- But will not make them go away.
What hormones are used most often for treatment?
- Oral contraceptives
- Birth control pills contain hormones
- Help keep the menstrual period
- Regular
- Lighter
- Shorter
- Can relieve pain.
- Help keep the menstrual period
- Birth control pills contain hormones
- Gonadotropin-releasing hormone (GnRH) drugs
- Decrease estrogen levels
- By stopping its production by the ovaries.
- Causes a short-term condition that is much like menopause.
- Given as a shot, an implant, or nasal spray.
- Efficacy
- In most cases, endometriosis shrinks and pain is relieved
- Side effects
- Hot flushes
- Headaches
- Vaginal dryness
- Decrease in bone density
- Duration
- Treatment with GnRH most often lasts at least 3 months.
- Bone Loss
- Long-term use can result in bone loss.
- Prevention
- Your doctor may prescribe certain hormones or medications to take along with GnRH treatment.
- In many cases, this therapy also may reduce other side effects.
- After stopping GnRH treatment, you should have periods again in about 6–10 weeks.
- Decrease estrogen levels
- Progestin
- Progestin works against the effects of estrogen on the tissue.
- Although you will no longer have a monthly menstrual period when taking progestin, you may have irregular vaginal bleeding.
- Progestin is taken as a pill or injection.
What types of surgery are used to treat endometriosis?
- Often is done by laparoscopy.
- During laparoscopy, endometriosis can be removed or burned away.
- Not all cases can be handled with laparoscopy.
- Sometimes a procedure called a laparotomy may be needed.
What can I expect after surgery?
- You may have relief from pain.
- However, symptoms return within 1 year in about one half of women who have had surgery.
- Many patients are treated with both surgery and medications to help extend the symptom-free period.
- If pain is severe and does not go away after treatment, a hysterectomy (surgery to remove your uterus) may be an option.
- Endometriosis is less likely to come back if your ovaries also are removed.
- After this procedure, a woman will no longer have periods or be able to get pregnant.
- There is a small chance that your symptoms will come back even if your uterus and ovaries are removed.
