What is endometriosis?

Endometriosis is a disorder in which the tissue that forms the lining of your uterus grows outside of your uterine cavity. The lining of your uterus is called the endometrium.

Endometriosis occurs when the endometrium grows on your ovaries, bowel, and tissues lining your pelvis. It’s unusual for endometrial tissue to spread beyond your pelvic region, but it’s not impossible. Endometrial tissue growing outside of your uterus is known as an endometrial implant.

The hormonal changes of your menstrual cycle affect the misplaced endometrial tissue causing the area to become inflamed and painful. This means the tissue will grow, thicken, and break down. Over time, the tissue that has broken down has nowhere to go and becomes trapped in your pelvis.

This tissue trapped in your pelvis can cause:

• irritation
• scar formation
• adhesions, in which tissue binds your pelvic organs together
• severe pain during your periods
• fertility problems

Endometriosis is a common gynecological condition, affecting up to 10 percent of women.

You’re not alone if you have this disorder but sometimes it can feel that way....

The symptoms of endometriosis can vary. While some women experience mild symptoms, others can have moderate to severe symptoms. The severity of pain doesn’t indicate the degree or stage of the condition. You may have a mild form of the disease, yet experience agonizing pain. It’s also possible to have a severe form and have very little discomfort.

Pelvic pain is the most common symptom of endometriosis. You may also have the following symptoms:

• painful periods
• pain in the lower abdomen before and during menstruation
• cramps one or two weeks around menstruation
• heavy menstrual bleeding or bleeding between periods
• infertility
• pain following sexual intercourse
• discomfort with bowel movements
• lower back pain that may occur at any time during your menstrual cycle

You may also have no symptoms. It’s important that you get regular gynecological exams, which will allow your gynecologist to monitor any changes. This is particularly important if you have two or more symptoms.

Medical and surgical options are available to help reduce your symptoms and manage any potential complications.

Pain medications

You can try over-the-counter pain medications such as ibuprofen (Advil), but these aren’t effective in all cases.

Hormonal therapy

Taking supplemental hormones can sometimes relieve pain and stop its progression. This therapy helps your body to regulate the monthly changes in hormones that promote the tissue growth that occurs when you have endometriosis.

Hormonal contraceptives

Hormonal contraceptives decrease fertility by preventing the monthly growth and buildup of endometrial tissue. Birth control pills, patches, and vaginal rings can reduce or even eliminate the pain in less-severe endometriosis.

The medroxyprogesterone (Depo-Provera) injection is also effective in stopping menstruation. It stops the growth of endometrial implants. It relieves pain and other symptoms. This may not be your first choice, however, because of the risk of decreased bone production, weight gain, and increase in the incidence of depression in some cases.

Gonadotropin-releasing hormone (GRNH)

Women take what are called gonadotropin-releasing hormone (GnRH) agonists and antagonists to block the production of estrogens that stimulate the ovary. Estrogen is the hormone that’s mainly responsible for the development of female sexual characteristics. This prevents menstruation and creates an artificial menopause. The therapy has side effects like vaginal dryness and hot flashes. Taking small doses of estrogen and progesterone at the same time can help to limit or prevent these symptoms.

Danazol

Danazol is another medication used to stop menstruation and reduce symptoms. While taking danazol, the disease may continue to progress. Danazol can have side effects including acne and hirsutism, which is abnormal hair growth on your face and body. Other drugs are being studied that may improve symptoms and slow disease progress.

Conservative surgery

Conservative surgery is for women who want to get pregnant or experience severe pain and for whom hormonal treatments aren’t working. The goal of conservative surgery is to remove or destroy endometrial growths without damaging your reproductive organs.

Laparoscopy, a minimally invasive surgery, is used to both visualize, diagnose, and remove the endometrial tissue. Your surgeon will make small incisions in your abdomen to remove the growths surgically or to burn or vaporize them. Lasers are commonly used these days as a way destroy this “out of place” tissue.

Last-resort surgery (hysterectomy)

Rarely, your doctor may recommend a total hysterectomy as a last resort if your condition doesn’t improve with other treatments. During a total hysterectomy, your surgeon will remove your uterus and cervix. Your doctor will also remove your ovaries because they make estrogen, and estrogen causes the growth of endometrial tissue. They will also remove visible implant lesions.

This radical approach to treatment is used only when other treatment approaches have failed, and the pain and inflammation are interfering with quality of life. This procedure will stop the cycle of menstruation, and symptoms of endometriosis should reduce. There is no guarantee that all pain will go away, however.

Endometriosis stages

Endometriosis has four stages or types. It can be any of the following:

• minimal
• mild
• moderate
• severe

Different factors determine the stage of the disorder. These factors can include the location, number, size, and depth of endometrial implants.

Stage 1: Minimal

In minimal endometriosis, there are small lesions or wounds and shallow endometrial implants on your ovary. There may also be inflammation in or around your pelvic cavity.

Stage 2: Mild

Mild endometriosis involves light lesions and shallow implants on an ovary and the pelvic lining.

Stage 3: Moderate

Moderate endometriosis involves deep implants on your ovary and pelvic lining. There can also be more lesions.

Stage 4: Severe

The most severe stage of endometriosis involves deep implants on your pelvic lining and ovaries. There may also be lesions on your fallopian tubes and bowels

Endometriosis prognosis ...

Endometriosis is a chronic condition with no cure. But this doesn’t mean the condition has to impact your daily life. Effective treatments are available to manage pain and fertility issues, such as medications, hormone therapy, and surgery. The symptoms of endometriosis usually improve after menopause.