ndometriosis is a condition in which the cells that usually line the uterus (the endometrium) are found outside of their normal location.
Endometriosis is a chronic pain condition that affects up to 10 percent of women of reproductive age, occurring in almost 40 percent of women with infertility and up to 81 percent of women with chronic pelvic pain (pain lasting more than six months). Patients with a family history of endometriosis have up to a 10 times increase in suffering from the illness themselves.
Risk factors for development of the disease include periods beginning prior to 11 years of age, cycles occurring more frequently than every 28 days, and heavy bleeding during periods. Although no one knows the exact cause of the disease, there are diagnostic and treatment options that can make living with the diagnosis of endometriosis easier.
Symptoms of endometriosis can be different in every patient, but the most common complaints include painful or heavy periods, pelvic pain that does not go away, and pain with sexual intercourse. Exam findings may include feeling abnormalities on the uterine ligaments or ovaries. The type of pelvic pain usually seen with a diagnosis of endometriosis is pelvic pain beginning within two weeks of menstrual bleeding and sometimes a low backache during menses. If the intestines are involved, diarrhea or constipation, cramping, and pain with bowel movements may occur. In cases of bladder involvement, pain with urination or blood in the urine during menses is possible.
There is no blood work that tests for endometriosis, and although ultrasound, CT and MRI may be helpful in the presence of abnormal examination findings, the only way to definitively diagnose endometriosis is through surgery. For the surgery, a small camera is inserted into the belly button, and one to three additional small incisions are made on the abdomen to take a look at the inside of the abdomen and pelvis.
Biopsies can be taken to prove the presence of disease and to treat the disease, but for women who do not desire immediate pregnancy, medications are often the first line of treatment, even without surgery. This is because the medical treatment for the symptoms is the same whether or not lesions (areas of disease) are present.
When a woman has a menstrual cycle, the endometrium (uterine lining) is the blood that comes out. Since endometriosis is the location of the glands that bleed, it stands to reason that those areas bleed as well during a woman’s monthly cycle.
In order to prevent pain associated with cycles, physicians often prescribe birth control pills or other hormonal forms of birth control to control the cycles. With oral contraceptive pills, periods become more predictable and usually lighter in duration, flow and cramping. In addition, most women on birth control pills have very regular cycles, which allows the provider to prescribe anti-inflammatory medications, such as Ibuprofen, before bleeding is expected to start. This decreases inflammation and the pain associated with the disease.
Coincidentally, oral contraceptive pills and NSAIDs are also the treatment for many women with irregular cycles, long cycles and heavy cycles. They can be used to manage heavy periods associated with fibroid tumors as well.
Other types of management of endometriosis include hormone-containing intrauterine devices, implants under the skin, or injections to decrease menstrual cycles. For some patients a medication called Lupron is prescribed. Lupron “tricks” the body into thinking it is in menopause, “starving” the endometriosis cells of the fuel they need to cause symptoms. Lupron is generally not the first treatment used in treating endometriosis. Some women do require removal of the uterus and ovaries to treat the symptoms of endometriosis.
Endometriosis is a chronic disease, usually occurring between the ages of 25 and 35 years of age. It can cause significant pain, infertility and interfere with the activities and enjoyment of a normal life. Although surgery is the only way to diagnose the disease with certainty and there is no cure for endometriosis, symptoms can be managed with medications, helping young women live a normal life.
For more information on endometriosis, visit www.mountainwestmc.com, choose the “Health Resources” tab and type “endometriosis” in the search box. If you are suffering from symptoms of endometriosis, contact an obstetrician/gynecologist for evaluation and treatment.
Megan Shutts-Karjola is an obstetrician/gynecologist in Tooele. Her office is located at
196 E. 2000 North, Ste. 107 and she can be reached at 882-1697.