Your Guide to Endometriosis
What is Endometriosis?
Endometriosis is not a disease you hear about every day, but if you have it, then you will be more than familiar with it. It is a medical condition that affects women during their childbearing age.
It is a condition that occurs when tissues similar to the tissues that normally line the uterus ( womb) grow outside of it, most commonly in the ovaries.
Endometrial tissues can also be found at several atypical sites like
fallopian tubes,
liver,
thorax,
bowel
extremities
Pelvis
Endometriosis affects about 10 million women in the United States.
What are the symptoms of Endometriosis?
You may present with debilitating or worse pelvic pain which is the most common symptom. It can be lower back and abdominal pain too.
Other symptoms include :
1. Dysmenorrhea (painful period): pain may be worse than usual and can even start a few days before menstruation
2. Heavy menstrual bleeding
3. Painful intercourse
4. Dyschezia: pain when defecating
5. Dysuria: pain when urinating
6. Fatigue
The severity of pain may not be the indicator of the stage of the disease. You may have mild endometriosis but the pain is worse or you may have advanced endometriosis but have no or little pain.
What are the causes of Endometriosis?
Despite extensive research since its first description 150 years ago, the exact cause of endometriosis remained unclear.
Some possible causes include :
Immune system: Several components of the immune system are found to be changed like lymphocytes and macrophages implying involvement of immunity.
Genetics: If your mother or sister is having endometriosis
Retrograde menstruation: Some experts suggest that menstrual blood containing endometrial cells may travel back from the fallopian tubes to the pelvis and thus get attached to other organs.
How is Endometriosis diagnosed?
The journey to accurate diagnosis of endometriosis for many women is challenging. Laparoscopy ( surgical procedure ) is found to be the gold standard which contributes to a delay of 4-11 years from the first onset of symptom and surgical diagnosis and thus delay in treatment.
The 2017 National Institute for Health and Care Excellence guidelines emphasize empiric therapy before laparoscopy in the diagnosis and treatment unless fertility is your utmost priority.
Endometriosis is mainly present with worsening or persistent pelvic pain. So your doctor might come to a diagnosis based on your history, physical examination, and some non-invasive tests.
These tests include:
Transvaginal Ultrasound: It is widely available, low cost, and identifies the presence of endometrial cysts in ovaries or other pelvic organs.
CT scan and MRI ( Magnetic Resonance Imaging): They provide an extensive picture of your organs.
Laparoscopy: This technique is a gold standard especially when the non-invasive procedure is not helpful. Your surgeon will insert a thin tube through your belly with a camera at the end called a laparoscope. This identifies the presence of lesions.
What is the treatment for Endometriosis?
In the treatment of pelvic pain, both drugs and surgical procedures seem to be effective. These include :
1. Nonsteroidal anti-inflammatory drugs and oral contraceptives are the initial therapy for the treatment of pain.
2. If these fail then GnRH- agonist ( Gonadotropin-releasing hormone ) combined with estrogen-progestogen therapy is indicated.
3. Laparoscopy is a surgical procedure in which lesions are removed.
4. For infertility associated with endometriosis, drug therapy is of no use. Only surgical treatment is effective in the removal of disease and thus gaining a successful pregnancy.
