Endometriosis

Endometriosis is a common health problem for women affecting more than 11% of women in the United States between 15 and 44. The Women’s Health Specialists of Dallas team is experienced in diagnosing and treating endometriosis and offers effective treatments and testing methods, including transvaginal ultrasounds, pelvic laparoscopies, and pelvic exams.

What is endometriosis?

Endometriosis occurs when the endometrium, the tissue lining your uterus, begins to grow outside the uterus.

This uterine tissue can grow on the ovaries, Fallopian tubes, and other surrounding pelvic organs. Less commonly, the tissue can grow in the bladder, intestine, bowel, appendix, or rectum. In rare cases, it is present outside of the abdominal cavity in the brain or lungs.

Endometriosis can also develop in scars left from surgery on pelvic organs, but it most commonly affects women in the prime of their child-bearing years, between the ages of 25 and 35.

Often, doctors misdiagnose the condition because symptoms are similar to other conditions. Some women might not even receive a diagnosis for many years.

What are the symptoms of endometriosis?

Some of the symptoms of endometriosis include:

Chronic fatigue
Pain during intercourse
Nausea or vomiting
Severe menstrual cramps
Moderate to severe pelvic pain
Longer and heavier menstruation

In more severe cases, endometriosis can lead to bowel and urinary disorders, and even infertility.

How and why does endometriosis cause infertility?

It is not clear to researchers yet why endometriosis causes infertility; however, some studies suggest that as the disease progresses endometrial lesions block the fallopian tubes and inhibit ovulatory functioning. Other studies suggest that endometriosis may alter the uterus in a way that disrupts embryo implantation, but further research is needed to understand this more clearly.

Approximately 30 to 40 percent of women with endometriosis are infertile. Unfortunately, many women are not aware of their infertility or endometriosis until they try to become pregnant.

Why does endometriosis can pause and health problems?

Even though endometriosis growths are benign (non-cancerous), they can still cause pain and health problems. This is because the tissue similar to the lining of the uterus grows outside of the uterus, and when the growths swell and bleed and have no way to get out of your body, this causes pain.

When endometriosis growths continue to expand, they can cause problems, such as

Formation of ovarian cysts from trapped blood in the ovaries as a result of a blockage to your Fallopian tubes when growths cover or grow into your ovaries.
Inflammation (swelling)
Formation of scar tissue and adhesions. This scar tissue may cause pelvic pain and make it hard for you to get pregnant.
Problems in your intestines and bladder

What causes endometriosis?

There are multiple theories on what causes endometriosis including:

Sampson’s Theory

Sampson’s Theory involves retrograde menstruation or the backward flow of menstruation. However, retrograde menstruation occurs in 90% of women, and only 10% of women develop endometriosis.

Meyer’s Theory

Meyer’s Theory shows that endometriosis is likely present during fetal development, and is activated during puberty when estrogen levels increase.

Inflammation

Many experts point to the immune system and inflammation as a cause of endometriosis.

Family History

Women with a family history of the condition are also much more likely to develop endometriosis.

How is endometriosis diagnosed?

During your consultation, your Women’s Health Specialist will ask you questions about your medical history and about your symptoms. Your doctor will also conduct a pelvic exam to feel for large cysts or scars behind your uterus. Other tests may be ordered as well, which may include:

Transvaginal Ultrasound – to check for ovarian cysts from endometriosis.
MRI – to take a picture of your reproductive organs
Laparoscopy – to look inside your pelvic area to see endometriosis tissue

Can pregnancy stop the progression of endometriosis?

Pregnancy often relieves women of symptoms due to the increase in progesterone. Symptoms, however, return after birth and/or after stopping breastfeeding.

What are the treatments for endometriosis?

Endometriosis cannot be cured, but there are treatment options available to alleviate pain and remove lesions.

Endometriosis treatments depend on the severity of the condition and your symptoms, your age, and whether or not you want children. Treatment options include lifestyle changes, pain medications, including over-the-counter medications as well as prescription medications; hormone therapy; or surgical treatment.

Hormone therapy comes in the form of a pill, a shot or injection, or a nasal spray. Therapy aims to treat endometriosis-associated pain. Treatments stop the ovaries from producing hormones, including estrogen, and usually prevent ovulation. Hormone therapy is used in some cases to balance and regulate the hormones that can worsen endometriosis.

If you are not trying to get pregnant, hormonal birth control is a good option for you. Some options may include:

Hormonal IUDs. These help to reduce pain and bleeding and protect against pregnancy for up to 7 years. Note that this treatment may not alleviate pain and bleeding due to endometriosis for that long.
Extended-cycle (you only have a few periods a year) or continuous cycle (you have no periods) birth control is available in the pill or the shot to help stop bleeding and reduce or eliminate pain.

If you are trying to get pregnant, your doctor may prescribe

Gonadotropin-releasing hormone (GnRH) agonists. These agonists block the menstrual cycle, lower the amount of estrogen your body makes, and help with pelvic pain. The treatment causes a temporary menopause, but it also helps control the growth of endometriosis. Once you stop taking the medicine, your menstrual cycle returns, and you have a better chance of getting pregnant.

Surgical treatment is an option for women who have severe symptoms, have not had significant relief from hormone therapy, or have fertility problems.

Surgical treatments can provide significant pain relief from endometriosis, although it can be short-term, with endometriosis growths and pain returning over time.

Because some surgical procedures cannot be reversed and others can affect a woman’s fertility, It is important to have a thorough discussion about surgical treatment options with your health care provider. Some of your options may include:

Laparoscopy – the surgeon removes the lesions and scar tissue without harming the healthy tissue around it through small incisions made in the abdomen.
Hysterectomy – the surgeon removes the uterus if the ovaries have endometriosis on them or if the damage is severe. Depending on the severity of the condition, the surgeon may also remove the ovaries and Fallopian tubes along with the uterus.

How can you prevent endometriosis?

You can’t prevent endometriosis, but you can manage your symptoms or reduce your chances of developing it by lowering the levels of the hormone estrogen in your body. Estrogen is known to thicken the lining of your uterus during your menstrual cycle.

To keep lower estrogen levels in your body, you can:

Talk to your doctor about hormonal birth control methods, such as pills, patches or rings with lower doses of estrogen.
Exercise regularly, more than 4 hours per week. Regular exercise and lower body fat help decrease the amount of estrogen circulating in your body.
Avoid large amounts of alcohol, limiting yourself to no more than one drink per day, as alcohol raises estrogen levels.
Avoid large amounts of drinks with caffeine, limiting yourself to one caffeinated drink a day, as caffeine can also raise your estrogen levels.

This information is provided for informational educational purposes only, and should not be considered as individual medical advice. Please discuss your specific situation with your medical provider.