Understanding Endometriosis

Endometriosis causes abdominal pain and irregular, painful, or heavy periods for more than 6.5 Million women in the U.S. Unfortunately, many of us who are affected are not aware that this disease is at the root of our significant and ongoing discomfort! Every affected woman’s experience can be different, and symptoms can often mirror those of IBS or other abdominal/pelvic disorders, so it’s no wonder that global studies show it can take years of discomfort for some women to be successfully diagnosed with this disease.

With a combination of vague symptoms and no clear causes for why the condition appears, it’s important to understand more about this disease, it’s symptoms, and treatment.

What is endometriosis?

Endometriosis occurs when tissue which is similar to the lining of the uterus (endometrium) is found in other areas of the body—most commonly in the pelvic region around the uterus, ovaries, or fallopian tubes. Since the tissue is similar to that of the uterine lining, it responds in the same way when your body’s hormones send out signals to start your menstrual cycle.

As this endometrium is not located in the uterus, there’s nowhere for these blood cells to be shed, and therefore pressure, pain, and inflammation in those areas begins to occur. In severe cases, this can even result in lasting damage to organs in the pelvic area stemming from scar tissue or cysts.

How do I know if I’m affected?

SYMPTOMS

Endometriosis can appear anytime from a woman’s first menstrual cycle to menopause, and as the symptoms mirror those of other disorders in the pelvic/abdominal area, it is not surprising that detection can sometimes take years. The best thing you can do is to have an open, honest dialogue with your gynecologist regarding your concerns and any symptoms you believe may be related so that appropriate testing takes place.

While the following doesn’t represent a comprehensive list, women who’ve been diagnosed with endometriosis most frequently reported symptoms such as:

• Irregular, or unusually heavy periods
• Pain during or after sex
• Significant menstrual pain which seems to ignore the presence of painkillers
• Significant abdominal, pelvic, or lower back pain occurring before the start of your menstrual cycle
• Difficulty getting pregnant
• Pain or discomfort when going to the bathroom, and/or bleeding from the rectum or in the stool
• Chronic fatigue

It’s important to note that, while many of the symptoms manifest with pain, studies have shown that the severity of the pain (or lack thereof) is not necessarily associated with amount or severity of the endometriosis. What’s also frustrating is that some women who’ve been diagnosed with this condition did not experience severe pain or any of the symptoms mentioned above—further highlighting the need for regular annual gynecologic examinations to give you and your doctor the best chance at finding and addressing the disease to bring you relief.

DIAGNOSING

If you are encountering symptoms possibly associated with endometriosis, then scheduling an appointment with your doctor is of critical importance, as it can take some time to successfully diagnose this condition. Diagnosis can include a number of options, but will generally include at least a pelvic exam to check for scar tissue or uterine cysts, and ultrasound or Magnetic Resonance Imagining (MRI) tests to visually inspect your reproductive organs. As endometriosis is often NOT seen on imaging methods such as ultrasound, or even MRI, the only way to definitively diagnose endometriosis is with surgery – usually minimally invasive gynecologic surgery using a laparoscope, to more closely examine affected areas and/or to remove affected tissue.  This allows for both diagnosis, and treatment of endometriosis.

How is endometriosis treated?

If your doctor finds evidence of this disease, treatment can take a variety of different forms. First, as pelvic and lower back pain are some of the most common symptoms, over-the-counter painkillers are generally recommended to help you manage your discomfort. In severe cases, stronger pain medication is sometimes prescribed, but for many, a combination of OTC pain medication and use of a hot water bottle, hot bath, or other anti-inflammatory physical aids will provide necessary relief. Additionally, approaching treatment from a hormonal perspective can lessen the intensity of the symptoms and begin to treat the cause. In these cases, prescription of progesterone, birth control pills, or danocrine or gonadatropin-releasing hormone (GnRH) options are applied–but this short list only represents a few of the most common treatments, and your specific program will be guided by your doctor. The decision to consider laparoscopic surgery for endometriosis can be for many reasons: if your pain is not well-controlled with medications, if you are planning to try to conceive soon and therefore need to stop hormonal birth control methods, or if you simply want a definite diagnosis for the cause of your pain.

Does it affect my ability to become pregnant?

Endometriosis can affect your fertility, but you shouldn’t necessarily be discouraged. It is considered one of the top three causes of female infertility, with 30% – 40% of women diagnosed with endometriosis encountering significant fertility issues. In some cases, the inflammatory response that endometrial cells triggers can cause adhesions and other distortions to normal reproductive functions which prevent the normal fertilization of an egg.

While it’s true that rates of successful pregnancy are lower for those diagnosed with endometriosis than those for women in general, having endometriosis does not guarantee you will encounter fertility problems. If you are diagnosed with this condition, it is critical to discuss with your doctor the specifics of your diagnosis and treatment options. For many, pregnancy after endometriosis is still possible!

We’ve discussed detection and treatment, but what about prevention?

Since the causes of endometriosis aren’t abundantly clear, prevention is similarly challenging, as there’s no guaranteed path to avoiding the condition. But that is not to say you are helpless to decrease your risk! One clear path to decrease your risk is to lower Estrogen, the hormone key to sexual and reproductive development. Experts agree that lowering your body’s estrogen levels can significantly reduce your chances of developing the condition, and this is fortunately an area where you do have some control:

• Regular exercise (at least 3-5 hours each week) will not only improve your overall health, but will help lower your percentage of body fat and reduce your body’s estrogen levels.
• Hormonal birth control methods can cause a reduction in estrogen levels, as well as helping to decrease overall pelvic pain associated with your period—discuss this pharmaceutical approach with your doctor.
• Both alcohol and caffeine have been shown to increase estrogen levels. Reducing your consumption of these to no more than one per day will remove one potentially aggravating factor.

It’s critically important that you discuss with your doctor any potential lifestyle and/or dietary changes targeted at estrogen reduction, but multiple studies have shown these methods can lower your estrogen levels, therefore reducing your risk of developing the disease or seeing it reoccur.