Endometriosis is a common and chronic gynecological disease which can result in cyclic pelvic pain occurring in conjunction with a woman’s periods.
The condition occurs when endometrial cells develop outside of their normal location inside the uterus. The misplaced endometrial cells respond to the menstrual cycle in the same way as those lining the uterus. The tissue grows and sheds blood at the time of menses. Instead of flowing out of the body through the vagina, the blood shed by the misplaced cells has no way out of the body. The resulting internal bleeding can lead to chronic inflammation and the formation of adhesions and scar tissue. Areas commonly affected include the ovaries, fallopian tubes, ligaments that support the uterus, the area between the vagina and rectum, the outer surface of the uterus, and the lining of the pelvic cavity.
Some women with endometriosis experience no symptoms. But for many others, endometriosis can cause severe pain that interferes with activities of daily living. Endometriosis can also lead to other distressing conditions such as infertility, adhesions, and scar tissue that entrap the reproductive organs. Other symptoms include:
- Focal pelvic tenderness
- Premenstrual spotting
- Heavy periods
- Painful urination and bowel movements during periods
In addition to physical symptoms, women with endometriosis also experience emotional problems such as depression and poor self-esteem.
The exact causes of endometriosis are unknown. There are several theories under current consideration including:
- Retrograde Menstruation: Endometrial cells back up from the uterus through the fallopian tubes, implant in the abdomen, and grow. This migration process occurs in all women, though an immune or hormonal problem may allow the tissue to grow in the women who develop endometriosis. This theory does not explain why women who undergo tubal ligation or hysterectomy can still experience symptoms of endometriosis.
- Environmental: There may also be a link between exposure to chemicals or allergens and endometriosis. However, there is no conclusive evidence.
- Immunological: Changes have been observed in women with endometriosis. According to this theory, an abnormality in the immune system allows the endometrial cells that are shed normally to attach elsewhere and grow. It is uncertain whether the immunological changes are responsible for the endometriosis or the result of the inflammation caused by the disease.
- Genetic: Endometriosis tends to run in families, though the mode of inheritance remains unknown. Women with an affected mother or sister are more likely to have severe endometriosis than those without affected relatives.
Endometriosis may be treated with drugs and/or surgery in an effort to reduce or relieve symptoms and eliminate or reduce growths. Some treatment options include:
- Pain medication: Over-the-counter or prescription drugs may be used to treat the pain resulting from endometriosis.
- Hormone Therapy: Birth control pills or another category of drugs which block the production of estrogen, called gonadtropin releasing hormone (GnRH) agonists may be prescribed. GnRH agonists have been used to reduce pain and make surgery easier by reducing the inflammation related to endometriosis.
- Laparoscopic Ablation: This procedure is used to remove the top layer of tissue in an affected area.
- Laparoscopic Excision: Cutting and removal of local areas of endometriosis.
- UPLIFT Procedure: Sometimes the scarring from endometriosis pushes the uterus into a tipped position. Women with a tipped uterus may experience pain during their periods or intercourse, because the penis hits the uterus and/or the endometrial implants. The UPLIFT procedure, which is performed laparoscopically, restores the uterus to its proper anatomical position. Women who have had the procedure have reported a reduction in pain during intercourse and menstruation.
- Uteral Sacral Nerve Ablation: In this procedure the nerves running to the uterus are severed in an attempt to eliminate pain and cramping.
- Presacral Neurectomy: In cases of severe pain, the sensory nerves leading to the pelvis are severed.
- Hysterectomy: In severe cases of endometriosis, hysterectomy including removal of all growths and the ovaries may also be recommended. It should be noted that hysterectomy does not always eliminate endometriosis because the lesions may not be confined to the reproductive organs.