Experiencing extremely painful menstrual cycles and pain during intercourse are topics too personal to talk about for some women. But these pains could be related to a debilitating condition called endometriosis that effects more than eight million women in North America alone, according to the Endometriosis Foundation of America.
Division director of OB/GYN at Scott & White Healthcare – Round Rock, Joseph I. Fernandez, MD, offers some information about this condition and why it is important to be diagnosed early.
What is endometriosis?
“Endometriosis is a condition where the tissue that is commonly found in the cavity of the uterus is found in other places,” Dr. Fernandez said. “The most common places are in the lining of the pelvis, on the ovaries, on the fallopian tubes and on the surface of the uterus.”
In rare cases, this endometrial tissue has been found in other areas of the body including the liver and the lungs. Some experts believe this happens because the tissue may be transported by the lymphatics; meaning it is transported through the body’s lymph system and deposited in other parts of the body.
Once the tissue adheres to a surface, it begins to grow. And because it is tissue that is typically found in the uterus, it responds to hormones of the menstrual cycle and bleeds.
What are the symptoms of endometriosis?
Some of the most common symptoms related to this condition are painful menstrual cycles, pain with intercourse and irregular or heavy menstrual bleeding.
“But a lot of those symptoms are not specific to endometriosis,” Dr. Fernandez said. “Endometriosis is often a diagnosis of exclusion.”
In order to confirm that a patient indeed has endometriosis, her doctor must perform a visual diagnosis.
“That requires the visualization of certain types of lesions in the pelvis through laparascopy,” he said.
What causes endometriosis?
There is some evidence that genetics plays a role in who develops endometriosis, but doctors and researchers are still not sure what role familial relations play in the condition.
The most common theory is that the patient has a sort of retrograde or reverse menstruation.
“The menstruation that comes out of the fallopian tubes and settles in the pelvis implants on the lining of the pelvis or the abdomen and begins to grow,” the doctor said.
This build-up of tissue and the development of scarring can eventually block the fallopian tubes, which can hinder fertility.
“In the mild and minimal stages of endometriosis, we really don’t know how it plays a role in fertility,” Dr. Fernandez said. “But in the higher stages—three and four—it may cause scarring and tubal obstruction. Typically, in patients like that, in-vitro fertilization is most likely necessary.”
How is endometriosis treated?
The condition, that effects more than 176 million women worldwide, is treated in a number of ways depending on the progression of the disease.
- Birth control pill – some patients might be placed on the birth control pill or other hormonal contraception to control the symptoms.
- Surgical destruction – the patients undergoes surgery to remove the affected tissue by the use of a laser or by excising the involved tissue, called the peritoneum or lining of the pelvis.
- An injection, leuprolide acetate – this medication works by placing the patient into a temporary menopausal state to decrease estrogen levels.
“We know that endometriosis is estrogen dependent, so by decreasing the estrogen levels, you hope that the tissue might not survive,” Dr. Fernandez said.
These treatments can help to minimize symptoms and improve fertility, but they can only help if the patient knows she has the condition.
“Some patients have very severe endometriosis, but have no pain whatsoever,” Dr. Fernandez said. “That’s why it is so important to make an early diagnosis because the amount of pain doesn’t equate with the amount of endometriosis.”
The OB/GYN also added that women who have irregular periods (less than once a month or more than once a month) or who are experiencing other endometriosis-like symptoms should contact their physician.