Take Charge of Your Health - Endometriosis Is NOT Easy
Endometriosis is an estrogen-dependent inflammatory disease characterized by the presence of endometrial glands and stroma outside the uterine cavity.
It affects 5-10% of women of reproductive age, up to 80% of women with pelvic pain,
and 20-50% of women with infertility.
-Yi-Heng Lin MD, Taiwan
Endometriosis is a chronic disease where tissue that is very similar to the lining of the uterus, grows outside the uterus and can cause the formation of inflammation, scar tissue, adhesions, or cysts in the pelvis, fallopian tubes, ovaries, bladder, and/or bowel. It can also lead to the growth of fibrous tissues that can cause organs to stick together.
Endometriosis is most commonly found in women between the ages of 25 and 40 and is diagnosed through: a pelvic exam; ultrasound tests, which can identify cysts; an MRI, which provides detailed images of tissue and organs; and/or a laparoscopy, which can aid diagnosis, be used to remove a biopsy tissue sample, or actually be used for treatment of the disease, for example the removal of a cyst or lesion.
With a long list of physical and mental/emotional symptoms, endometriosis can bear a heavy weight on quality of life. Symptoms can include: excessive menstrual bleeding; severe back and abdominal pain during periods, sexual intercourse, bowel movements or urination; chronic pelvic pain; bloating, nausea, fatigue; depression and anxiety; and infertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant since the disease can obstruct the fallopian tube, keeping the egg and sperm from uniting. Endometriosis also seems to affect fertility by causing inflammation, which damages the sperm or egg.
According to the World Health Organization, endometriosis is thought to arise due to:
Retrograde menstruation - when menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity during periods. This can result in endometrial-like cells being deposited outside the uterus where they implant and grow.
Cellular metaplasia - when cells change from one form to another. Cells outside the uterus change into endometrial-like cells and grow.
Stem cells that give rise to the disease, then spread through the body via the blood and lymphatic vessels.
Endometriosis spreading at the time of surgery. For example, a woman with endometriosis that undergoes a cesarean section could have endometriosis implant in the abdominal incision.
Although endometriosis cannot be cured, treatment can reduce pain, shrink the growths/lesions, help preserve fertility, and delay growth of the disease. Patients can benefit from:
Pain medications: Aspirin and acetaminophen, prostaglandin inhibitors such as ibuprofen, naproxen sodium, indomethacin, and tolfenamic acid as well as prescription drugs can be helpful.
Hormonal therapy: Hormone medication can slow endometrial tissue growth and prevent new implants of endometrial tissue. Hormone therapy to stop ovulation for as long as possible can include: oral contraceptives, progesterone drugs, a testosterone derivative and GnRH agonists/antagonists to limit or stop ovarian hormones.
Conservative or more radical surgery can be used to remove the growths, relieve pain, and help enable pregnancy.
In some cases, endometriosis improves on its own after menopause when there is a drop in the amount of estrogen in the body.
If you notice any symptoms of endometriosis, please talk with your physician. There are effective treatment options to reduce pain, improve daily life, and manage symptoms over the long term. There are also many advocacy support groups online that offer both valuable information and supportive care.