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Endometriosis

Overview

Endometriosis deposits on uterus and ovaries

Endometriosis
Photo taken from Mayo Education site

Endometriosis

Endometriosis is painful! It is a common misconception that monthly or daily menstrual pain is normal. If you have been given birth control pills as a way to help with menstrual pain or have been told to “deal with the pain”, come see us at Virginia OB/GYN, we can help!

What is endometriosis

Endometriosis is a condition where the lining of the uterus grows either outside of the uterine muscle or into the muscle, with the latter known as adenomyosis. Endometriosis can spread to other sites in your body including the peritoneum, which is the lining of the pelvis, and even the ovaries and fallopian tubes.

Endometrial tissue acts as it is supposed to during your period - it grows, then breaks down and causes bleeding. Because the bleeding has no place to go, it becomes trapped in your pelvis. Ovarian cysts called endometriomas, may also form, and due to irritation of the surrounding tissues, adhesions and scar tissue may develop, causing organs to stick together. This is thought to be a cause of infertility.

Symptoms

Common signs and symptoms of endometriosis include:

  • Painful periods (dysmenorrhea). Pelvic pain and cramping usually begin several days before your period and may continue for a few days into it.
  • Pain with intercourse. This is usually described as pain with deep penetration. This is due to endometriosis growing in the pelvis and causing scar tissue.
  • Pain with bowel movements or urination. Constipation, diarrhea and/or painful bowel movements usually occur during menses. Bloating, nausea and fatigue during menses are also common.
  • Excessive bleeding. This can be either heavy bleeding during menses, known as menorrhagia, or bleeding between menses, known as menometrorrhagia. Adenomyosis, endometriosis in the uterine muscle, may contribute to these symptoms as well.
  • Infertility. Endometriosis may be associated with infertility.
  • Low back pain during menses. This is a common complaint in women with endometriosis.

Endometriosis lesions are usually inversely associated to the severity of pain. Therefore, the severity of pain isn't necessarily a reliable indication of the extent of disease. It is common to see women who don’t have much pain are the ones that have a “frozen pelvis” where everything is severely scarred.

Women with endometriosis commonly complain of pain from recurring ovarian cysts. Ovarian cysts are rarely the cause of pain. However, ruptured ovarian cysts may cause pain but this is an exception for the cause rather than the norm.

Endometriosis is commonly mistaken for other disorders

Endometriosis can be mistaken for pelvic inflammatory disease (PID), ovarian cysts, or even irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. These may be blanket diagnoses, and the “real” diagnosis is endometriosis.

It is estimated that 8-10% of women have endometriosis. Due to the “writing off” of symptoms as normal menstruation for women, endometriosis is severely underdiagnosed.

When to see a doctor

See your doctor if you have signs and symptoms that may indicate endometriosis.

Endometriosis can be a challenging condition to manage. An early diagnosis, a multidisciplinary medical team and an understanding of your diagnosis may result in better management of your symptoms.

Request an appointment at Virginia OB/GYN today.

Causes of endometriosis

Although the exact cause of endometriosis is not certain, possible explanations include:

  • Retrograde menstruation. In 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 transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial cells.
  • Embryonic cell transformation. Hormones, such as estrogen, may transform embryonic cells — cells in the earliest stages of development — 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. It's possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that is growing outside the uterus.

Risk factors

These factors may place a woman at greater risk of developing endometriosis:

  • Never giving birth
  • Starting your period at an early age
  • Going through menopause at an older age
  • Short menstrual cycles — less than 27 days
  • Higher levels of estrogen in the body
  • Low body mass index
  • Alcohol consumption
  • One or more relatives (mother, aunt or sister) with endometriosis
  • Any medical condition that prevents the normal passage of menstrual flow out of the body
  • Uterine abnormalities

Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis end temporarily with pregnancy and end permanently with menopause, unless a woman is on estrogen replacement.

Complications

fertilization implantation
Photo taken from Mayo Education site

Infertility

The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant.

For pregnancy to occur, an egg must be released from an ovary, travel through the neighboring fallopian tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development. Endometriosis may obstruct the tube and keep the egg and sperm from uniting. But the condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.

Even so, many women with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise women with endometriosis not to delay having children because the condition may worsen with time.

Ovarian cancer

Ovarian cancer does occur at higher than expected rates in women with endometriosis. The overall lifetime risk of ovarian cancer is low. Some studies suggest that endometriosis increases that risk, but it is still relatively low. Although rare, another type of cancer called endometriosis-associated adenocarcinoma can develop later in life in women who have had endometriosis.

Source: Mayo Clinic