What is endometriosis? Every month, our ovaries produce hormones that tell the uterus to make a thick, plush lining of cells called the endometrium. When a woman has her menstrual cycle, this lining is removed. For those with endometriosis, these cells grow on the outside of the uterus creating endometrial implants. These implants stay in place during the menstrual cycle and continue to grow larger each month, sometimes bleeding, which can cause pain.
We do not know the actual cause of endometriosis. One theory is that during the monthly menstrual cycle, a woman sheds her uterine lining and some of that lining travels backwards through the fallopian tubes into the pelvis. It is here that the lining implants and accumulates on the outside of the bladder, ovaries, intestines, uterus, and other abdominal/pelvic organs. This accumulation may cause the body to produce adhesions, which can also cause a variety of symptoms. Some researchers believe that women with endometriosis may have a different immune system as well.
Approximately 176 million women worldwide suffer from endometriosis with 8.5 million in North America alone. In the United States, an estimated 6-11 percent of women of childbearing age have endometriosis. The average woman affected by endometriosis is between the ages of 25-35. Despite these numbers, endometriosis is commonly misdiagnosed as other conditions such as appendicitis, ovarian cysts, bowel obstruction, diverticulitis, fibroids, irritable bowel syndrome (IBS), or pelvic inflammatory disease (PID).
The most common symptom of endometriosis is pelvic pain with the menstrual cycle and/or sexual intercourse. There are many other symptoms such as:
• nausea, vomiting, gastrointestinal cramping, diarrhea/constipation, rectal pain;
• chronic or intermittent pain, large painful cysts, irregular vaginal bleeding;
• blood in urine, urinary frequency, retention, or urgency;
• fatigue, chronic pain, infertility, miscarriage, and ectopic pregnancy.
There are, however, many women that have few or no symptoms. Endometriosis usually develops several years after the onset of menstruation. The signs and symptoms will temporarily end during a pregnancy and permanently with menopause.
Some factors that place you at greater risk of developing endometriosis are:
• Never giving birth;
• Relatives with endometriosis;
• Menstrual cycles shorter than 27 days with bleeding lasting longer than eight days;
• Any medical condition that prevents the normal passage of menstrual flow;
• A history of pelvic infections.
One complication of endometriosis is difficulty with fertility. Approximately one-third to one-half of women with endometriosis have a problem getting pregnant. In order to get pregnant, an egg has to travel down the fallopian tube and meet up with the sperm to become fertilized. It is thought that endometriosis can interfere with this process. Endometriosis is associated with increase in the inflammation around the tubes, ovaries, and uterus, inhibiting sperm function and ciliary tubal function thus decreasing the chance of fertilization. Not all women with endometriosis are infertile. Many women with mild to moderate endometriosis are able to conceive and carry a pregnancy to term. The longer you have endometriosis, the greater your chance of becoming infertile.
There is not yet a cure for endometriosis, but there are many treatments to help suppress its reoccurrence. Your health care provider can use hormones such as birth control pills, patches, vaginal rings, implants, or hormonal intrauterine devices to help reduce the frequency of menstrual cycles or the thickness of the endometrial lining, which in turn will decrease the pain associated with endometriosis. Alternative options include using a gonadotropin-releasing hormone (GnRH) medication that essentially lowers your hormone levels in order to shrink the endometriotic implants. These injections are given either monthly or every three months.
The main way to diagnose and remove endometriosis is through surgical biopsy. This is commonly done through a minimally invasive outpatient procedure called laparoscopy. The surgeon will look into the abdominal/pelvic area using an instrument known as a laparoscope and remove the endometriosis for confirmation. By using a combination of both hormones and surgical intervention, the symptoms from endometriosis can be well managed.
Endometriosis is a common cause of severe pelvic pain with menses and sexual intercourse. Pain and infertility of endometriosis can be treated. The first step is evaluation by an experienced health care provider. The bottom line is don’t wait; contact your health care provider today for a complete evaluation.
Melissa Waddell, WHNP, a Hampton Roads native, is a nurse practitioner at Atlantic Ob/Gyn. For more information, please call 463-1234 or visit www.atlanticobgyn.com.