By: Dr. Amy Jones, DO, Ob/Gyn
If you have painful periods, pelvic pain, painful sex and heavy periods you might be among an estimated 10 percent of women who have endometriosis. Endometriosis is a common gynecological condition that can cause a wide array of problems. The name of this condition comes from the word "endometrium," which is the tissue that lines the uterus.
What the heck is going on in there?
During a woman's regular menstrual cycle, this tissue builds up and is shed if she does not become pregnant. Women with endometriosis develop tissue that looks and acts like endometrial tissue outside of the uterus, usually inside the pelvis or in the abdominal cavity
Each month, this misplaced tissue responds to the hormonal changes of the menstrual cycle by building up and breaking down just as the endometrium inside the uterus does, resulting in small bleeding inside of the pelvis. This leads to inflammation, swelling and scarring of the normal tissue surrounding the endometriosis implants and causes the intense pain that is often associated with this condition.
When the ovary is involved, blood can become embedded in the normal ovarian tissue, forming a blood filled cyst surrounded by a fibrous capsule, called an endometrioma.
Causes of Endometriosis
There are many theories about what causes endometriosis, but ultimately we are yet to prove a definitive etiology. One theory suggests that during menstruation, some of the tissue backs up through the fallopian tubes into the abdomen, a sort of "reverse menstruation," where it attaches and grows.
Another theory suggests that endometrial tissue may travel and implant via blood or lymphatic channels, similar to the way cancer cells spread. A third theory suggests that cells in any location may transform into endometrial cells.
Endometriosis can also occur as a result of direct transplantation—in the abdominal wall after a cesarean section, for example. Additionally, it appears that certain families may have predisposing genetic factors to the disease.
While any woman may develop endometriosis, the following women seem to be at an increased risk for the disease:
- Women who have a first-degree relative (mother, sister, daughter) with the disease
- Women who are giving birth for the first time after age 30
- White women
- Women with an anatomically abnormal uterus
The following are the most common symptoms for endometriosis, but keep in mind that each woman may experience symptoms differently, and some may not exhibit any symptoms at all. Symptoms of endometriosis may include:
- Pain, especially excessive menstrual cramps that may be felt in the abdomen or lower back
- Pain during intercourse
- Abnormal or heavy menstrual flow
- Painful urination during menstrual periods
- Painful bowel movements during menstrual periods
- Other gastrointestinal problems, such as diarrhea, constipation and/or nausea
It is important to keep in mind that the amount of pain a woman experiences is not necessarily related to the severity of the disease. Some women with severe endometriosis may experience no pain, while others with a milder form of the disease may have severe pain or other symptoms.
How do you know if you have endometriosis?
The only way to know for certain endometriosis is the cause of symptoms is by sampling a piece of tissue during surgery and then evaluating the tissue under a microscope. The diagnosis of endometriosis is often delayed because the symptoms of endometriosis are vague, and are similar to a number of gynecological and gastrointestinal processes, and a surgical diagnosis entails risk. Studies have reported an average delay in diagnosis of 7 to 12 years in women with endometriosis.
How can my doctor help me?
If you have endometriosis or you think you have endometriosis you should discuss it with your doctor and come up with a specific treatment plan that works best for you. In general, treatment for endometriosis may include:
- “Watchful waiting” to observe the course of the disease
- Pain management with medication: nonsteroidal anti-inflammatory drugs, such as ibuprofen or other over-the-counter analgesics
- Hormone therapy, including:
- Oral contraceptives, with both estrogen and progestin (a form of progesterone) hormones, to prevent ovulation and reduce menstrual flow
- Progestins alone
- Gonadotropin-releasing hormone agonists, which stop ovarian hormone production, creating sort of a temporary “medical menopause”
- Danazol, a synthetic derivative of testosterone
- Surgical techniques that may be used to treat endometriosis include:
- Laparoscopy (also used to help diagnose endometriosis): A minor surgical procedure which uses a surgical camera to see into the pelvic area. The doctor can often remove the endometrial growths.
- Laparotomy: A more involved surgery to remove as much of the displaced endometrium as possible without damaging healthy tissue
- Hysterectomy: Surgery to remove the uterus and sometimes the ovaries
Often if symptoms are mild, health care providers agree that no further treatment, other than pain medication and other pain relief products, is necessary.
What can I do myself?
Throughout the month eating a diet low in processed foods, minimizing red meat and increasing intake of fruits, vegetables, and whole grains can help to improve overall health. Regular exercise is a great way to release endorphins. These are “feel good” hormones that can help reduce the pain.
Using heat can help to ease cramping, relax pelvic muscles and reduce pain. This is a common menstrual care measure that can offer quick relief. The Rael Natural Herbal Heating Patch is a great option for heating on the go. It heats up to an ideal, therapeutic temperature to promote blood flow and help muscles relax for maximum relief. It can be used under clothes for relief anywhere.
During the roughest times of the month we recommend a good self care regimen to keep symptoms in check. Making time for a bath is another great way to relax muscles and help eliminate pain.
Light your favorite candle and add Maude's Soak No 1 Mineral Bath Salts to warm bath water. These soothing salts contain natural magnesium, sodium, and potassium which help to enhance skin's natural hydration process. It’s a gentle, exfoliator that helps to relax muscles and relieve soreness.
Dealing with endometriosis can be a struggle but with the help of your provider, a little self care and the support of each other symptoms can be identified and managed. What is your experience with endometriosis? Please comment below.