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Endometriosis is a condition that occurs when the tissue that normally lines and grows inside a woman’s uterus (endometrium), is found growing outside instead. The endometrial tissue can be found anywhere in the pelvic cavity or abdomen and in rare cases in other parts of the body. The endometrial tissue, grows and thickens and then bleeds like the lining of the uterus during the menstrual cycle. This bleeding every month causes scar tissue also known as adhesions to form that can prevent a woman from getting pregnant. The places that endometriosis grows most often are on a woman’s reproductive organs-the outside of the uterus, on the ovaries and around the fallopian tubes as well as on the outside of the bowel, bladder and in the space behind the uterus.  According to the National Institutes of Health (NIH) endometriosis affects more than 5.5 million women in North America and they estimate that 2 percent to 10 percent of women in their childbearing years are afflicted with the disease; it occurs most commonly in women in their 30s and 40s. Studies have shown that 30% to 50% of women with endometriosis are infertile and other reports have confirmed that infertile women are 6 to 8 times more likely to have endometriosis than fertile women. The two most common symptoms of endometriosis are pelvic pain and infertility but some women have no symptoms at all. The pain from endometriosis usually happens around the time of the menstrual cycle. Here is a list of the common symptoms associated with endometriosis:
 If you are experiencing symptoms such as the pelvic pain described above and suspect you may have endometriosis make an appointment with your health care provider. Your doctor will need to perform a physical exam and a pelvic exam to help diagnose the condition. Additional tests such as an ultrasound scan may be ordered however the only procedure that can definitively confirm the diagnosis is a surgical procedure known as a laparoscopy. Because this is an invasive surgical procedure it is not done in all cases. Treatment for the condition varies according to the severity of the disease. Since pain is the most common symptom a range of medications to relieve pain from simple analgesics such as aspirin to narcotics such as codeine may be prescribed. Most researchers agree that estrogen promotes the growth and spread of endometriosis so hormonal therapies may be used to stop or block the release of estrogen from the ovaries to manage pain. These therapies however have side effects and may not work for all women. Some of the hormonal therapies used include the following: Oral contraceptive pills: In women who elect to use oral contraceptives as a method of contraception, combination oral contraceptive pills have non-contraceptive health benefits such as regulating menstrual cycles and decreasing menstrual flow. Gonadotropin-releasing hormone (GnRH): GnRH is the hormone that controls the menstrual cycle. GnRH agonists are drugs that lower estrogen levels by turning off the ovaries stopping the menstrual cycle. They come in several different forms: daily injection, monthly injection and three month injection or in a nasal spray. The agonists can cause menopausal-like side effects such as hot flushes and headaches. Progestins: Progestins are hormones that act like the female hormone progesterone. They work by suppressing the growth of endometrial implants causing them to gradually waste away. Like the agonists they stop the menstrual cycle. They come in pill or injectable form and may cause side effects such as bloating, weight gain, moodiness and irregular vaginal bleeding among others. In severe cases of endometriosis surgery to cut or burn away adhesions and scar tissue may be the best treatment. It is important to note however that symptoms return within one year in about half the women who have had surgery according to the American College of Obstetricians and Gynecologists (ACOG). For this reason many women may be treated with both surgery and medications to prolong their symptom free period. Coping with this chronic condition can be challenging but there are many resources available. For more information on coping with all aspects of endometriosis please visit the following websites: ACOG: http://www.acog.org/publications/patient_education/bp013.cfm References:
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