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Endometriosis
- A disorder in which endometrium-like tissue is found outside the uterus
- Each month, the misplaced tissue responds to the hormonal changes of the menstrual cycle by building up and breaking down just as the endometrium does, resulting in small bleeding inside of the pelvis
- Leads to inflammation, swelling and scarring of the normal tissue surrounding the endometriosis implants
- When the ovary is involved, blood can become embedded in the normal ovarian tissue, forming a “blood blister” surrounded by a fibrous cyst, called an endometrioma
- All women can get this condition, but those who are more susceptible to it include those who are:
- Genetically predisposed
- Giving birth after 30
- The body’s inability to break down backflow (retrograde) menstruation
- Genetics
- Metaplasia (transformation of one differentiated cell type to another differentiated cell type)
- Circulatory/lymphatic distribution of endometriosis lesions
- Potential Cause of Infertility from Endometriosis
- Scar tissue may impair the release of the egg from the ovary and subsequent pickup by the fallopian tube
- Changes in the pelvic environment may potentially result in impaired implantation of the fertilized egg
- Very painful menstrual cramps that may be felt in the abdomen/lower back
- Pain with/following intercourse
- Occasional heavy menstrual periods/intermenstrual bleeding (bleeding between periods)
- Painful urination/bowel movements during menstrual periods
- Other gastrointestinal problems, such as diarrhea, constipation, bloating and/or nausea
- Difficulty getting pregnant
- The severity of pain is not necessarily related to the severity of the disease
- Some women have mild endometriosis with severe pain and others have advanced endometriosis with little/no pain
- Evaluation of medical history
- Pelvic exam
- Ultrasound
- CT/MRI scan
- Laparoscopic surgery performed in some cases to determine the location, extent and size of the endometrial growths
- Tissue is biopsied to confirm diagnosis
- Stages:
- Stage 1: Minimal
- Stage 2: Moderate
- Stage 3: Mild
- Stage 4: Severe
*Stages are based on the location, amount, depth and size of the endometrial tissue and do not necessarily reflect the level of pain experienced, risk of infertility or symptoms present
- Specific criteria include
- The extent of the spread of the tissue
- The involvement of pelvic structures
- The extent of pelvic adhesions
- The blockage of the fallopian tubes
- Pain relievers: Anti-inflammatory drugs (NSAIDs)
- Hormone therapy: Oral contraceptives to prevent ovulation, reduce menstrual flow and pain
- Progestin therapy: An intrauterine device (IUD) with levonorgestrel, contraceptive implant, contraceptive injection or progestin pill can stop menstrual periods and the growth of endometrial implants
- Gonadotropin-releasing hormone agonists and antagonists: Block the production of ovarian-stimulating hormones, lowering estrogen levels and creating an artificial menopause
- Causes endometrial tissue to shrink
- Aromatase inhibitors: Medications that reduce the amount of estrogen in your body
- Work in conjunction with progestin or combination hormonal contraceptive
- Fertility treatment: Stimulating your ovaries to make more eggs/in vitro fertilization
- Laparoscopy: To remove endometrial tissue for those in severe pain/trying to get pregnant
- Laparotomy: A more extensive surgery to remove as much of the displaced endometrium as possible without damaging healthy tissue
- *A combination of therapies can be used such as conservative surgery along with hormone therapy
- Helpful ways to ease the pain of endometriosis include the following:
- Rest
- Relaxation through restorative yoga and meditation
- Heat application via baths, heating pads and hot water bottles
- Staying regular
- Exercise
- Alternative treatments used in conjunction with other medical and surgical therapies can be beneficial and include the following:
- Traditional Chinese medicine
- Diet modifications
- Homeopathy
- Immunotherapy
