What is it and what causes it?

Endometriosis happens when tissue normally found inside the uterus grows in other parts of the body. It may attach to the ovaries, fallopian tubes, the exterior of the uterus, the bowel, or other internal parts. As hormones change during the menstrual cycle, this tissue breaks down and may cause painful adhesions, or scar tissue.

Doctors don’t know why endometrial tissue grows outside of the uterus, but they have several theories. Heredity plays a role, and some endometrial cells may be present from birth.

Another theory suggests that menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These cells are thought to stick to organs and keep growing and bleeding over time.

Cells could also move to the pelvic cavity other ways, such as during a Caesarian-section delivery. A faulty immune system may fail to get rid of the misplaced cells.

Symptoms

Pain just before, during, or after menstruation is the most common symptom. For some women, this pain may be disabling and may happen during or after sex, or during bowel movements or urination. It sometimes causes ongoing pain in the pelvis and lower back.

Many women with endometriosis have mild or no symptoms, though. The symptoms may be related to the location of the growths.

It is just normal cramps?

Most women have some mild pain with their menstrual periods. They may get relief from over-the-counter pain medications.

If the pain lasts more than 2 days, keeps you from doing normal activities, or remains after your period is over, tell your doctor.

Fertility issues

Sometimes the first, or only, symptom of endometriosis is trouble getting pregnant. Infertility affects about a third of women with the condition, for reasons that aren’t well understood. Scarring may be to blame.

The good news is that medical treatments can help someone overcome infertility, and pregnancy itself can relieve some symptoms of endometriosis.

Could it be fibroids?

Endometriosis is one cause of severe menstrual pain. But the pain can be caused by another condition, such as fibroids, which are noncancerous growths of the muscle tissue of the uterus.

Fibroids can cause severe cramps and heavier bleeding during your period. The pain of endometriosis or fibroids can also flare up at other times of the month.

Who is at risk?

There are a few factors that may increase your risk and the condition is more common in women who:

• Are in their 30s and 40s
• Have not had children
• Have periods longer than 7 days
• Have cycles shorter than 28 days
• Started their period before age 12
• Have a mother or sister who had endometriosis

Help with diagnosis

Your pattern of symptoms can help to identify endometriosis so it helps to keep a record that shows:

• When the pain happens
• How bad it is
• How long it lasts
• A change or worsening of pain
• Pain that limits your activities
• Pain during sex, bowel movements, or urination

Once you know what’s occurring then there are several options.

Option 1 – Pelvic exam

Your doctor will do a pelvic exam to check your ovaries, uterus, and cervix for anything unusual. An exam can sometimes reveal an ovarian cyst or internal scarring that may be due to endometriosis.

The doctor also looks for other pelvic conditions that could cause symptoms similar to endometriosis.

Option 2 – Pelvic scan

Although it isn’t possible to confirm endometriosis with scanning techniques alone, your doctor may order an ultrasound, CT scan, or MRI to help with diagnosis. These may be able to detect larger endometrial growths or cysts. The scans use sound waves, X-rays, or magnetic fields with radio frequency pulses to create the images.

Option 3 – Laparoscopy

Laparoscopy is the only sure way to determine if you have endometriosis. A surgeon inflates the abdomen with gas through a small incision in the navel. A laparoscope is a viewing instrument that’s inserted through the incision. The surgeon can take small pieces of tissue for a lab to examine, a biopsy, to confirm the diagnosis.

Treatment options

Option 1 – Pain medicine

Pain medications, such as acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, often help relieve the pain and cramping that comes with endometriosis.

But these drugs only treat the symptoms and not the underlying endometriosis.

Option 2 – Birth control pills

Oral contraceptives manage levels of oestrogen and contain a synthetic progestin, which make your menstrual periods shorter and lighter. That often eases the pain of endometriosis. Your doctor may prescribe pills to be taken continuously, with no breaks for a menstrual period, or progestin-only therapy.

Endometriosis symptoms may return after you stop taking the pills.

Option 3 – Other hormone drugs

These drugs mimic menopause, getting rid of periods along with endometriosis symptoms. GnRH agonists, block female hormones from being made. These are serious drugs and can cause hot flushes, vaginal dryness, fatigue, mood changes, and bone loss.

Side effects can include weight gain, smaller breasts, acne, facial hair, voice and mood changes, and birth defects.

Option 4 – Excision and/or surgery

During a laparoscopy, the surgeon may remove visible endometrial growths or adhesions. Most women have immediate pain relief. A year after the surgery, though, about 45% of women will have a return of symptoms. The likelihood of symptoms returning rises over time.

Severe cases of endometriosis may require laparotomy, or open abdominal surgery, to remove growths, or a hysterectomy. Although this treatment has a high success rate, endometriosis still recurs for about 15% of women who had their uterus and ovaries removed.

How to help yourself

Although the conventional options are the only ones you are likely to be offered there is certainly an alternative. Bioidentical natural progesterone is helpful at getting this heavy bleeding under control, but needs to be used continuously for the first two months, after which the normal monthly break can be taken.

Although there is no way to prevent endometriosis, you can make lifestyle choices that will help you feel better. Regular exercise may help relieve pain by improving your blood flow and boosting endorphins, the body’s natural pain relievers. Acupuncture, yoga, massage, and meditation also may help ease symptoms.

For most women, endometriosis recedes with menopause. Some women find relief from endometriosis during pregnancy. In some cases, symptoms may simply go away. About one-third of women with mild endometriosis will find that their symptoms resolve on their own.