All About Endometriosis

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Endometriosis is a condition in which the tissue that forms the lining of the uterus grows outside of it and on other organs in the pelvic area. About 10% of women in their reproductive years have endometriosis, and it’s most often diagnosed in women in their 30s and 40s.

Endometriosis most often implants on the:

  • Peritoneum – the membrane that lines your abdominal cavity and surrounds your internal organs
  • Ovaries
  • Fallopian tubes
  • The outside linings of your uterus, bladder, ureters, intestines, and rectum
  • The area behind your uterus

 Just like the lining of the uterus, endometriosis implants respond to changes in your estrogen levels each month as part of your menstrual cycle. The areas of tissue grow, then break down and bleed. This cycle of growing and bleeding can irritate the surrounding tissue on which the endometriosis is implanted. This can cause inflammation and lead to the formation of scar tissue called adhesions. Sometimes these adhesions can even cause organs to stick together. The bleeding, inflammation, and scarring can cause pelvic or abdominal pain, especially before and during your menstrual period.

About 40% of women who have problems with infertility have endometriosis. The endometriosis implants can interfere with the movement of sperm and eggs and your fallopian tubes may even become blocked by adhesions or scar tissue.

Symptoms of Endometriosis

The most common symptom of endometriosis is long-term pelvic pain that gets worse right before and during your menstrual period. Depending on the location of the endometriosis implants, you may experience pain during sex, during bowel movements, and during urination. You may also experience heavy menstrual bleeding. However, many women with endometriosis have no symptoms at all.

To diagnose endometriosis, your doctor will start by performing a pelvic exam. But the only sure way to tell if you have endometriosis is through a minor surgical procedure called a laparoscopy. Your doctor inserts an instrument called a laparoscope through small incisions in your pelvic cavity that will allow him or her to look inside. If any abnormal tissue is present, he or she may remove a small amount for a biopsy to learn more about it.

Treating Endometriosis

Doctors usually treat endometriosis with medication or surgery. If your endometriosis is severe, you may need both.

Pain relievers such as NSAIDs can treat the pain and reduce the inflammation associated with endometriosis. Hormonal medications such as birth control pills can help slow the growth of endometriosis implants and prevent new adhesions from forming, but they usually won’t eliminate the tissue that’s already there.

To remove the endometriosis implants usually requires surgery. This will usually take care of the pain related to endometriosis and may also reduce your chance of infertility. But even with surgery, 40 to 80% of women experience pain from endometriosis again within two years. The more severe your case, the more likely it is to return. Taking hormonal medications after surgery may help to extend your time without endometriosis.

A last-resort option for treating severe pain that doesn’t go away after surgery or medication, especially for women not planning to have any or any more children, is a hysterectomy that also includes removing your ovaries. With your ovaries removed, the endometriosis is less likely to return. If you choose to keep your ovaries, having the endometriosis implants removed at the same time as your hysterectomy reduces the chance that the endometriosis will come back.

If you have been experiencing chronic pelvic pain that gets worse before or during your periods, you could have endometriosis. Talk to your doctor about your symptoms and he or she will create the best plan for diagnosis and treatment.


Source: American College of Obstetricians and Gynecologists

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