Endometriosis occurs when the normal lining of a woman’s uterus travels outside of the uterus and appears in other locations in the abdominal cavity. The tissue can adhere to the ovaries, Fallopian tubes, bowel, bladder or other spots within the abdomen. Endometrial cells respond to monthly hormones, shedding blood during the time of the monthly period but leaving that blood with no place to go. When it remains in the abdomen, it can cause scarring, adhesions and/or cysts.
Why do endometrial cells travel?
Dr. Guile notes that there are three theories for the appearance of endometrial issue outside of its normal location:
Retrograde menstruation. This theory explains that menstrual blood may flow out of the fallopian tubes instead of only traveling out of the vagina.
Endometrial cells may travel through the lymph system of the body, landing in other locations.
Another theory posits that the cells that line the inside of the abdomen can develop into endometrial cells and begin responding to hormones in the same manner as those inside the uterus.
What are the symptoms of endometriosis?
No matter the source of the errant endometrial cells, the impact on the women is the same. The monthly bleeding that occurs with menstruation occurs in the endometrial cells that are outside of the uterus. This results in pain and cramping. This tenderness and pain can always be present, and it can be triggered by urination, bowel movements or sexual intercourse – depending on where the endometrial implants sit.
Some women may have endometriosis but not experience painful symptoms. Their first hint of the disease may be the inability to get pregnant. Months of menstrual cycling may have resulted in scar tissue in the abdomen, on the ovaries or fallopian tubes. Often a workup for infertility may be the first time a woman realizes she has endometriosis.
Who is at risk for endometriosis?
Endometriosis can occur in a woman at any time from her first menstruation through menopause, when the monthly hormonal cycling ceases. It is most often diagnosed in women in their 20s and 30s.
There is some evidence that women whose mother or sister has the disease are more likely to experience it. And it also appears that an early first pregnancy can delay the development of endometriosis. Any pregnancy serves to “turn off” the cyclic monthly bleeding, giving the body a rest.
Endometriosis is more common in Caucasian and Asian women than in African American or Hispanic women. And in contrast to many other conditions, it seems to strike women with slimmer frames and a lower body mass index.
It is difficult to measure the full extent of the condition, says Dr. Guile, as some women may have endometriosis but never have symptoms severe enough to warrant a diagnosis by a physician. And he notes there is no known way to prevent the condition from happening.
What are treatment options for endometriosis?
Treatment for endometriosis is determined by the degree of the woman’s symptoms; her desire for future pregnancies; and the particular problems she is experiencing in her body due to endometrial implants.
Non-surgical treatments for endometriosis
The first level of treatment is often to relieve pain and cramping with pain relieving drugs. The most effective are non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen or Aleve. For some women, taking NSAIDs during their cycle will bring enough relief.
Another option is taking birth control pills continually, which will eliminate the monthly cycling and therefore the symptoms of endometriosis. “The patient throws out the ‘placebo pills’ in the packet of birth control pills, so menstruation doesn’t happen,” says Dr. Guile. A woman considering this option should consult with her doctor about using this as an ongoing treatment.
Surgical treatment for endometriosis
For women whose endometriosis has resulted in infertility, surgery may be the best option. Surgery to remove implanted tissue and release adhesions and scarring may increase a woman’s chance of getting pregnant.
Some women who don’t plan to become pregnant still opt for surgery to remove larger implants and relieve severe pain.
Dr. Guile notes, however, that endometriosis may recur. “Until menopause, cycling estrogen may still spur more endometrial tissue.”
For women who have severe symptoms and don’t desire future pregnancies, a hysterectomy with removal of the ovaries will provide the ultimate relief.
For all women, the arrival of menopause will stop the monthly aggravation of endometrial tissue, bringing relief.
Dr. Guile notes that for post-menopausal women, hormone replacement therapy may be appropriate to relieve menopausal symptoms and, in the majority of cases, does not cause a flare up or return of the endometrial pain.
When should you seek treatment?
Dr. Guile notes that regular visits to your physician for pap smears and physical exams can help detect the condition.
If you have severe menstrual symptoms, including pain and cramps, see your doctor. Endometriosis may – or may not – be the cause, but your doctor can help you find appropriate relief.