According to the Endometriosis Foundation of America, over six million women have endometriosis, a menstruation disorder. It is a common condition that causes extreme pain every month during the menstrual cycle. Here at John Macey, MD, we offer expert diagnosis and treatment and help you manage symptoms while improving your likelihood of becoming expectant. If you have endometriosis, we are here to help you find lasting relief and improved quality of life. Contact us by phone or via the online booking platform.
What Is Endometriosis?
Endometriosis occurs when uterine cells begin to grow outside the uterus. It can spread to the fallopian tubes, ovaries, and pelvis tissues. The growths are known as endometrial implants, which behave as they would in the uterus; they thicken, break down, and bleed (on a 28-day cycle). The endometrial tissues outside the uterus have no way out and remain trapped inside your body. With time, this results in inflamed, irritated tissue, scarring, adhesions, and ovarian cysts. This causes intense pain during your menstruation and potential urinary and bowel issues. The pain often worsens with time. If endometriosis is left untreated, it can result in fertility issues.
You may develop endometriosis in the following areas:
- Peritoneum (the lining of the abdomen and pelvis)
- Bladder and ureters
- Outside and back of your uterus
- Fallopian tubes
- Space between the uterus and the rectum or bladder
- Ligaments around the uterus (uterosacral ligaments)
Endometrial implants stay in the pelvic area; rarely, they might appear in other areas in the body, such as outside of the abdominal cavity in the brain or lungs. Endometriosis commonly occurs in people aged between 25 and 40. It can also occur during the teen years or when one begins their menstrual cycle. Most people find relief from symptoms when they reach menopause; however, endometriosis might still cause discomfort and pain.
Types of Endometriosis
The main types of endometriosis are based on where it is and include:
Superficial peritoneal lesion: It is the most common kind of endometriosis. There are lesions in your peritoneum, a thin film lining the pelvic cavity.
Endometrioma: These ovarian lesions may develop deep into your ovaries or fallopian tubes. Dark, fluid cysts, also known as chocolate cysts, can damage healthy tissues. They do not respond well to treatment.
Deeply infiltrating endometriosis: This is the most severe form of endometriosis, and it spreads to organs near or inside the pelvic cavity, such as your bowels or bladder.
Signs and Symptoms of Endometriosis
Endometriosis symptoms vary from person to person, ranging from mild to moderate to severe. The severity of your pain does not correlate with the extent or stage of your condition. Some people experience extensive pain yet have mild endometriosis and vice versa. You may also not experience any noticeable endometriosis symptoms, so it is crucial to have regular gynecological exams.
The main common symptom is painful periods, and other symptoms include:
- Cramps 1 or 2 weeks around your period
- Heavy menstrual bleeding
- Bleeding or spotting between periods
- Infertility or difficulty getting pregnant
- Pain during or after sexual intercourse
- Feeling sick
- Digestive issues such as constipation, bloating, nausea, and diarrhea
- Fatigue that does not go away
- Blood in your urine or stool during your period
- Discomfort or pain with bowel movements (when urinating or defecating during your period), especially during your period
- Lower back pain (pelvic pain) that may occur at any time during your menstrual cycle
- Menstrual pain that stops you from doing your normal activities
Endometriosis can greatly impact your life and lead to depression and anxiety. Sometimes the condition might be mistaken for other conditions that cause pain in the pelvis, such as irritable bowel syndrome, ovarian cysts, and pelvic inflammatory disease.
Causes of Endometriosis
The exact cause of endometriosis is not known. Various potential factors may increase the risk of developing endometriosis, including:
- Family history of endometriosis (especially a mother, sister, or aunt has endometriosis)
- Frequent menstruation or short cycles (less than 27 days)
- Starting your menstrual period at a young age (before age 11)
- Going through menopause at an older age
- Long and heavy menstrual periods (more than seven days)
- Short menstrual cycles (periods less than 27 days apart)
- Never giving birth
- Giving birth for the first time after the age of 30
- Low body weight
- Higher than normal levels of estrogen
- Reproductive tract abnormalities, or conditions that block the normal passage of menstrual blood flow out of the body
Health Conditions Linked to Endometriosis
According to research, there is a link between endometriosis and health conditions, including:
- Chronic fatigue syndrome
- Ovarian cancer and breast cancer
- Sensitivity to some chemicals
- Certain types of cancers, such as ovarian and breast cancer
- Some autoimmune diseases (whereby the body’s immune system attacks itself), such as multiple sclerosis, lupus, and some types of hypothyroidism.
If you suspect you have endometriosis, it is essential to talk to your doctor. During your consultation, our specialists will talk to you about your symptoms and perform the following tests which include:
The Pelvic exam: This is done to feel for large cysts or scars behind your uterus.
Transvaginal ultrasound: This is done to check for ovarian cysts from endometriosis. During the procedure, a wand-shaped scanner is inserted into the vagina. A scanner can also be moved across your abdomen to make images of your reproductive organs.
MRI (magnetic resonance imaging): An MRI takes pictures of your reproductive organs.
Laparoscopy: This is done to look at your pelvic area to check for endometriosis tissue. Your doctor can diagnose endometriosis by taking a look at your growth. A small tissue sample can be harvested to confirm if you have endometriosis. The procedure is also used to excise and remove lesions.
Endometriosis has no cure, but there are treatments that help ease symptoms. You may try various treatments to identify which works best for you. Treatment options include:
Pain medications include non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin). If they are ineffective, ask your doctor for other options.
Aromatase inhibitors reduce the amount of estrogen produced in your body and are used alongside hormone therapy to relieve symptoms.
Hormonal medications and contraceptives: Hormonal therapy helps reduce your body’s estrogen and stop menstruation. This prevents excessive bleeding and helps reduce inflammation, cyst, and scarring. These may include the following:
- Birth control pills
- Contraceptive patches
- Contraceptive implants
- Intrauterine system (IUS)
- Vaginal rings
- Danazol (Danocrine)
- Progestin-only contraceptives
- Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists which lower estrogen levels in your body and manage pelvic pain.
These medications only work as long as you are taking them. When you stop, your pain may come back.
Surgery: This is recommended to remove infected tissues, cut away patches of endometriosis tissues, improve symptoms and increase your likelihood of getting pregnant. Surgery is also done to remove part or all of the organs affected by endometriosis, such as surgery to remove part of your colon or your appendix or womb (hysterectomy). A hysterectomy is performed for severe cases to take out your uterus, cervix, and ovaries. This means you cannot get pregnant.
Fertility treatments: These are recommended if you want to get pregnant and endometriosis affects your fertility. In-vitro fertilization (IVF) is one of the options that can help.
Your doctor will discuss the best treatment options suited to your needs and severity. Typically, endometriosis symptoms improve significantly after menopause (when your menstrual cycle stop).
Endometriosis cannot be prevented, but you can manage symptoms (if you already have it) and minimize your chances of developing it. This can be achieved by lowering estrogen amounts made in your body. Estrogen thickens the uterus lining during your menstrual cycle.
To lower estrogen levels in your body, you can do the following:
- Discuss with your doctor regarding hormonal birth control methods such as patches or pills that have lower doses of estrogen.
- Avoid alcohol or minimize intake to one drink daily. This is because alcohol heightens estrogen levels.
- Avoid the consumption of large amounts of caffeine since it may increase estrogen levels.
- Regular exercises to help lower body fat to help minimize estrogen levels in your body. You can take one caffeinated drink per day.
Endometriosis and Infertility
Between 30% to 50% of women with endometriosis have fertility issues. However, you can get pregnant with endometriosis. If you want to get pregnant, talk to your doctor about your fertility goals.
It is not known exactly how endometriosis causes infertility. Possible theories for infertility may include the following:
- The shape of the pelvic area can change the endometrial implants and may block reproductive organs. This may prevent the sperm from reaching the egg.
- During early pregnancy, the immune system may attack the developing embryo
- Those with stage III or IV of endometriosis are highly likely to be pregnant than women in stages I and II
- Improper development of the uterus lining, which becomes unable to support the embryo
- Endometriosis may damage sperm or fertilized eggs before they implant in the uterus.
Surgery to remove the endometriosis implants can help improve the chances of getting pregnant. Your doctor may refer you to a fertility specialist for fertility preservation and in vitro fertilization (IVF), among other methods that may help you become pregnant.
Contact us today for more information about our treatments at John Macey, MD. We are glad to help you minimize the painful symptoms of endometriosis and help you get pregnant.