The Facts on Endometriosis
Endometriosis is a common chronic condition found in women of childbearing age. It is estimated that 5.5 million women in the United States suffer from this illness. It is the abnormal growth of endometrial tissue outside of the uterus. Endometrial tissue reacts to the hormonal changes that occur during menses, thickening in response to those hormones, potentially causing pelvic pain and other symptoms.
Diagnosing and treating endometriosis has improved drastically over the last 30 years. Prior to the 1970s, diagnosis was based primarily upon symptomatology and pelvic examinations. The only treatment options available were pain medication, pregnancy, or hysterectomy. Research has led to more choices when making a decision about care.
- General Information Pamphlet – Pamphlet produced by the American Congress of Obstetricians and Gynecologists to educate the newly diagnosed.
- Overview – Informative website created by The Cleveland Clinic.
What is Endometriosis?
Endometrium is the lining of the uterus that grows and thickens within the uterus every 28 days or so in response to hormonal changes. Called “endo” by the sufferers of the disorder, endometriosis is derived from the word “endometrium.” In Latin, “endo” means within, and “metrium” means mother. Endometrial tissue lines the uterus and thickens in preparation for fertilization. Sometimes that tissue grows outside of the uterus on another organ located within the peritoneum. The ovaries and uterus are the primary sites, including the ligaments and tissues that hold them in place. As stated, endometrium responds to hormonal changes even if it is outside the uterus, causing bleeding, scar tissue, and adhesions. Over time, endometriosis will cause worsening pain and bleeding, necessitating treatment. Even though endometriosis is a condition that cannot be cured, it can be medically managed.
- Endometriosis.org – Everything you ever wanted to know, including current research and support groups.
- Statistics/Detailed Information – In-depth, detailed information geared toward those either newly diagnosed or who need to talk with their physician.
What are the Symptoms of Endometriosis?
Chronic pelvic/lower back pain is the chief characteristic of this disorder. Painful menstrual cramps, known as dysmenorrhea can be debilitating, lasting several days as can excessively heavy bleeding. It is estimated that 40 to 60% with regularly painful menses have endometriosis. Other symptoms include any discomfort during intercourse, intestinal pain, blood in the urine, and unexplained infertility. Symptomatology, however, is not indicative of endometriosis. Women who are asymptomatic can have severe endometriosis, and conversely those with acute pain and bleeding might have a very mild case. Approximately 2 to 22% of those with endometriosis have no symptoms. It mimics other disorders such as PID (pelvic inflammatory disease), ovarian cysts, ectopic pregnancy, and reproductive system cancers.
- Typical Symptomatology – Details the classic symptoms of the disorder.
- Atypical Symptomatology – Details the classic as well as the atypical signs of endometriosis.
How Do I Know I Have Endometriosis?
As stated, symptomatology is not indicative of endometriosis. A gynecologist will first perform an examination with a complete family history, since it is genetic. However, even if performed during the menstrual cycle, results will be mixed and inconclusive. Definitive clinical diagnosis is made through surgical means, namely laparoscopy. This is an outpatient procedure whereby a thin telescope (laparoscope) is inserted through a small puncture in the abdomen. This allows the surgeon to see the endometrial lesions, biopsy the tissue, and sometimes eliminate the scar tissue and adhesions. A new technique called pain mapping is done under a local anesthesia. Endometriosis can be localized more efficiently with this method. Laparoscopy is the definitive diagnostic tool.
- Diagnosing Endometriosis – Discusses the clinical approaches to diagnosing endometriosis.
- Non-invasive Diagnosis – New, less invasive technique designed to diagnose endometriosis.
Who Gets Endometriosis?
Chiefly women of peak childbearing years, 25 to 44 are prone to this disorder with a rate of 7 to 15% of women in this age bracket actually having endometriosis. Teenage females can also be affected by endometriosis, but this is less common. Research has shown that it is a genetic condiiton. If a direct female relative suffers from it, the likelihood of being inflicted with this disorder increases significantly. An abnormally shaped uterus, a first pregnancy after the age of 30, and an irregular menstrual cycle lasting a week or more are risk factors for endometriosis.
- Risk Factors for Endometriosis – Summary of risk factors including age, ethnicity, and associated disorders.
- Endometriosis in Teenagers – Overview of endometriosis geared toward the teenager.
What Causes Endometriosis?
No distinct causative factors have been linked to endometriosis. Unproven theories abound, from cell changes to chemical exposure to spillage of menstrual flow. The only known contributing factor that has been identified is genetic predisposition. Those with first-degree relatives, such as a mother or sister who suffer from the disorder, are more likely to have it than those who do not. Research data has found a correlation between endometriosis and possible immune system deficiencies, although it is unknown whether it stimulates tissue overgrowth or reacts to it. Other suggestions include endometrial fragments traveling through the lymphatic system and retrograde menstruation whereby menstrual blood and tissue flows backward into the fallopian tubes. Areas of concern also include assorted environmental issues.
- Possible Causal Factors – Theories about potential causes.
- Theories Defined – Outlines theories in the medical community along with reasoning.
What are the Treatments for Endometriosis?
With the advances in the medical system over the last few years, options are not as limited. Pain is generally treated with NSAIDs (nonsteroidal anti-inflammatory drugs). Oral contraceptives are used to regulate the menstrual cycle and decrease bleeding. A promising therapy, GnRH (gonadotropin-releasing hormone) also controls the menstrual cycle. Estrogen levels are lowered as the ovaries are in effect turned off. With this therapy, menopausal symptoms often result temporarily. Using GnRH is a long-term commitment requiring constant physician supervision. Finally, Danazol, a weakened male hormone has proven effective, although it is not utilized as much due to unpleasant side effects.
For those with fertility issues, conservative surgery to remove scar tissue is usually better than hormonal treatment alone. With more severe cases of endometriosis, surgery might be the only choice. Over time, scar tissue forms, causing adhesions. These adhesions can actually bind organs together, and surgical excision is the only way to remove them. The final treatment option for those with chronic severe endometriosis refractory to medical management is the salpingo-oophorectomy, complete removal of the ovaries and uterus. Research has shown a recurrence rate of 10-15% with removal of the uterus only. This is considered a last resort treatment.
Alternative therapies have come into vogue over the last few years. Chinese medicine is a holistic or whole body approach to medicine. One such Chinese therapy is acupuncture. Acupuncture is the placing of small thin needles at specific points on the body to increase life force flow and alleviate pain. It has been practiced in China for over 4000 years. Ayurvedic medicine which originated in India over 5000 years ago also relies on holistic methodology. According to Ayurvedic medicine, every living thing is comprised of five elements: air, water, fire, earth, and space. The key is finding balance between those five elements. Finally, diet, herbal, and naturopathic remedies are aimed at balancing estrogen levels, reducing inflammation, improving immune system response, and stabilizing emotions.
- Medical Management – Current medical treatments for endometriosis.
- Alternative Treatments – Outlines alternatives to medical therapy for relief of endometriosis.
Can Endometriosis Grow on Other Body Parts?
The majority of endometriosis is found within the pelvic cavity, where the reproductive organs are located. While not as common, endometriosis has been found in the urinary tract system and bowel areas. The symptoms mimic a multitude of other common disorders such as urinary tract infections, hypertension, and kidney stones. Atypical instances of endometriosis can also occur in the lungs, skin, and sciatic nerve. Pain and the menstrual cycle are the only common denominators. The unusual signs of endometriosis in the lungs include coughing up bloody sputum, air in the lungs, shortness of breath, and intense shoulder and/or chest pain.
- Sites Endometriosis Can Occur – Describes every place abnormal endometrial tissue can grow.
- Catamenial Pneumothorax – Focuses on endometriosis that grows on the lungs, signs, symptoms, and diagnosis.
Does Having Endometriosis Make Me Infertile or Unable to Have Children?
Endometriosis is one of the top causes of infertility in females with up to 40% having fertility issues. Since endometriosis is sometimes asymptomatic, women who have been attempting to conceive for a long time may only be aware they have the disorder while getting treatment for infertility. It is estimated that 20 to 30% of females who go for fertility treatment have undiagnosed endometriosis. The extent of the endometriosis as well as personal preference will help determine an appropriate course of action. If the case is very mild, opting to continue fertility treatments such as IUI (intrauterine insemination) or IVF (in vitro fertilization) might be the best plan of care. Cases that are more severe in nature may require hormonal/surgical treatment options to restore fertility.
- Endometriosis and Infertility – Details how endometriosis causes infertility.
- Further Information – Additional information regarding fertility and how endometriosis affects it.
What Research is Being Done to Learn More About Endometriosis?
Currently research is focused on finding simpler, non-invasive ways to diagnose and treat endometriosis and also discovering other contributing factors. Specifically, it has been found that those with certain DNA biomarkers for the disorder can be reliably used to determine the likelihood of becoming a victim to this disorder. Creating a test that can be performed in the physician’s office is the next step. As stated, other research attempts to delineate additional causal factors. Examination into possible cures for endometriosis is ongoing as well.
- Pesticides – Technical study conducted to determine the relationship of pesticide exposure and risk for endometriosis.
- Biomarkers for Endometriosis – Study that focuses on finding serum biomarkers to determine likelihood of having the condition.
- Progestin Resistance – Study performed to establish a connection between progesterone resistance and instances of endometriosis and possibly the creation of a test to measure the hormone resistance.
Where Can I Go for More Information?
- www.asrm.org – American Society for Reproductive Medicine
- www.acog.org – American Congress of Obstetricians and Gynecologists.
- www.endometriosisassn.org – The Endometriosis Association
- www.endometriosis.org – Endometriosis.org
