1. What is endometriosis?
It’s a condition in which the same cells that make up the uterus lining (known as endometrial cells) grow outside the uterus too. No one’s sure what causes this.
These cells are most commonly found in the ovaries, fallopian tubes, ligaments holding the uterus in place, and the pelvic cavity lining.
Although it’s rarer, they can also grow almost anywhere in the pelvis – such as the vagina, cervix, bladder and bowel. They’ve even been reported growing in other organs of the body, including the lung, liver, brain and skin.
Normally, endometrial cells of the uterine lining are shed during the monthly menstrual cycle. Outside the uterus, they’ll bleed out monthly wherever they’re located.
If these cells grow on organs that don’t have an exit from the body, the blood will remain, causing pain and, eventually, scar tissue.
2. What are its symptoms?
The primary symptom is pain.
It’s most commonly felt as painful periods or discomfort in the lower abdominal, pelvic and low back area any time throughout your cycle. Women also often have pain during or after sex, or with bowel movements or urination.
Some also get gastrointestinal issues, including diarrhea or constipation, bloating or nausea. Others become extremely fatigued.
3. What are the risk factors? How common is it?
Endometriosis is common. More than 5 million women in the U.S. have this condition.
Risk factors include:
* Age. It’s most common in women of reproductive age, and unusual in postmenopausal women.
* Family history. Having a family member with endometriosis (a mother, sister or aunt) raises your chances.
* Ethnicity. Caucasians are more likely to get it than Asian or African-American women.
* Menstrual cycle characteristics. Women with long periods (more than seven days) or short cycles (more frequently than every 28 days) may face a higher risk. Starting your period at a very early age is another possible factor.
* Pregnancy history. Never giving birth or having your first child at an older age may make you more susceptible.
* Medical history. An infection of the reproductive tract (pelvic inflammatory disease) could damage your uterine cells, making you more susceptible to endometriosis. Also, a medical condition that prevents menstrual flow from exiting the body, such as a closed hymen, may also increase risk.
* Physical traits. Women who are tall and thin (with a very low BMI) are more likely to get endometriosis, according to some studies.
4. Can a woman have endometriosis without any symptoms?
Yes.
Symptoms aren’t dependent on severity of the condition. Some women with severe endometriosis have no symptoms, while others with very mild cases suffer extreme pain.
5. How is it diagnosed? Would a doctor find it during a routine gynecological exam?
Endometriosis can only be definitely diagnosed by pelvic laparoscopy [when your ob-gyn examines the pelvic organs using an instrument inserted into the navel].
If the endometrial implants [growths outside the uterus] are large enough, or if cysts form, they may be seen on a pelvic ultrasound or felt during a routine gynecologic exam.
But endometriosis can still be present, even with a normal ultrasound or pelvic exam.
6. What are treatment options?
Because pain is the most common symptom, treating the discomfort is important.
In addition, endometriosis can lead to infertility, and should therefore be treated if a woman wants to leave open the option of pregnancy.
The treatments for pain and infertility caused by endometriosis can be different. We will discuss treatment for the pain first. (See question 11 for a discussion of the treatments for infertility related to endometriosis.)
Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) are usually prescribed first. If they don’t ease the pain, your doctor may try narcotics such as codeine.
Hormone treatments [to lower or regulate female hormones circulating in your body] also help because estrogen makes endometriosis worse. But they have side effects and often offer only temporary relief.
Here are the most common:
The Pill
How it works: The combined oral contraceptive pill (OC) turns off ovaries so you don’t ovulate and have regular periods, which reduces hormones levels.
Possible side effects: Bloating, breakthrough bleeding and acne. The pill can also increase chances of blood clots, especially in smokers, and may raise blood pressure.
Progestins and progesterone
How they work: Synthetic progestins and natural progesterone decrease endometrial tissue growth and probably inflammation. They can be given as pills, injections, nasal spray, or through an IUD (such as the Mirena IUD) that releases a small amount of progestin.
Possible side effects: Progestins can cause weight gain, depression, headache, nausea, dizziness and sore breasts. Natural progesterone is safer, but can also make breasts tender and increase body weight.
Gonadotropin-releasing hormone (GnRH) agonists and antagonists
How they work: These medications, such as Lupron, essentially turn off the brain’s stimulation of the ovaries.
Possible side effects: Hot flashes, night sweats, body aches, vaginitis, depression, palpitations and loss of libido.
Danazol
How it works: This modified form of testosterone lowers estrogen and essentially induces a state of menopause. However, its many side effects make it hard to tolerate for any length of time.
Possible side effects: Weight gain, acne, depression, voice changes, increased body hair and raised cholesterol levels.
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