The endometrium is the mucus membrane that normally lines the inside of the uterus. During the menstrual cycle, it responds to hormones by thickening with blood vessels in preparation for pregnancy. Once this does not occur, it breaks down and becomes your period.
What is Endometriosis?
Endometriosis is a condition in which endometrial tissue grows outside the uterus. It can grow on the fallopian tubes, ovaries, the external surface of the uterus, and even the rectum, intestines, and urinary organs. The areas where the endometrium is growing abnormally are called implants.
The implants respond to hormones in the same way that the uterine lining does by thickening, breaking down, and shedding. However, since this is occurring outside the uterus, the tissue can become inflamed, irritated, and scarred. The areas of scar tissue are called adhesions. Adhesions can cause organs to stick together, which can be painful during and just before your period.
Endometriosis is fairly common, affecting around 10 percent of women in their childbearing years. Most patients are diagnosed between the ages of 30-40.
Signs & Symptoms of Endometriosis
Endometriosis usually feels like severe PMS symptoms, such as:
- Chronic pelvic cramping, especially before and during your period
- Heavy bleeding
- Painful intercourse
- Painful bowel movements or urination (if implants are affecting these organs)
Endometriosis can also cause fertility problems. It’s estimated that around 40 percent of women who have difficulty getting pregnant suffer from endometriosis. Inflammation of the ovaries and fallopian tubes may hurt the sperm or egg, and adhesions may cause the fallopian tubes to stick together and block the egg’s path to the uterus.
What Causes of Endometriosis?
The exact cause of endometriosis is not certain, some explanations include:
- Retrograde menstruation. Menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
- Transformation of peritoneal cells. In what’s known as the “induction theory,” experts propose that hormones or immune factors promote a transformation of peritoneal cells into endometrial cells.
- Embryonic cell transformation. Hormones such as estrogen may transform embryonic cells into endometrial cell implants during puberty.
- Surgical scar implantation. After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
- Endometrial cell transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
- Immune system disorder. A problem with the immune system may make the body unable to recognize and destroy endometrial tissue that’s growing outside the uterus.
How is Endometriosis Diagnosed?
If you’re experiencing pain and heavy bleeding, make an appointment with us for an examination. Many different conditions present with similar symptoms. At your appointment, we will go your medical history and perform a physical and pelvic exam.
The only way to diagnose endometriosis with certainty is to take a look at your pelvic organs with surgery. A laparoscopy is a surgical procedure in which a thin, flexible, lighted instrument is inserted through a small incision in the abdomen. The doctor may take a biopsy of the tissue for further testing.
Treatment for Endometriosis
There are a few different treatments available for endometriosis. You and your doctor will have a discussion about the best course of treatment for you based on the severity of your symptoms and your plans to bear children in the future.
Pain and cramping associated with endometriosis can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs). You can buy these over-the-counter or your doctor can give you prescription-strength medications.
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Many women successfully treat endometriosis with birth control pills, GnRH agonists, and progestin medications. These treatments won’t cure endometriosis or remove the existing tissue, but it can reduce the growth of new tissue and prevent adhesions from forming.
Women who are trying to get pregnant might elect to have their endometrial implants surgically treated. This can break up scarring and improve fertility. It can also reduce pain, but some women report that their pain has returned within a few years after the procedure. Combining surgery with hormone therapies seem to work best to combat both pain and fertility problems.
A hysterectomy is the surgical removal of the uterus and ovaries. Removing the ovaries significantly reduces the chance that the pain will come back after surgery. A hysterectomy is typically only used as a last resort, because after the procedure, you will no longer have a period or be able to become pregnant.
If you believe you are experiencing symptoms of, or suffering from Endometriosis, or have questions about it, please see your doctor.
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