Angels of Hope information on endometriosis
Endometriosis is defined as the presence of endometrial tissue (this tissue normally lines the uterus of menstruating females) outside of the uterine cavity. These endometrial implants are found in the lower parts of the pelvis - affecting the ovaries/tubes and the area behind the uterus. Rarely it may affect the abdominal organs, the urinary tract, and the lungs.
Endometriosis usually effect women of childbearing age. It is found in 12-32% of women who have pelvic pain. Women with infertility problems have an occurrence rate of 21-48%.
The uterus is lined with a type of tissue called endometrium. Each month a women’s body releases hormones that cause the endometrium to thicken and get ready for the implantation of an egg. If a woman does not get pregnant, the endometrium breaks down, and the body sheds it as menstrual blood (a woman’s period). In endometriosis, the implants of tissue outside the uterus act just like the tissue lining the uterus. During the menstrual cycle the implants get thicker, then break down and bleed. Since the implants are outside the uterus, the blood cannot flow out to the body. The implants can get irritated and painful. Sometimes they form scar tissue or fluid filled sacs (cysts). The scar tissue may make it difficult for a woman to get pregnant.
Experts do not really know what causes endometrial tissue to grow outside the uterus (many theories have been put forth). We do know that the female hormone estrogen makes the problem worse. Women during the childbearing age have high levels of estrogen. It is during these years- from the teens to the 40’s- that women have endometriosis. When estrogen levels drop the women is in menopause. Symptoms usually disappear at that time and the disease process stops.
The most common symptom is pain. Pain is related to where the implants are growing. The pain may be in the lower abdomen, the rectum, the vagina, or the lower back. The pain may be present during the menses (the most common time) or all the time. Some woman may have pain during sex, when they have a bowel movement, or during ovulation.
Abnormal bleeding is also common- it may be heavy periods, spotting or bleeding between periods, bleeding after intercourse, or the presence of blood in the woman’s urine or stool.
Difficulty in becoming pregnant may be the only symptom some women have. The diagnosis of endometriosis is made from many different investigations. A detailed medical history is required. The presence of painful, abnormally heavy and irregular periods is important for the physician to obtain. A pelvic examination, including a vaginal and rectal exam is of great importance. The use of pelvic sonograms, CT scans and MRI’s is useful in the diagnosis of endometriosis. However, the only truly diagnostic procedure is to have a pelvic laparoscopy. This surgery involves the insertion of a telescopic instrument into the woman’s abdomen. This procedure allows the physician to see into the abdomen and the pelvis. If the physician finds the implants typical of endometriosis he may biopsy them for pathological confirmation. The physician may also remove scar tissue, cysts or the implants themselves.
There is no known cure for endometriosis. The treatment of patients with this disease is temporary. Treatment of these women should be based on the extent of the disease, severity of symptoms, the patient’s desire for childbearing, the patient’s age, and other coexisting medical and surgical factors. Available modalities of treatment are expectant (wait and see), hormonal, surgical, and a combination of medical and surgical treatment. Over the counter pain medications like ibuprofen (Advil or Motrin) or naproxen (Aleve), may be used with limited results. They may reduce bleeding and pain. Birth control pills are probably the best treatment for control of pain and to shrink the implant. Most women can use the birth control pills for many years. The patients obviously have to sop the pills when they wish to become pregnant. Hormonal therapy with drugs such as Lupron is very successful, except it will stop woman’s periods-thus preventing her from becoming pregnant. Laparoscopy to remove scar tissue and to eliminate the implants is successful and may increase the fertility of the patient. When a patient has completed her family, and the pain is very severe, the removal of the uterus and ovaries may be considered. If the ovaries are removed, the patient’s estrogen level will drop and all her symptoms will resolve (you have produced a surgical menopause).
Endometriosis is a fairly common disorder found in many women. The diagnosis is made more often because of the multiple modalities available to the physician. We also see the disease more often because women are waiting longer to have children in our society today. These women who put off pregnancy to have a career are allowing endometriosis to have many years to establish itself. Previous generations had children at much earlier ages and a greater number of pregnancies- thus preventing endometriosis from establishing itself in a woman’s pelvis.
Endometriosis is an ongoing problem to women and their physicians.