Any woman who has endometriosis knows that it is so much more than bad cramps. It is a leading cause of infertility, and can cause chronic pelvic pain, painful intercourse, and debilitating fatigue.
Endometriosis is a condition in which the tissue that normally lines the uterus (endometrium) grows in other areas of the body. This tissue growth can occur in the pelvic area, outside of the uterus, on the ovaries, fallopian tubes, bowel, rectum, bladder, the lining of the pelvis and in other areas of the abdominal cavity. In rare instances, endomentrial growths are found in the limbs or head.
The cause of endometriosis is unknown. However, there are a number of theories. One prevalent theory suggests that cells released during menstruation may back up through the fallopian tubes into the pelvis, where they implant and grow in the pelvic or abdominal cavities. This theory is called retrograde-menstruation. Other theories for endometriosis include genetics (endometriosis tends to run in families) and immune system disorders (many women with endometriosis also have other autoimmune disorders).
Symptoms of endometriosis include increasingly painful periods, lower abdominal pain or pelvic cramps that can by felt for a week or two before menstruation, lower abdominal pain felt during menstruation, lower back pain during menstruation, pain during or following intercourse, painful or uncomfortable bowel movements, premenstrual spotting and infertility. Rarer symptoms can include frequent yeast infections and allergies.
Not all women will exhibit any or all of these symptoms. There are women with severe endometriosis who have no pain or discomfort, and others with mild endometriosis who have terrible pain and fatigue.
Endometrial cells respond to the menstrual cycle, however, during the normal shedding of uterine cells the endometrial tissue stay in place. This stimulation leads to scarring and adhesions. Many times these adhesions stick to the ovaries or fallopian tubes. When this occurs, the tubes can become blocked, preventing the egg from passing from the tube into the uterus. This is a common cause of infertility.
Endometriosis can only be definitively diagnosed after a laproscopic surgery. A surgeon will insert a tiny lighted tube through one or more small incisions and look for scar tissue, adhesions or other evidence of endometrial growth. During laproscopic surgery a surgeon can also remove the endometrial tissue.
Each year more treatments for endometriosis become available. There are some treatments which prevail, including laproscopy or laparotomy (a more invasive surgery utilizing a larger incision), hormone therapy, pain relievers, and alternative therapies such as acupuncture, nutrition, homeopathy, allergy management, and immune therapy.
Hormone treatment aims to stop ovulation for as long as possible. According to womenshealthchannel.com, oral contraceptives initiate the shedding of endometrial tissue that normally occurs during menstruation, causing endometrial thinning that reduces pain associated with endometrial implants. Combination oral contraceptives work about 75% of the time, and because they are less expensive than Danazol or GnRH agonists, they are often a first-choice treatment option. Common side effects include breast tenderness, swelling, weight gain, hypertension (high blood pressure), and blood clots in the legs. Low doses produce fewer side effects.
Womenshealthchannel.com also states that progestins, also know as birth control minipills, create an environment in which there is not enough cell-building estrogen to keep the endometrial thick, and thereby reduce the pain associated with the growths. Progestins are less expensive than oral contraceptives, but they produce more side effects.
GnRH agonists, or analogs, are a newer class of drugs designed to reduce estrogen. This helps reduce both the size of the growths and the pain they cause. GnRH analogs can be injected or inhaled with a nasal spray. The dosage will depend partly on the severity of the endometriosis. Common side effects include hot flashes, vaginal dryness, and a decreased sex drive. GnRH analogs may cause a small amount of bone loss, which is reversible if the medication is discontinued. Some doctors will prescribe supplements to reduce the amount of bone loss.
The first medication approved by the FDA for the treatment of endometriosis is Danazol. Danazol has shown to relieve pain and other symptoms. However, Danazol will not prevent recurrences, and many women experience unpleasant side effects, including weight gain, muscle cramps, decreased breast size, flushing, mood change, oily skin, depression, sweating, edema, acne, hirsutism (abnormal hair growth), decreased sex drive, headache, dizziness, and deepening of the voice. Due to both the number and severity of side effects, Danazol is no longer the first drug of choice for most doctors.
If the endometriosis is mild and not interfering with fertility, a woman may choose to simply take pain relievers as needed. This can range from over-the-counter aspirin, ibuprofen, or acetaminophen to prescribed drugs including narcotics and NSAIDS.
As a last resort a woman may be advised to have a full hysterectomy. This would entail removal of the uterus, ovaries and fallopian tubes. This is a drastic step and many factors play into this decision: Age and fertility issues are among the most prominent. Women considering a hysterectomy will also need to prepare for the onset of menopause and its accompanying symptoms.
Newer treatments include special laser surgery, which can vaporize rather than burn away scar tissue and adhesions and newer drugs which continue to inhibit ovulation without the usual side effects.
The two most important things a woman with endometriosis will need are 1) knowledge and 2) a caring physician. There are several Internet sites which give enormous amounts of information. Choosing a physician can be more challenging. Word-of-mouth remains the best way to find a doctor who suits a woman’s particular style and personality. Some prefer a straightforward doctor who sticks to the business at hand. Others prefer a doctor with a gentle bedside manner and one who takes time to know your lifestyle and expectations.
Endometriosis is serious, but treatable. It is a frustrating disease, but with the right knowledge and the right doctor, women have more choices than ever.
