Endometriosis is a disease that affects millions of women. It is responsible for hundreds of thousands of missed work hours, pain ranging from mild to crippling, and, for some women, infertility.
Endometriosis (also known as lesions or implants) is found in the female pelvis. It has been found on every pelvic organ including the uterus, ovaries, tubes, ligaments, ureters, bowel, bladder, and other peritoneal surfaces.
Pain caused by endometriosis depends in part on where it is and how much a woman may have. A small spot of endometriosis may stay small and relatively inactive for many years. However, even the tiniest implant can cause incapacitating pain if it irritates a nearby nerve.
Larger implants can become locally invasive as they respond to hormone stimulation. The tissue surrounding the implant can begin to break down and bleed. The body's natural reaction is to try to cover this raw area with scar tissue (also called adhesions). But if active endometriosis becomes trapped beneath adhesions, enormous pain and pressure can result.
A large walled-off area (frequently an ovary) can lose its central blood supply. Then degeneration and destruction of the localized blood can create a cystic mass called an endometrioma. An endometrioma can be quite small, like a BB. They can also grow very large. the size of a softball.
Advanced endometriosis can result in pelvises frozen with adhesions. This means that organs designed to float freely within the pelvis are stuck together. Then, any movement of any one of those structures (such as ovarian movements during ovulation, movements during sexual intercourse, or moving material through the bowel) can result in enormous pain.
Pain is the most common symptom. Symptoms include:
- severe menstrual cramps
- pelvic pain apart from menses
- backache
- painful intercourse
- painful bowel movements
- fatigue
- bloating
- constipation
- menstrual diarrhea
- pain with exercise
- painful pelvic exams
- painful and frequent urination
Treatment for endometriosis varies, but are usually contained to the following:
Observation
You may decide with your doctor to observe endometriosis without treatment. This decision usually takes place when endometriosis is first diagnosed. Close attention to symptoms and frequent exams by your doctor or specialist with considerable experience with endometriosis will lead to appropriate treatment at the right time. Observation is not a good option when symptoms are significant or the pelvic exam shows progressive changes.
Pregnancy
Pregnancy is not a cure for endometriosis.
During pregnancy, ovulation stops. The endometriosis implants generally become less active, and may get smaller and less tender. This seems to be the result of the hormonal changes that pregnancy brings. These include high levels of progesterone, the presence of HCG (human chorionic gonadatropin) and prolactin, among others. Menstruation stops, and many women with endometriosis feel much better while they are pregnant. However, the disease does not go away during pregnancy. After pregnancy and nursing (and sometimes before then), the symptoms return, sometimes stronger than before.
Medical suppression
Drugs do not make endometriosis disappear, but can offer temporary relief from symptoms.
- Oral contraceptives offer a regulated, low-dose combination of estrogen and progesterone to prevent ovulation. Because ovulation is difficult for many women with endometriosis, this can be a big plus for OCs.
- Progesterone is usually given in a long-acting depot form via injection (depo-provera). Progesterone can also prevent ovulation and reduce circulating estrogen levels. Side effects include irregular bleeding, bloating, weight gain, and more. Expense is reasonable.
- GNRH analogs (Synarel, Lupron, Zoladex and Danocrine) are drugs that stop virtually all ovarian activity (hormone production and ovulation
Surgery
There are four levels of a doctors surgical approach to endometriosis:
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Diagnostic surgery has diagnosis as its highest priority. That is, the whole point of the operation is to diagnose what's going on with the patient. No attempt is necessarily made to treat any disease that may be found.
Conservative surgery is one in which a surgeon might treat very large, obvious, or easily treatable disease. For example, a leaking endometrioma might be drained, or an area of powder-burn implants ablated. Other areas of disease may, by design, be left untreated. Doctors who believe that endometriosis can never be controlled and will always come back often do this type of surgery.
- Aggressive conservative surgery removes all disease while preserving all organs. The emphasis is on removing all areas of endometriosis and possible endometriosis, while maintaining fertility.
- Radical surgery describes the removal of the reproductive organs. Certainly there are some women who have benefited from this approach, but the majority of women can receive long-lasting pain relief without resorting to such drastic measures. In addition, there are a host of reports of endometriosis persisting after hysterectomy. Removing a woman's uterus but leaving implants of endometriosis behind often does not relieve pain.