Dr. Crutchfield, my cousin was recently diagnosed with endometriosis. What is endometriosis?
Endometriosis (en-doe-me-tree-OH-sis) is a painful condition that
occurs in women when cells that normally reside inside the uterus grow
outside the uterus in the pelvis. Normally, these cells reside in the
inner lining of the uterus called the endometrium.
During a regular menstrual cycle, under the influence of hormones,
especially estrogen, the endometrial tissue swells and prepares to
accept a fertilized egg. If a fertilized egg does not arrive, the
endometrial tissue is shed (the bleeding associated with a woman’s
period) and the monthly cycle begins over with new endometrial tissue in
the uterus developing for a possible pregnancy in the future.
With endometriosis, endometrial cells can become attached to ovaries,
fallopian tubes, and the lining of the pelvis (see picture above).
During the regular menstrual cycle, the tissue thickens, swells, and
sheds, but the ectopic (normal cells in an abnormal location)
endometrial tissue does not get shed during menstruation as it normally
would as a part of the inner lining of the uterus.
As a result, the tissue is trapped in place and can cause pain, scarring, and even adhesions in the pelvis.
Endometriosis is a common cause of pelvic pain and infertility.
Rarely, endometriosis can be the cause of a rare form of pelvic cancer.
It affects an estimated 12 percent of women (almost six million) in the
U.S. and is most common in women in their 30’s and 40’s, but can occur
any time after menstruation begins.
The primary symptom of endometriosis is significant discomfort and
pain. Frequently, women can experience discomfort and cramping during
menses. In endometriosis, patients report a much more intense pain and
discomfort than usual. The pain of endometriosis tends to worsen over
time and can be quite severe.
- Painful periods (dysmenorrhea). The pain can also seem like it is coming from your lower back and abdomen.
- Infertility. Endometriosis is a common cause of infertility.
- Heavy menstrual bleeding.
- Pain with urination and/or bowel movements. This presents most commonly during menses.
- Pain with intercourse. This is common with endometriosis.
The severity of pain is not necessarily an indication of how severe
endometriosis is. Although endometriosis is associated with pelvic pain,
there are other medical conditions like ovarian cysts, inflammatory
bowel disease, and pelvic inflammatory disease that can cause pelvic
pain. A doctor must determine the correct diagnosis as sometimes a
patient can have more than one condition causing pelvic pain.
Cause of endometriosis
Doctors are not sure what causes endometriosis. Theories include a
backward flow of blood during a period to deposit endometrial tissue in
the pelvis, an abnormal response to hormones causing pelvic tissue to
become endometrial tissue, and endometrial tissue being present in the
pelvis since birth. There are several other hypotheses, also, but no one
is certain of the exact cause.
Endometriosis risk factors
- Not ever giving birth
- A family history of endometriosis
- Starting menses at an early age
- Short menstrual cycles
- Having high levels of estrogen
- Having an abnormally shaped uterus
- Experiencing menopause at an older age
A doctor will take a careful medical history and perform a pelvic
exam. Additionally, imaging studies like ultrasound or an MRI may be
obtained to assist in the diagnosis of endometriosis.
Also, a surgical procedure called laparoscopy can be performed. This
is where a very small incision is made in the abdomen and a special
viewing tool is inserted to inspect the areas for endometriosis
directly. During this procedure a sample of tissue can be obtained and,
sometimes, the area of endometriosis can be removed.
Fortunately, many effective treatments are available. Initially, only
mild pain medications may be required. Because the endometrial tissue
is affected and activated by hormonal activity, especially estrogen,
other treatments may include hormonal modulation and hormonal therapy.
In severe cases (including some cases of infertility), surgery may
remove or reduce the affected tissue. In other instances in which
pregnancy is not an issue, a hysterectomy with removal of the ovaries
may be an option.
Endometriosis can be a challenging medical condition to diagnose and
treat. Fortunately, endometriosis can be managed with success. If you
have pelvic pain, see your doctor for appropriate evaluation, diagnosis,
and treatment plan.