What is endometriosis?
Endometriosis is a common gynecological condition, particularly among women of childbearing age, affecting an estimated two to 10 percent of American women in this age group.
During a woman’s regular menstrual cycle, the endometrium, or tissue that lines the uterus, builds up and is shed if she does not become pregnant. Endometriosis occurs when this tissue grows outside of the uterus, usually on other reproductive organs inside the pelvis or in the abdominal cavity. Each month, this misplaced tissue responds to the hormonal changes of the menstrual cycle by building up and breaking down just as the endometrium does, resulting in internal bleeding.
Unlike menstrual fluid from the uterus that is shed by the body, blood from the misplaced tissue has nowhere to go resulting in the tissues surrounding the endometriosis becoming inflamed or swollen. This process can produce scar tissue around the area that may develop into lesions or growths. In some cases, particularly when an ovary is involved, the blood can become embedded in the tissue where it is located, forming blood blisters that may become surrounded by a fibrous cyst.
What are the symptoms?
- Pain, especially excessive menstrual cramps which may be felt in the abdomen or lower back
- Abnormal or heavy menstrual flow
- Painful urination during menstrual periods
- Painful bowel movements during menstrual periods
- Other gastrointestinal problems, such as diarrhea, constipation, and/or nausea
- Pain during intercourse
What treatment options are available?
- Birth control pills with combined estrogen and progestin (a synthetic form of progesterone) hormones to prevent ovulation and reduce menstrual flow. Once a woman stops taking birth control pills, she can get pregnant again. However, stopping these pills will cause endometriosis symptoms to return.
- GnRH (Gonadotropin-releasing hormone) agonists and antagonists stops ovarian hormone production, creating a sort of “medical menopause.” Taking a low dose of progestin or estrogen along with these drugs can protect against side effects such as hot flashes, bone loss and vaginal dryness. When a woman stops taking this medicine, monthly periods and the ability to get pregnant return. She also might stay symptom-free for months or years afterward.
- Progestins. The hormone progestin can shrink spots of endometriosis by working against the effects of estrogen on the tissue. While the normal menstrual cycle will be stopped, irregular vaginal bleeding may occur. Side effects can include weight gain, depressed mood, and decreased bone growth.
- Danazol is a weak, synthetic form of testosterone that lowers the levels of estrogen and progesterone in a woman’s body. This stops a woman’s period or makes it come less often. It is not often the first choice for treatment due to its side effects, such as oily skin, weight gain, tiredness, smaller breasts, and facial hair growth. It does not prevent pregnancy and can harm a baby growing in the uterus. It also cannot be used with other hormones such as birth control pills.
- Laparoscopy (also used to help diagnose endometriosis). A minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic area, the doctor can often remove the endometrial growths.
- Laparotomy. A more extensive surgery involving a larger cut in the abdomen to remove as much of the displaced endometrium as possible without damaging healthy tissue.
- Hysterectomy. Surgery to remove the uterus and possibly the ovaries. A woman cannot get pregnant after this surgery, so it should only be considered as a last resort.