Endometriosis

Approximately 5 million women in the USA and 1.5 million women in the UK suffer from endometriosis.

Endometriosis is characterized by cells from the endometrium (the lining of the uterus) that have migrated to form endometrial patches in other parts of the body – most commonly in the pelvic cavity (on the ovaries and cervix), but also more rarely in the bladder and bowel, lungs, heart, eyes, armpits, knees, or nasal passages. A serious condition, it’s most common in women aged over 30. Up to half these women will have fertility problems because of it.

Symptoms

Pain in the pelvic region is the most striking and debilitating symptom of endometriosis and is not always confined to the lead up to and during your period. Some women experience pain all month. If the endometrial patches have migrated to your bowel or bladder, you may experience pain when you have a bowel movement or urinate. If you suspect you have endometriosis, keep a record of any pain you experience and see if it is cyclical – patterns of pain can help establish a diagnosis. You may also experience pain during intercourse (known as dyspareunia). This is one of the most common symptoms of endometriosis, so it’s worth visiting your doctor if it applies to you.

Although pelvic and intercourse pain are the most identifiable symptoms, there are a number of others that in isolation may mean nothing , but together can indicate an endometriosis problem. Sadly, many women with endometriosis experience all of them, making this a truly debilitating condition. They include irregular and/or heavy periods, tiredness, lower back pain, digestive problems (such as bloating, diarrhea, and nausea) and difficulty in getting pregnant.

Causes

Doctors remain unclear as to exactly what causes endometriosis. Theories range from “retrograde menstruation”, when endometrial blood sheds into the Fallopian tubes instead of out of the vagina, to problems with the immune system. No one has been able to say definitively which of the many theories is right, although probably, as with most things, a combination of factors lies at the root of the problem. We do know that the condition seems to run in families, and perhaps the most widely accepted explanation is that endometriosis is estrogen sensitive: The more estrogen you have in your system, the more susceptible you are. This would certainly explain an increasing trend for the condition in the modern world – if you delay having babies (as many women now do), you have more periods, so are exposed to more estrogen.

Diagnosis

Doctors commonly under-diagnose endometriosis. For this reason, if your symptoms are cyclical and especially if you suffer from pain during intercourse and painful periods, insist your doctor tests you for the condition. The following are the most common methods of diagnosis your doctor will use.

Ultrasound Although an ultrasound scan is useful, it can’t actually diagnose endometriosis. What it can show, however, is any abnormalities in the pelvic cavity, including any adhesions and cysts, which may be caused by endometriosis. An ultrasound can also pick up a condition called adenomyosis, in which patches of endometrium (uterine lining) are present in the myometrium, the uterus’s layer of muscle tissue. Having adenomyosis is a strong sign that you have full-blown endometriosis and your doctor will probably send you for a laparoscopy.

Laparoscopy This is the gold-standard test for diagnosing endometriosis. You’ll be given a general anaesthetic so that your doctor can use a harmless gas to “inflate” your abdominal cavity. Once your abdomen is inflated, your pelvic organs can be viewed easily using a laparoscope. This is a thin viewing tube your doctor inserts through an incision just below your navel. Using the laparoscope, he or she can see whether or not any endometrial patches exist in your abdominal cavity. If they do, the doctor can laser them off during the same procedure.

Conventional Treatments

The conventional way to endometriosis is to shut down your reproductive hormones using medication. This stops your periods, reducing the levels of estrogen in your body. Endometriosis is a complex condition and if anything your doctor sys to you doesn’t fit your experience or just doesn’t make sense to you, don’t be afraid to ask for a second opinion.

Danazol Because endometriosis grows in the presence of estrogen, giving you a weak, male hormone to take effectively stops ovulation altogether, shutting off your body’s estrogen supply. Bear in mind that nay male hormone may have the effect of giving you “male” symptoms, notably acne, facial hair, weight gain, and a deeper voice. Nausea, rashes, headaches, and moodiness may also occur.

The contraceptive pill If you take the Pill “back to back”, without breaking for a withdrawal bleed, you can reduce the impact of endometriosis.

Gonadotrophin-releasing hormone (GnRH) analogues These drugs put you in a temporary state of menopause, shutting down your estrogen supply. Your doctor will prescribe them as an injection, nasal spray, or implant (which goes just under the skin).

Diathermy or laser surgery If drug treatments aren’t successful, your doctor may advise you to have diathermy (the use of intense heat) or laser surgery to burn off the endometrial patches. A doctor performs the procedure during a laparoscopy with the aim of removing as much endometriosis as possible and freeing up any organs that have fused together with adhesions (endometrial scar tissue).

Hysterectomy As an absolute last resort, your doctor may offer you a hysterectomy. However, unless your ovaries are removed as well as your uterus, the patches are likely to grow back elsewhere in your body because your ovaries will continue to make estrogen. Most doctors agree that, although endometriosis affects the uterus, the uterus itself isn’t the problem.

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