Endometriosis Awareness Week 4th – 10th March 2013
and in some parts of the world for the entire month
What is Endometriosis?
Each month during her reproductive years, hormones cause the lining of the uterus to grow and become thick in anticipation of a fertilized egg implanting. This thick lining of the uterus is called the Endometrium. If a fertilized egg does not implant, the uterus sheds the lining and the woman has a period.
When the endometrial cells form and grow outside the uterus, the condition is called Endometriosis. The endometrial tissue can grow on the outside of the uterus, the ovaries (most common), even on the bowel, rectum and bladder. The endometrial cells that grow outside the uterus and cause Endometriosis do not shed like they do in the uterus. Instead they continue to grow and can cause scar tissue to form in the fallopian tubes, ovaries and other abdominal organs.
What are the symptoms?
The main symptom women experience with Endometriosis is pain. Sometimes women who have Endometriosis have no pain and sometimes women who have very mild Endometriosis experience severe pain. Pain can occur in any of all of the following places or circumstances:
- Painful menstrual periods.
- Pain during sexual intercourse.
- Pain following sexual intercourse.
- Pain with bowel movements.
- Lower pelvic pain or pelvic cramps that can be experienced a week or two before the woman’s period.
- Abdominal pain that may be mild, moderate or severe during the woman’s period.
- Lower back or pelvic pain that happen at any time during the menstrual cycle.
- Painful urination.
Other symptoms women may experience include:
- Long periods with a heavy flow of blood and clots.
- Diarrhea and bloating.
- Spotting before a period.
What causes Endometriosis?
The exact causes of Endometriosis are still up for debate. While no one specific cause has been identified, there are some factors that seem to increase a woman’s chances for getting Endometriosis.
Some of these factors are:
- Estrogen level. Endometriosis appears to be estrogen dependent which is why women who are in their reproductive years are more prone to getting it.
- Retrograde Menstruation. Retrograde Menstruation occurs when for some unknown reason some of the endometrial lining that is shed during menstruation does not completely leave the uterus. Instead it backs up into the fallopian tubes and the pelvic cavity. Once there, the endometrial cells implant and grow causing endometriosis.
- Genetics. Research studies suggest that if a woman’s Mother or sister have endometriosis, she is up to 6 times more likely to have it than a woman with no family history.
- Women who have never had children are more likely to have Endometriosis.
- Women who have early onset of menses-the start of menstruation are more likely to have Endometriosis.
- Scar tissue from abdominal surgery.
- Immune System problems. One theory is that women who have problems with their immune system lack the ability of the body to recognize and destroy endometrial cells when they grow outside the uterus.
Possible Complications of Endometriosis
Women with Endometriosis sometime experience one of more of the following complications:
- Pelvic cysts.
- Internal scar tissue.
- Bowel obstruction
- Chocolate cysts-cysts filled with brown fluid and old blood.
- Ruptured cysts.
- Urethral obstruction.
One of the most common complications women experience from Endometriosis is Infertility. Scar tissue can block fallopian tubes and ovaries and make the ability of the mature egg to travel from the ovary down the fallopian tube impossible. Another cause is the production of hormones that block ovulation, fertilization and implantation of an egg. With successful treatment infertility problems are often resolved. However, the longer treatment is delayed and the Endometriosis progresses the more difficult resolving infertility becomes. An estimated 20-50% of women experiencing infertility issues have Endometriosis. Women with mild Endometriosis can usually conceive with no intervention. Women with more severe Endometriosis usually require treatment for the Endometriosis as well as assisted reproduction techniques and fertility treatments to achieve pregnancy.
Impact on Everyday Life
Some women who have severe Endometriosis and experience debilitating pain have different aspects of their life affected. Aside from the obvious impact on her sexuality, activities of daily living may also prove difficult. The pain may cause her to miss school, work, and social activities. This can contribute to depression which is certainly associated with Endometriosis.
How is Endometriosis Diagnosed?
Most cases of Endometriosis are diagnosed in women between the ages of 25-35 as Endometriosis is a disease of the reproductive years. While rare, there are cases of Endometriosis in post menopausal women and also young girls. The exact number of women with Endometriosis is not known because many women do not experience any symptoms but it is estimated that over one million women in the United States alone are affected by Endometriosis.
Diagnosis of Endometriosis starts with a pelvic exam. Often the pelvic exam is painful because of the Endometriosis and that in itself is an indicator. Sometimes the doctor can feel the nodules and endometrial tissue growing outside the body during the manual part of the exam when one finger is inserted into the vagina and the abdomen is palpated.
Use of ultrasound can be helpful by ruling out other pelvic diseases and sometimes can distinguish endometrial tissue.
Unfortunately, neither a pelvic exam, or ultrasound can really be counted on for a concrete diagnosis of Endometriosis. In order to really be sure a woman has Endometriosis biopsy of the cells and tissue growing outside the uterus is needed as well as a visual inspection of the tissue.
Biopsy and visual examination is performed either through laparoscopic or open incision surgery.
How is Endometriosis Treated?
Several factors are considered when determining treatment for Endometriosis. These include:
- Age of the woman
- Whether future pregnancy is desired
- Severity of symptoms
- Severity of the Endometriosis.
Treatment for the pain associated with Endometriosis is often the first line of treatment for Endometriosis. Anti inflammatory drugs such as ibuprofen are tried to relieve pelvic pain and menstrual cramps. These drugs do nothing to reduce the growth of endometrial tissue and is really helping the symptoms not curing the problem. However, if pain is relieved, very often no other medical intervention is given.
Another medical intervention is the use of oral contraceptives, or birth control pills. This can interrupt the normal hormone production of the ovaries and prevent the growth of endometrial cells.
Other estrogen suppressing drugs such as Gonadotrophin-releasing hormone analogs have been effective in reducing the size of endometriosis and in treating the pain. These drugs stop menstruation so the body mimics menopause. Hot flashes, irregular bleeding and vaginal dryness can be side effects of this treatment. Usually the plan with GnRH agonist treatment is to gradually add back estrogen and progesterone which helps minimize the side effects and allows the treatment to still work.
If medical treatment doesn’t work, pain is still severe or the growth of the Endometriosis is causing impediment on some other organ like a bowel obstruction, surgical intervention is often warranted. The conservative surgical approach is to perform a laparoscopic procedure and laser off the endometrial tissue which preserving the ovaries, fallopian tubes and uterus. If the Endometriosis is extensive, a hysterectomy may be performed to remove the uterus and sometimes the ovaries.
It is important to remember that these treatments are for the symptoms of Endometriosis and most importantly to manage the pain. There is no true “cure” except for the option of a complete hysterectomy including the ovaries. Otherwise, there is a high probability that the Endometriosis will return as the cells and tissue start to grow again.
How does Endometriosis Affect Sexuality?
Endometriosis can cause painful intercourse. This alone will make a woman avoid intimacy. Especially if she has always suffered from painful intercourse. For some women who have Endometriosis, it is hard to imagine a world or sexual encounter without it.
The pain, constipation, headaches, fatigue and other symptoms associated with Endometriosis can certainly affect the sex drive. The decrease in libido may be experienced by the woman’s sexual partner as well as they may fear hurting the woman during sex.
If the choice of treatment includes medication that makes your body mimic menopause, vaginal dryness may impact sexual activity. Using a liberal amount of lubricant can help with vaginal dryness and help make sex more comfortable.
Emotional issues regarding Endometriosis can also impact sexuality. For example, women who have a hysterectomy sometimes emotionally feel that they are less of a woman since they have lost their uterus and can no longer have children. Counselling can help a woman work through these issues and recognise having a uterus does not make her a woman or a sexual being.
Treating the symptoms and side effects can help make sex less painful and more fulfilling. However, good communication between partners is vital.
As is good communication between doctor and patient. Any time a woman has pain with intercourse it is a sign there is a problem. It may or not may not be Endometriosis but the first step a woman should take to determine the cause of the pain and resolve the problem should be to consult with her health care professional. With correct diagnosis and care she should be able to treat the Endometriosis and have a much better quality of life.
Copyright©2013 Marie-Elise Allen. Permission is granted to copy and redistribute this article on the condition that the content remains complete and intact, and that full credit is given to the author(s), that a link is provided to the author(s) website and that the information is distributed freely. https://www.marie-elise.com