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Endometriosis: An Overview

Gainesville and Lake City GYNS of All About Women discuss the common occurrence of endometriosis, its causes, and treatment.

When most women hear the word endometriosis, they automatically think of menstruation pain, but it can involve much more than that. Endometriosis refers to a condition where tissue similar to the lining of the uterus grows outside the uterus, causing chronic pain, inflammation, scarring, and even fertility issues that can affect daily life well beyond menstrual cycles.

It can appear any time between a woman's first menstrual cycle and post-menopause. While painful and problematic for many women, endometriosis is usually treatable once properly diagnosed.

Did you know?

According to the American Medical Association (AMA), endometriosis affects about 1 in every 10 women in the U.S.

...research has found that women with endometriosis often also have other immune disorders such as allergies, eczema and asthma.

What Is Endometriosis?

Endometriosis occurs when the tissue lining the uterus, called endometrium, grows outside of the uterus. Though this tissue is not inside the uterus, it still responds to the same hormones that cause the uterus to grow and shed its endometrial lining.

While grown and shed endometrial lining within the uterus is able to exit the body through a period, patches of endometriosis outside of the uterus grow and shed tissue and blood that is unable to leave the body. The growing and shedding of this endometrial tissue can lead to endometrial growths (where scar tissue forms and grows together), cysts, inflammation and severe pain.

Endometrial growths may also be called nodules, lesions, implants or even tumors, but endometrial growths are benign. They are not cancerous. These growths most often occur around the uterus—on the ovaries, in the area between the vagina and the rectum, on the ligaments that support the uterus, on the fallopian tubes, or on the outer surfaces of the uterus, rectum or pelvic lining.

Symptoms of Endometriosis

Some women with endometriosis will not experience any symptoms, but most experience a series of symptoms:

Chronic pelvic pain — the most common symptom of endometriosis — is often debilitating before and throughout the menstrual cycle.

Heavy periods

Fatigue

Pain during or after sexual activity, which can lead to a decreased desire to have sex

Lower back pain and intestinal upset (including diarrhea, constipation or painful bowel movements) during periods

Mood swings due to hormonal imbalances

Lowered immune defenses, which can lead to frequent colds or bladder infections

One of the most upsetting symptoms of endometriosis can be infertility, which occurs in an estimated 30 percent of women. Infertility can often be successfully treated.

Diagnosis

Pelvic exams are often a first step in diagnosing endometriosis. Pelvic exams can reveal large cysts or scar tissue around your uterus, but will not reveal smaller patches of endometriosis or patches that are located beyond the scope of a pelvic exam.

Ultrasounds of the vagina can reveal if endometriosis has caused ovarian cysts.

Laparoscopy is the only way to know for sure if you have endometriosis. A laparoscopy is a minor surgery that can reveal things endometriosis pelvic exams and ultrasounds cannot. Because laparoscopy is a surgery, and surgery has inherent risks, your doctor may first try to treat your symptoms with birth control to see if your pain subsides.

If not, then your doctor may perform a laparoscopy. During the procedure, the abdominal cavity is filled with carbon dioxide and the abdominal organs are checked with a laparoscope. A laparoscope is a fiber-optic lit tube. The doctor may just examine the organs or may also biopsy a small amount of tissue for further examination.

Treatment Options

Your doctor will consider your age, symptoms, if you are considering having children in the future, and your family history when deciding on treatment options for your endometriosis. There are three main treatment options: pain relievers, hormone therapy and surgery.

Pain Relievers

Over-the counter pain relievers are often recommended for mild pain, including naproxen (Aleve) or ibuprofen (Advil and Motrin). Let your well woman care provider know if you have already tried these medications without success. They may prescribe a stronger pain reliever.

Hormone Treatments

The goal of hormone treatments is to slow or stop the production of hormones that aggravate endometriosis. Hormone therapy can be very effective in relieving symptoms of pain, sometimes for many years after stopping the medication. There are several hormone therapy options your well woman care provider may consider:

Progestins including Depo-Provera (a progesterin shot) and the Mirena IUD
GnRH agonists and antagonists
Birth Control Pills
Danazol

Surgery

For women whose lives are greatly impacted by endometriosis, such as those who are unable to conceive or who are suffering extreme pain, surgery is a likely option. The procedure of laparoscopy can also be used to treat endometriosis by removing endometrial growths and scar tissue while keeping healthy surrounding tissue intact. The surgery can improve or preserve a woman's fertility.

Hysterectomies are sometimes called the "last-resort option" for women with severe endometriosis. Obviously, a hysterectomy is not a treatment option for women who wish to bear children. Hysterectomies are most successful if the ovaries are taken out at the same time, though this major surgery can cause symptoms similar to menopause.

Cause of Endometriosis

The cause of endometriosis is unclear, but doctors do know that endometriosis is linked both to a woman's hormones and to her immune system. In fact, research has found that women with endometriosis often also have other immune disorders such as allergies, eczema and asthma. Researchers also believe that a woman with a family history of endometriosis has a higher risk of also having endometriosis.

While endometriosis cannot be technically cured, it can be effectively treated.

Role of GYN in endometriosis diagnosis and treatment

There is no reason to silently suffer through endometriosis. If you or a loved one has symptoms of endometriosis or is suffering from extreme menstruation pain, contact the experienced gynecologists at All About Women to schedule an endometriosis screening at our Lake City or Gainesville location.

Our well woman care providers can explore treatment options with you—from hormone therapy to surgery. Our North Florida gynecologists are able to provide you with all the latest surgical options, including laparoscopy, hysterectomy, and minimally invasive da Vinci surgery.

Regardless of where you are in the process of dealing with endometriosis, the dedicated physicians and nurses at All About Women will be here for you through every step.