Endometriosis: symptoms, treatment, diagnosis
Endometriosis is when the tissue that makes up the uterine lining (the lining of the womb) is present on other organs inside your body.
Talking to West Fm Dr. Rose Gitonga, a gynecologist said endometriosis is usually found in the lower abdomen, or pelvis, but can appear anywhere in the body.
“Women with endometriosis often have lower abdominal pain, pain with periods, or pain with sexual intercourse, and may report having a hard time getting pregnant. On the other hand, some women with endometriosis may not have any symptoms at all.” Said Rose.
Endometriosis is estimated to affect between 3% and 10% of reproductive-aged women.
“Endometriosis is rarely found in girls before they start their period, but it is found in up to half of young girls and teens with pelvic pain and painful periods.” She added.
Causes of Endometriosis
According to Rose, there are several different ideas of how and why endometriosis happens.
When a woman has her period, some of the blood and tissue from her uterus travels out through the fallopian tubes and into the abdominal cavity.
This is called retrograde menstruation. Some cells in the body outside of the uterus can change to become the same kind of cells that line the uterus.
Another possible explanation is that the cells from the lining of the uterus travel through the blood vessels or through the lymphatic system to reach other organs or body areas. Also, endometriosis can spread at the time of surgery.
“For example, a woman with endometriosis that undergoes a cesarean section could inadvertently have some endometriosis cells attach to the abdominal incision so that she has endometriosis in the scar from the surgery.” Explained Rose.
Interestingly, nearly all women have some degree of retrograde menstruation, but only a few women will get endometriosis.
This may be due to differences in a woman’s immune system. Also, endometriosis is much more common if a close relative also has endometriosis, so there may be genes that influence endometriosis.
When a woman with endometriosis has her period, she has bleeding not only from the cells and tissue inside the uterus, but can also have bleeding from the cells and tissue outside the uterus.
“When blood touches these other organs, especially inside the abdomen, it can cause inflammation and irritation, creating pain. Sometimes, scar tissue can also develop from the endometriosis which can also contribute to the pain.” She said.
Endometriosis and Fertility
Between 20 and 40% of women with infertility will have endometriosis. With an assistive voice, Rose said that endometriosis seems to impair fertility in two different ways.
“A woman with endometriosis, her fertility will actually be affected. First, by causing distortion of the fallopian tubes so that they are unable to pick up the egg after ovulation, and second, by creating inflammation that can adversely affect the function of the ovary, egg, fallopian tubes or uterus.” She said.
Pain, including pelvic or lower abdominal pain and pain with menses, is the most common symptom of endometriosis.
“Women may also have pain with intercourse. The symptoms are often “cyclical” meaning that the pain is worse right before or during the period, and then improves.
Women may have constant pelvic or lower abdominal pain as well. Other symptoms include sub fertility, bowel and bladder symptoms (such as pain with bowel movements, bloating, constipation, blood in the urine, or pain with urination), and possibly abnormal vaginal bleeding.” Advised Rose.
To diagnose endometriosis, a doctor must perform a laparoscopy (a surgery where a doctor looks in the abdomen with a camera usually through the belly button) and take a sample of a suspected endometriosis lesion.
“Some physicians and patients may try to treat suspected endometriosis with certain medications to see if symptoms are improved without having to undergo surgery. Although this may be possible, endometriosis cannot be diagnosed by improvement in symptoms with medication alone.” She said.
During surgery, endometriosis lesions are often described as looking like “cigarette burns” inside the abdomen, although there are many different variations as to how an endometriosis lesion may appear.
Endometriosis can be located on and even within an ovary, causing an endometrioma, or a cyst of endometriosis. These cysts are often referred to as “chocolate cysts,” because the material inside the cyst looks like chocolate syrup.
If a woman with endometriosis is having trouble getting pregnant, there are different medications and treatments available that can help her to become pregnant.
The most conservative therapy for endometriosis is with medications. Non-steroidal anti-inflammatory medications, like ibuprofen, may help with the pain associated with endometriosis.
According to Rose, some doctors may prescribe medications that affect a woman’s hormones in order to help with endometriosis pain.
“Some examples are oral contraceptive pills and gonadotropin releasing hormone (GnRH) agonists, the latter of which put women into a “temporary” menopause-like state. Surgery can not only help to diagnose endometriosis, but can also be used to treat it.
Because hormones cause endometriosis patches to go through a cycle similar to the menstrual cycle, hormones also can be effective in treating the symptoms of endometriosis.
Additionally, the perception of pain may be altered by different hormones.
Hormone therapy is used to treat endometriosis-associated pain. Hormones come in the form of a pill, a shot or injection, or a nasal spray.” She said.
Hormone treatments stop the ovaries from producing hormones, including estrogen, and usually prevent ovulation.
“This may help slow the growth and local activity of both the endometrium and the endometrial lesions. Treatment also prevents the growth of new areas and scars (adhesions), but it will not make existing adhesions go away. Added Rose.
Surgery has been shown to improve pain symptoms associated with endometriosis and may also help women become pregnant. If a woman with endometriosis is not interested in becoming pregnant, she and her doctor may decide to remove the ovaries and possibly the uterus.
A woman cannot become pregnant if she doesn’t have a uterus.