Endometriosis is an often painful condition that is caused by tissue (similar to that found in the lining of the uterus) growing outside of the uterine cavity. The tissue typically grows on the ovaries, bowel, and general pelvic region, but it can sometimes occur outside of these areas. These areas of tissue growth are known as endometrial implants.

The exact cause of this condition is not known, but treatments are available to help alleviate symptoms. Here are some facts that everyone should know about endometriosis.

1. Potential causes of this condition

There are many potential causes of endometriosis, but none of them have concrete scientific studies to back them up. Here are just some of the most accepted theories.

• Retrograde menstruation: This is a condition in which menstrual blood and tissue travel up and through the fallopian tubes into the pelvic cavity.
• Cell transformation: This happens when hormones change the cells outside of the uterus into something similar to endometrial cells. Similarly, tissues in the abdomen can change into endometrial tissue due to their embryonic cell origin.
• Surgical scars: It is possible for blood and tissue to leak into your pelvic cavity through surgical scars. An example is a scar from a c-section.
• Transportation: Some say that the lymphatic system can be responsible for moving endometrial tissues out of the uterus and into other abdominal areas.

2. Who does endometriosis affect?

Although we don’t know the exact cause, we do know that endometriosis affects 2-10% of childbearing women between the ages of 25 and 40. Because this condition can only be diagnosed through laparoscopy, this number is only the percentage of known cases. There are a few risk factors that women should be aware of.

A family history of endometriosis

If you have a family member who has this condition, you might be at a higher risk of getting it too. Speak with your doctor for more information if this is a concern.

Your age

As stated above, if you are between 25 and 40, you are more likely to experience endometriosis. It usually occurs years after starting your menstrual cycle, but symptoms can be seen at the age of puberty.

Your menstrual history

Sometimes your menstrual symptoms can be an indicator of endometriosis. This includes longer or shorter periods, heavy periods, and menstruation that starts at a young age, severe cramping with periods that may or may not include nausea, vomiting, and diarrhea. Speak with a doctor if you are concerned that your symptoms may sound similar to this.

Your pregnancy history

Although pregnancy has been shown to lessen the symptoms of this condition, those who have never been pregnant are at a higher risk of developing it. Women who have already been pregnant can still develop endometriosis, which many consider a supporting factor in hormones being a cause.

3. Symptoms and stages of endometriosis

This condition affects women differently, so the symptoms vary. Some report mild pain while others report that it is debilitating. Some women have endometriosis but report no symptoms at all. This is one reason why it is important to get regular gynecological exams with your doctor. For women who have two more symptoms, exams should be done as soon as possible and regularly from there.

Here are some common symptoms.

• General pelvic pain
• Painful periods
• Heavy bleeding between periods
• Uncomfortable bowel movements
• Pain during intercourse
• Lower back pain
• Nausea and/or vomiting with periods

There are four stages of endometriosis, so it is important to remember that the severity of symptoms does not indicate a certain stage. Different factors indicate the separate stages include the depth, location, number, and size of the endometrial implants. The stages can only be diagnosed through surgery.

Stage 1 (Minimal)

In this stage, there is usually mild inflammation in the pelvic region as well as small lesions (or wounds) on one or both ovaries. The endometrial tissue is typically shallow at this stage.

Stage 2 (Mild)

During the mild stage, tissue can be found in small amounts on the ovaries and in the pelvic cavity. The lesions are also light at this stage.

Stage 3 (Moderate)

In the moderate stage, the lesions are more numerous and the endometrial tissue is deeper. The tissue will likely be present on both ovaries and in areas of the pelvic cavity.

Stage 4 (Severe)

The endometrial tissues are very deep on the ovaries in this stage, and there may also be lesions on your fallopian tubes and bowels.

4. Diagnosing endometriosis

Because the symptoms of this condition are similar to those found in pelvic inflammatory disease and with ovarian cysts, an accurate diagnosis is required for treatment. First, your doctor will do a detailed review of your medical history and that of your family. Then, they will perform or order one or more of the following tests to see if you do have endometriosis.

A physical examination

This will be a pelvic exam in which the doctor will check for scars or cysts behind the uterus. This may not be the best way of detecting endometriosis if the tissue build-up or lesions are small.

Ultrasounds

Your doctor may also suggest a transvaginal or abdominal ultrasound. Both of these show images of your reproductive organs. Although endometriosis often cannot be diagnosed with ultrasound, sometimes ovarian cysts can form that can give more insight to confirming the diagnosis.

Laparoscopy

This is a minor surgical procedure that can directly find endometrial tissue outside of the uterus. It is the only sure way to diagnose endometriosis. The tool used is called a laparoscope, which has an intense light and HD camera to provide images of your internal organs. If tissues are found, they can be removed during the same procedure.

5. Treatment options for endometriosis

Because the symptoms of this condition can be life-altering, quick treatment is important. There are medical and surgical treatment options available, but your doctor may want to start out conservatively. If non-surgical treatments do not work, they may suggest a procedure.

Non-surgical treatments

First, your doctor will likely suggest medications to reduce the pain, like Ibuprofen. Hormone therapy may also be an option, which can help stop the progression of endometrial tissue by regulating your hormones. Along the same line, hormonal contraceptives can help regulate hormones within your body.

GnRH (Gonadotropin-releasing hormone) agonists and antagonists

Women take these to block the production of estrogen, a hormone that stimulates the ovaries. This treatment essentially creates a false and temporary menopause. It can help with endometriosis symptoms but may come with uncomfortable side effects.

Minimally invasive surgery

This is the next step if medicines do not lessen your endometriosis symptoms. This is great for women who are suffering from pain, but still want to be able to have children in the future. Laparoscopy is an example of this type of procedure.

Major surgery

This is a last resort, but it may be a treatment option in cases where no other treatment has worked. During this procedure, the doctor will remove the uterus, cervix, and possibly the ovaries, as well as any endometrial tissue found outside of the uterus. Be sure to get as much information as possible before considering a major surgery.

Living with endometriosis

Most women with endometriosis live happy, healthy lives despite their chronic symptoms. If you have endometriosis, you are not alone! You can speak with your doctor to find the best treatment methods for your specific case.

At Women’s Healthcare Associates, we understand that every woman is unique. To schedule an appointment with one of our nurse practitioners or doctors, call (806) 355-6330 or check out our Services to learn more.