Endometriosis occurs when growth of the tissue that lines the inside of the uterus (endometrium) is found outside of the uterus in other areas of the body. It can only occur after menstruation begins in a woman. Women in their 20s, 30s, and 40s are most likely to get endometriosis.
Symptoms
The most common symptoms of endometriosis are:
- Pain before and during menstrual periods (usually worse than the pain in "normal" menstrual cramps)
- Pain during or after sexual intercourse
- Painful urination
- Lower back pain and painful bowel movements or loose stools with menstrual periods
- Pelvic soreness/tenderness
Pain, however, is not always present. Other symptoms include:
- Premenstrual vaginal spotting of blood
- Abnormally heavy or long menstrual periods
- Infertility
The exact cause of endometriosis is unknown. One theory suggests that some of the lining of the uterus during menstruation moves backwards through the fallopian tubes into the abdominal cavity where it attaches and grows. Other theories point to problems with the immune system and/or hormones. There is also some evidence that the condition may be inherited. Places where endometriosis is commonly found are:
- The outside surface of the uterus
- Fallopian tubes
- Ovaries
- The lining of the pelvic cavity
- The area between the vagina and the rectum
An accurate diagnosis of endometriosis must be made by your gynecologist. He or she may perform a laparoscopy, which is an outpatient surgical procedure. A slim telescope is inserted through a very small opening made in the navel. This allows your doctor to examine the abdominal and pelvic organs and evaluate the extent of the disease.
Treatment
The management of endometriosis is aimed at suppressing levels of the hormones estrogen and progesterone. These hormones cause endometriosis to grow. Mild to moderate endometriosis may be relieved at menopause.
Treatment for endometriosis can include surgery or medication therapy.
- TreatmentSurgery:
- Conservative surgery, such as removing areas of endometriosis using laser, cautery, or small surgical instruments to destroy the growths. These methods are used to reduce pain and to allow pregnancy to occur in some women.
- Nonconservative surgery which removes the ovaries. The fallopian tubes and uterus can also be removed. Surgeries of this kind would likely eliminate pain, but leave a woman unable to conceive.
- Medication therapy:
- Pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs). These include ibuprofen and naproxen sodium.
- Oral contraceptives given in a specific regimen to temporarily stop ovulation and menstruation. They are more likely to be used for very mild cases of endometriosis.
- Antiestrogens, which suppress a womanÕs production of estrogen. This will stop the menstrual cycle and prevent further growth of endometriosis since endometriosis needs estrogen to grow. These can have side effects such as acne, hair growth on the face, and changes in the libido.
- Progesterone, which is used to cast off the endometrial cells and thus destroy them
- Gonadotropin-releasing hormone (GnRH) agonist drugs, which will stop the production of estrogen. This causes a medically induced menopause that is temporary.
Questions to Ask
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Do you have premenstrual spotting of blood and/or abnormally heavy or long menstrual periods?
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Do you have a lot of pain at any of these times?
- During sex
- When you menstruate and this has gotten worse over time
- When you urinate
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Have you tried to get pregnant, but have not been able to in 12 or more months?
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Self-Care Tips
Self-care is very limited for endometriosis. It needs medical treatment. Things you can do to enhance medical treatment include:
- Exercise regularly.
- Eat a diet high in nutrients and low in fat, especially saturated fat, mostly found in coconut and palm oils, animal sources of fat, and hydrogenated vegetable fats.
- Take an over-the-counter medicine for pain. Check with your doctor for his/her preference. {Note: See "Pain relievers" in "Your Home Pharmacy" on pages 22 and 23.}
- Consider using oral contraceptives for birth control. Women who take the pill are less likely to have endometriosis.