By Charles E. Crutchfield III, M.D. and Nathan Guimont
Endometriosis is a very common female condition and is defined as the presence of tissue that lines the uterus (or womb) in a location where it is not normally supposed to be.
Normally during a woman’s monthly cycle, a mucus tissue (the endometrium) in a women’s uterus builds up and thickens in preparation for fertilization of an egg. When fertilization does not occur, the lining of the uterus breaks down and is discharged at the end of the cycle called menstruation or “period.”
This process is guided by female sex hormones. The endometrium tissue can also grow in other parts of the body, outside of the uterus, and when this occurs it is called endometriosis.
The growths are benign but can respond to the hormones as well circulating in your body and guiding menstruation. This extra tissue will also grow and shed, but due to the lack of an outlet or exit, as the vagina normally provides for this tissue when it is in the uterus, this tissue build-up can result in complications.
Oftentimes the woman is unaware of such growths and will have no symptoms (asymptomatic), but some women experience symptoms including chronic pelvic pain, pain during intercourse and/or menstruation, lower abdominal pain and cramps before and during menstruation, or pain with bowel movements. This occurs when the extra tissue builds up, scars, and becomes inflamed.
Depending on where the extra tissue is, such as on the fallopian tube, pregnancy can be difficult later on. Thus, early recognition is essential.
Why should I care about endometrioses?
Endometrioses is a fairly common gynecological problem affecting 6-10 percent of the general female population. According to one study, endometrioses is the third most common inpatient gynecological diagnosis among women aged 15 to 44 years of age.
It is uncertain why endometrioses occurs in some women and not others. There are a few theories of its causes. One is that shedding tissue, during normal menstruation, backs up and implants in areas where it should not instead of being discharged or released.
Another thought is that, due to the common origin of the tissue in the area, hormones can result in a change of tissue outside of the uterus. There may also be an imbalance between the immune system and hormones guiding where the tissue should normally grow.
How is endometrioses diagnosed?
Due to pain during menstruation being common, a detailed conversation with your doctor should be held about your symptoms. The doctor will then perform a pelvic exam to determine if further tests are necessary, looking for painful lumps or hard areas in the womb.
An ultrasound may be done to look for abnormalities. A transvaginal ultrasound may be used to get a better look by placing the ultrasound probe in the vaginal canal. Treatment decisions can be made at this point.
A surgical procedure, called laparoscopy, may be done in which two small incisions in the abdomen are made and a camera is used to look for abnormal tissue. A biopsy can occur at that time in addition to treatment where excess tissue may be removed.
Can endometrioses be prevented?
While there is uncertainty as to the cause of endometrioses, there are some women who have been found to be at higher risk. Endometriosis can run in families, with women who have a mother or sister with endometriosis being five to eight percent at risk compared to the normal population at one percent.
Other risk factors include having your period at a young age, never having children, frequent periods or periods lasting more than seven days, and a closed hymen blocking menstrual blood during the period.
Oral contraceptives may help to prevent or slow down the development of endometrioses.
How is endometrioses treated?
A discussion with your doctor will help him or her determine what treatment option is best for you. The treatment does depend on age, severity, and the choice of whether or not to have children.
The goal of treatment is relief from pain. Nonsteroidal anti-inflammatory drugs such as Advil and Aleve are used for the pain. In addition, there may be steps taken to prevent the disease from getting worse by using hormone medication or surgery to reduce the abnormal growths.
Hormone therapy and laparoscopy cannot cure endometrioses but can relieve associated symptoms. If symptoms are severe and the woman does not desire children in the future, the uterus (womb), in addition to the ovaries and fallopian tubes, may be removed in a hysterectomy.
Endometrioses can also resolve despite treatment choice. One small study found this occurring in 25 percent of patients after one year. A doctor should be consulted to follow up on the disease regardless, as symptoms can recur without proper management.
Action steps for anyone with endometrioses
Endometrioses is difficult to diagnosis due to it being confused for normal menstrual pain. If a woman is experiencing abnormal symptoms such as chronic pelvic pain, especially around menstruations, sexual intercourse or bowel movements, she should have a conversation with her doctor about the possibility of endometriosis.
Remember, endometriosis is a very painful and miserable condition. After the appropriate evaluation and diagnosis, your gynecologist may recommend either surgical treatment (sometimes with a laser) and/or a medicinal approach. The medicinal approach should include chronic, low-dose, suppressive hormonal treatment as well as medications to control any pain and discomfort.
Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.
Nathan Guimont is a second-year medical student at the University of MN in Duluth. He has been involved in the student section of Minnesota Medical Association and serves as director of the HOPE student clinic in Duluth.