What is endometriosis? Endometriosis is defined as endometrial glands or stroma (tissue that is inside of the uterus) occurring outside the uterus. Endometriosis affects 1 in 10 women worldwide, and can occur in adolescents and teens. Let’s talk a little more about this disease. Typically, the endometrium comprises the innermost lining of the uterus. It grows, in response to the female hormones estrogen and progesterone, during the month and then is shed when a woman has her menstrual cycle. Endometriosis is what happens when this tissue does not remain in its usual neighborhood, but instead grows outside the uterus. It can grow on organs such as the uterus, ovaries, small or large intestines, rectum, bladder, peritoneum or even outside the pelvis. It has been found in organs such as the diaphragm, lung or even the brain, but luckily these sites are less common. The cause of endometriosis is currently believed to be multifactorial. It was believed that endometriosis starts when endometrial cells and menstrual blood flow backwards out through the fallopian tubes and make their way into the abdominal cavity. They can then implant, grow and disseminate further from there. However, there are many additional factors that are known to be related to endometriosis, including altered immune system function and genetics.
What about the symptoms of endometriosis? Well, the symptoms vary according to how extensive the endometriosis is and where the endometrial implants are located. These symptoms typically occur during the menstrual cycle but some women have symptoms throughout the month, even daily.
Symptoms – may include but are not limited to:
- Heavy or prolonged bleeding
- Breakthrough bleeding/bleeding between cycles
- Pain or bleeding during or after intercourse
- Pelvic, abdominal, and/or back pain
- Pain with urination or bowel movements
- Change in bowel habits (diarrhea or constipation)
- Infertility or difficulty getting pregnant
- Pain outside the abdomen/pelvis – such as shoulder, under the rib cage or chest (this can happen due to endometriosis on the diaphragm or in the lungs).
It can cause no pain, minimal pain or debilitating pain. Women may suffer for many years before being diagnosed or may be misdiagnosed with other causes of pain or heavy bleeding. The definitive method to diagnose endometriosis is through a laparoscopy (typically by a gynecologist) to identify endometriosis lesions, both inside and outside the pelvis. There are some gynecologists who focus specifically on endometriosis and pelvic pain. Once it is diagnosed, there are many options for treatment. Options can include no treatment if the symptoms are mild or tolerable. Or can range from medical options to surgery. Medical options for treatment can include forms of birth control (pills, ring, patches), IUDs, or imjectable medications to suppress hormones, such as Depo Lupron. Surgical options include laparoscopic or open surgery to remove the endometriosis. Expert laparoscopic excision(LAPEX) is an effective approach to treating patients withendometriosis. However, depending on where the lesions are located, excision may not be an option, without causing damage to the organ that the lesion is on (such as bowel or diaphragm). Ablation of endometriosis may only be temporarily effective unfortunately, as the return of endometriosis can occur. Some studies have quoted a recurrence rate of up to 70% after ablation/fulgaration (burning) of endometriosis.
Endometriosis may often take an emotional toll on Women, in addition to the physical manifestations. Women may feel like their bodies are defeating them or lose hope for living without pain/discomfort. It effects them personally, but can effect marriages, their sex lives, work (due to needing time off due to pain), and relationships with friends. Much like mental illness, the disease does not show outward physical signs other than pain, and patients may not receive the needed support from those around them. Many women may suffer in silence. March is Endometriosis Awareness Month. If you, or someone you know, may be suffering from endometriosis, it is best to seek out an endometriosis specialist or gynecologist to discuss further evaluation. Information and support about endometriosis and treatment options are available through seeking medical care and via local support groups such as
Endometriosis Warriors of Central Florida on Facebook. By joining support groups, you will receive reviews on current medicines, procedures and practicing professionals. This information may help you better advocate for yourself or someone you love who is suffering from this “invisible disease”.
Reviewed, revised and validated by: Dr Amanpreet S Bhullar, MD FACOG with Physician Associates of Lake Nona