Endometriosis is one of the top three causes of female infertility. And while it’s one of the most treatable causes, it remains the least treated. For the approximately 6.3 million women and girls in the United States who suffer from endometriosis, according to the Endometriosis Foundation of America, many suffer silently because they believe the pain – especially pain during sexual intercourse – is too personal to discuss with their doctor.
Most women suffer with the pain from endometriosis for up to a decade prior to proper diagnosis. The good news: the severe pain of endometriosis is actually treatable.
During monthly menstruation, the female body sheds the uterine lining, or endometrium. Endometriosis occurs when some of these fluids stay in the body and abnormally implant in areas outside of the uterus – on the bladder, bowel, ovaries, and other organs – developing adhesions, scarring and invasive nodules.
The nodules can cause painful menstrual periods, chronic pelvic pain, pain during intercourse, painful or difficult bowel movements, and in extreme cases, infertility. Other common symptoms are:
•Irregular vaginal or uterine
bleeding and/or clotting
•Large, painful ovarian cysts
miscarriage, ectopic (tubal)
tinal cramping, diarrhea/con-
stipation, particularly during
•Blood in the urine; urinary
frequency or retention
Interestingly, some women may have no symptoms and still have significant tissue growth; other women with a milder form of the disease may have severe pain. Endometriosis does not need to be advanced to cause significant symptoms; the higher stage of the disease (3 and 4) may cause little to no symptoms. Every woman’s situation is unique, which is why medical evaluation by an OB/GYN is crucial.
Causes and Risk Factors
Endometriosis is typically diagnosed between ages 25 - 35, though the condition probably begins with the onset of regular menstruation, according to the National Institutes of Health. A woman is more likely to develop endometriosis if she started her period at a young age, has never had children, has frequent periods that last 7 or more days, and has a closed hymen, which blocks the flow of menstrual blood. A woman or girl whose mother has had endometriosis is seven times more likely to have the disease. Endometriosis has also been associated with autoimmune disorders such as certain types of thyroid disease.
Often due to a lack of medical community awareness, women are frequently directed by their doctors to “manage” their discomfort with powerful painkillers, but these only mask symptoms.
Also, endometriosis symptoms often are similar to other diseases, and frequently misdiagnosed as irritable bowel syndrome, pelvic inflammatory disease, appendicitis, ovarian cysts, bowel obstruction, colon cancer, diverticulitis, and more.
Finding an OB/GYN who is familiar with advanced gynecological issues and diseases and who will perform the right tests to get to the root of the problem is the first step. The OB/GYN will compile a complete medical history, perform a thorough examination, and conduct necessary tests to diagnose the source of the pain and other symptoms.
A confirmation of endometriosis requires surgical biopsy through a minimally-invasive, outpatient procedure called laparoscopy. The surgeon looks into the abdomen and pelvic cavity through a laparoscope (a lighted tube), to determine location, size, and extent of the growths, which will help determine treatment. Most gynecologists also insist that a biopsy (sample) of the endometrial tissue be examined by a pathologist before confirming the diagnosis.
Treatment for endometriosis will depend on age, severity of symptoms and severity of the disease, and whether the woman wants to have children in the future. If the symptoms are mild and the woman never wants to have children, she may choose to have regular exams every 6 to 12 months so the doctor can make sure the disease isn’t getting worse. For other women, treatment options include hormone medications to stop the endometriosis from getting worse.
Also, if adhesions are found during the diagnostic laparoscopy, they can be removed at that time (laparoscopic excision surgery) with prior permission. If severe endometriosis involving the bowel or urinary system is detected during the diagnostic laparoscopy, the removal by laparoscopy may be delayed, so the bowel or bladder can be prepared for surgery. A hysterectomy should only be considered as a last resort.
It’s important to remember that hormone therapy and laparoscopy cannot cure endometriosis; however, these treatments can help relieve some or all symptoms in many women for years.
Consider an evaluation for endometriosis if your mother or sister has been diagnosed with the disease, or if you are unable to become pregnant after trying for 1 year. Don’t suffer in silence if you’re experiencing symptoms of endometriosis. Find out the true cause and, and if it’s endometriosis, get treatment to relieve pain and slow the progression of the disease.
(Editor’s Note: Thomas Waliser, M.D. is a board-certified gynecologist who specializes in minimally invasive gynecological surgery and practices with Northwest Allied Physicians. The office phone is 520-742-1565 or www.mytucsondoc.com.