What is Endometriosis?
Endometriosis is a disease of the female reproductive organs and pelvic area. It affects approximately 5.5 million girls and women in the U.S., and approximately 90 million worldwide. It is most often characterized by generalized pelvic pain, increased pelvic pain before, during, and after the menstrual period, pain during and after intercourse, functional pain during urination and bowel movements, particularly during the menstrual period, and heavy or irregular periods. However, there are a large number of other symptoms also associated with endometriosis. (Endometriosis Association, Wikipedia)
In patients with endometriosis, microscopic particles of tissue, similar to the tissue that makes up the lining of the uterus (that lining is called the endometruim), are found elsewhere in the pelvic cavity. The particles of tissue that are displaced outside the endometruim behave just as they would if they were within the uterus walls, physically preparing the body for pregnancy each month. The stray endometrium cells perform the natural process of reacting with hormones and building up blood cells and other chemicals the body needs to sustain a pregnancy. However, because these extra particles of endometrium tissue are found in the pelvic cavity of a woman with endometriosis, and not inside the uterus, during the process of discarding that blood that a healthy woman experiences during her menstrual cycle, there is no way for the blood of the stray endometrium tissue to exit the body. This causes a woman with endometriosis to experience internally bleeding and inflammation, and can lead to the development of scar tissue and adhesions in the pelvic cavity as well.
Endometriosis is categorized into four stages. These stages are based on the severity of the endometriosis and the depth of the resulting adhesions. Stage I (minimal) endometriosis is characterized by superficial endometriosis with filmy adhesions. Stage II (mild) endometriosis is characterized by superficial and deep endometriosis with filmy adhesions. Stage III (moderate) endometriosis is characterized by superficial and deep endometriosis, with filmy and dense adhesions. The final stage, stage IV (severe) endometriosis is characterized by superficial and deep endometriosis, with dense adhesions. (Breitkopf, L. J., & Bakoulis, M. G. (1988). Coping With Endometriosis. New York: Prentice Hall Press.) These classifications signify the pathological and observable findings of endometriosis, and not the symptoms the patient experiences, which may be significantly more or less severe than the diagnosed stage of endometriosis may suggest.
What are the Symptoms of Endometriosis?
The most common symptom of endometriosis is pain in the pelvic area. For many women, this pain can be severe and debilitating. This pain occurs most often, and is the most relentless, before, during and after a woman’s menstrual cycle. Other symptoms of endometriosis include pain during ovulation, heavy or irregular menstrual periods, pain during and after sexual intercourse, pain during urination and bowel movements, low back pain, diarrhea and constipation, abdominal bloating, bowel obstructions, digestive problems, fatigue, and, in 30-40% if women with endometriosis, infertility. (Endometriosis.org)
How is Endometriosis Diagnosed?
An exact and constant picture of the symptoms a woman with endometriosis will experience is impossible to paint. The effects of the disease are specific to the location and volume of the misplaced endometrium tissue, and of any adhesions or areas of scar tissue that form as a result. In the early stages of endometriosis, or in less severe cases, it is common for women with the condition to be misdiagnosed. Some common misdiagnoses for endometriosis include ovarian cysts, fibroid tumors, ovarian and colon cancers, irritable bowel syndrome, and even ectopic pregnancies.
There are a number of tests that can be performed to determine whether a woman may have endometriosis, but the only reliable way to conclusively diagnose the condition is through an exploratory procedure called a laparoscopy.
The first step to diagnosing endometriosis is to have a full physical examination done, and to have blood work performed. Information in a woman’s medical and family history, and her reporting of symptoms, can start the process in the right direction. Sometimes, if the endometriosis is advanced enough or if it is manifested in a location that is easy to palpate, the physician may be able to detect lumps or lesions in the pelvic area, or notice irregularities in the size and position of the ovaries and uterus. Blood work may reveal elevated levels of a cell surface protein called CA-125, which may be indicative of endometriosis. (IVF.com) None of these findings alone are conclusive for a diagnosis, however.
Further exploration through the use of ultrasound and MRI may also be used to attempt to determine whether or not a woman is likely to be suffering from endometriosis. They may identify lesions or inconsistencies in the uterus and ovaries. Unfortunately, however, like the results of the physical exam and blood work, the imaging results are not enough to diagnose endometriosis.
Once the suspicion of endometriosis has been explored, the only truly reliable way to diagnose the disease is through a laparoscopy. A laparoscopy is an exploratory procedure, performed under general anesthesia, which allows the physician to see inside the pelvic region and check for endometrial growths. The procedure involves making a small incision near the navel and inserting a long, thin, lighted instrument called a laparoscope into the abdomen. The laparoscopy allows the physician to actually see the endometrial growths, and to surgically remove lesions for examination under a microscope, which will conclusively confirm the diagnosis of endometriosis. (Endo Resolved)
What Causes Endometriosis?
The cause of endometriosis is currently unknown. Researchers have some theories about possible causes which individually, or in combination may possible cause the condition, but at this time there is no standard recognized cause.
One theory is the retrograde menstruation theory. Retrograde menstruation refers to a condition in which some menstruation tissue travels back up through the fallopian tubes during menstruation and implants itself in the abdomen. Another theory hypothesizes that some tissue may still exist in a woman’s body from when she, herself, was an embryo, causing the tissue to exist outside the uterus. Still another suggests that the lymphatic system may carry endometrial tissue of some women through the blood stream and deposit it outside the womb. Other factors, like a genetic link to endometriosis and introduced causes, such as surgery and reaction to medications have also been explored. (Endometriosis Association)
How is Endometriosis Treated?
There is currently no cure for endometriosis. The treatment options for the disease are variable depending on the patient’s symptoms and treatment preferences.
Many women with endometriosis find some relief from the pain through the use of analgesic pain killers, such as NSAIDs (non-steroidal anti-inflammatory drugs) like aspirin and ibuprofen, and mild narcotics like codeine. For others, hormonal therapy (through the use of birth control pills or other hormone medications) may provide some relief from the pain associated with endometriosis.
Laparoscopic surgery can be used to remove some of the adhesions, lesions and cysts caused by endometriosis. In more advanced cases, a procedure called a laparotomy, which is a surgical procedure, and is more aggressive than the laparoscopy, or a hysterectomy may be required to clean out some of the growths caused by the endometriosis.
