Endometriosis

Causes of endometriosis

During a woman’s menstrual cycle, the endometrial tissue outside the uterus will thicken, break down and bleed without a place to exit the body. The blood and tissue will then become trapped and cause complications. If this occurs in the ovaries, cysts can form. In other areas, it may develop scar tissue causing pain, excessive bleeding, infertility and other complications.

Although the cause of endometriosis is not known or understood, there are several theories that may explain why endometrial tissue grows outside the uterus including:

• Retrograde menstruation occurs when your menstrual blood moves backward through the fallopian tubes into the pelvic cavity instead of exiting the body through the cervix and then the vagina.
• Endometrial cells may travel outside the uterus through the lymphatic system.
• Your immune system is not properly eliminating the endometrial cells that are displaced.
• Menstrual blood may be displaced into the pelvic cavity during a cesarean delivery.
• Hormones may convert cells residing outside the uterus into endometrial cells.
• Because cells in the abdomen grow from embryonic cells, small pockets of tissue may convert into endometrial tissue due to the increase of estrogen in the body during puberty.
• Environmental toxins
• Genetics

Risks factors for endometriosis

There are a variety of risk factors that could increase the likelihood that you may develop endometriosis.

Risk factors may include:

• Not experiencing childbirth before the age of 30
• White women are at a higher risk when compared to other races
• Early onset of menstruation
• Late onset menopause
• Short menstrual cycles - you consistently experience a 27-day (or fewer) cycle
• Excessive alcohol consumption
• Low fat percentage or body mass index
• Family history of endometriosis (sister, aunt or mother)
• Higher estrogen levels in your body

In most people, endometriosis develops a few years after you start menstruation. Symptoms of endometriosis stop during pregnancy but resume when you start menstruating after pregnancy. They permanently end during menopause.

Symptoms of endometriosis

Although the most common symptom of endometriosis is pelvic pain, some people may not experience any symptoms. Other symptoms you may experience with endometriosis include:

• Pain during your monthly period
• Lower abdominal pain before and during your period
• Mild to severe cramping before, during and after your period
• Heavy bleeding during your period
• Bleeding in between periods
• Infertility
• Pain during and after sexual intercourse
• Lower back pain during your period
• Fatigue during your period
• Diarrhea during your period
• Constipation during your period
• Nausea or bloating during your period

If you have two or more of these symptoms, discuss your risk for endometriosis with your doctor.

Diagnosis of endometriosis

Your gynecologist can diagnose endometriosis. During a clinic visit, your doctor will take a full medical history, evaluate your symptoms and perform a pelvic exam. The pelvic exam can help your doctor examine your reproductive organs for any abnormalities such as cysts or scars.

Your doctor may order diagnostic testing such as:

Ultrasound 

An ultrasound uses high-frequency sound waves to take detailed pictures inside the body. The test can be performed either externally on the abdomen or in a transvaginal way. An ultrasound can help identify cysts that could be associated with endometriosis.

Magnetic resonance imaging (MRI) 

An MRI uses radio waves to produce images of the reproductive organs in the body. The data gathered during an MRI can help your doctor identify the location and size of the endometrial implants.

Laparoscopy 

A laparoscopy procedure allows your surgeon to look inside your abdomen for signs of any endometrial tissue that has grown outside the uterus. During a laparoscopy, your surgeon will make a small incision on your abdomen and insert a surgical instrument, called a laparoscope, that allows him or her to see clearly inside your pelvic region. A laparoscopy is often used to identify the location and size of endometrial implants to develop a treatment plan most appropriate for your case.

Biopsy

During a laparoscopy, your doctor may take a sample of tissue to evaluate for any abnormalities.

Treatment of endometriosis

Although there is not a cure for endometriosis, your symptoms can be managed. Your doctor will evaluate your case to determine what treatment will be most effective for you.

As you progress to the more advanced stages, there are a variety of medical and surgical options to help you manage side effects from endometriosis.

Medical treatments for endometriosis include:

• Medication – Pain medication, such as nonsteroidal anti-inflammatory medications such as ibuprofen, may be used to relieve mild to moderate pain associated with endometriosis.
• Hormone therapy – Hormone therapy may include oral birth control pills or patches alone or in combination with another hormone, called progesterone, that prevents ovulation and/or reduces your menstrual flow.
• Progesterone – Progesterone is a hormone that stops hormone production in the body.
• Synthetic hormones – Danazol is a synthetic man-made male hormone that can stop menstruation to relieve your symptoms. Although you may feel better, the disease can continue to progress while on this medication, and it may lead to unwanted side effects such as acne and abnormal hair growth.

Surgical treatments for endometriosis include:

Laparoscopy

Laparoscopy is a minimally invasive surgical procedure that is used to diagnose endometriosis as well as remove endometrial growths. During a laparoscopy, your doctor will insert a tube with a light and lens attached to it into the abdominal wall. Once your doctor locates the endometrial growth, he or she will burn or vaporize them — typically with a laser.

Laparotomy

A laparotomy is a more invasive surgery that is used when medical management or laparoscopy is not effective. It is similar to a laparoscopy but uses a full-size incision instead of multiple smaller incisions used in a laparoscopy. The larger incision provides greater visibility into the abdominal cavity to locate and surgically remove any displaced endometrial tissue.

Hysterectomy

A hysterectomy is an option only when all other treatments have failed, and the pain is drastically interfering with your quality of life. During a total hysterectomy, your doctor will remove your uterus, cervix, ovaries and any visible endometrial growths.