“It’s a pain like nothing else,” one woman relates regarding her experiences with endometriosis. “Some days I would be doubled over, completely disabled by the pain.”
This woman is not alone. Endometriosis is estimated to affect more than one million women in the United States – most often during their reproductive years. Endometriosis is the abnormal growth of endometrial cells – similar to those that form the inside of the uterus, but in a location outside of the uterus. As the endometrial cells, or endometrium, attach to tissues outside of the uterus, they become endometriosis implants – most commonly affecting the ovaries, fallopian tubes, outer surface of the uterus or intestines, and the lining of the pelvic cavity.
During menstruation, the displaced endometrial tissue continues to act as it normally would; it thickens, breaks down, and bleeds. Because the displaced tissue has no way to exit your body, it becomes trapped and causes pain each menstrual cycle –sometimes much more often.
Symptoms of Endometriosis
Some women with endometriosis run the gamut of symptoms, while others may only notice one or two. Common symptoms include:
• Extremely painful periods (dysmenorrhea)
• Excessive, heavy bleeding (menorrhagia) or bleeding between periods (menometrorrhagia)
• Pelvic pain (not just during menstruation)
• Pain during ovulation
• Pain during urination
• Pain during or after intercourse
• Lower back pain
• Abdominal bloating
• Irregular cycles
• Fatigue
Endometriosis may also affect the bowel, which can cause:
• Painful bowel movements
• Constipation
• Diarrhea
• Intestinal cramping
• Nausea and/or vomiting
• Abdominal pain
• Rectal pain and/or bleeding
Another well-known symptom of endometriosis is infertility. It is estimated that between 20 and 50 percent of women being treated for infertility have endometriosis. With the right treatment, many women can successfully control their endometriosis and conceive.
Treatments for Endometriosis
Although a pelvic exam and ultrasound may indicate that you have endometriosis, laparoscopy is the only way to know for certain. Laparoscopy is a minor surgical procedure where the surgeon makes a tiny incision near your navel and a laparoscope (small viewing instrument) is inserted. Your abdomen is expanded with carbon dioxide gas so that your organs are easier to see. Your surgeon will then look for signs of endometrial tissue, noting the size and extent of any implants or adhesions.
Once endometriosis has been diagnosed, you have a few options, including:
Hormone Therapy
Supplemental hormones are often effective in reducing or eliminating the pain of endometriosis because they help control the hormones responsible for the buildup of endometrial tissue each menstrual cycle.
Your doctor may suggest oral contraceptives for mild to moderate endometriosis, or a Gonadotropin-releasing (Gn-RH) analog if your condition is more serious. These drugs block the production of ovarian-stimulating hormones, preventing menstruation and drastically reducing estrogen levels. Gn-RH agonists and antagonists force endometriosis into remission during treatment, and sometimes for months or years afterward.
The downside of these drugs is that it brings on an artificial menopause. You may experience hot flashes, irritability, headaches, or vaginal dryness – but your doctor can prescribe Add-back, a daily pill that adds back a small amount of hormone into your system to eradicate these side effects.
Conservative Surgery
Hormonal therapies are not a permanent fix for endometriosis. A considerable percentage of women who suffer from endometriosis at one point in their life will likely get it again. Surgery will remove endometrial growths, scar tissue, and adhesions (bands of scar tissue) without harming your reproductive organs.
Hysterectomy
In severe cases of endometriosis, a hysterectomy may become necessary. A complete hysterectomy removes the uterus, cervix, and both ovaries. Most women view having a hysterectomy as a last resort, especially those who are still in child-bearing years. Some even continue to experience pain after a hysterectomy, so it is far from a cure-all treatment.
Coping with endometriosis can be physically and emotionally taxing. Not everyone understands how difficult it is to suffer from chronic pain, so most women would benefit from joining a support group to meet others who are going through the same trials.
Sources (8/22/11):
Endometriosis: About Endometriosis
Mayo Clinic: Symptoms
The Endometriosis Association: What is Endometriosis?
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