It is one of the most common gynecological diseases out there, affecting more than five million American women each year. Endometriosis, a condition where the lining of the uterus grows elsewhere in the body, affects the most intimate aspects of a women’s health. It can lead to chronic pelvic pain, spotting between periods, severe menstrual cramps, painful intercourse, heavy menstrual periods, and, for some, infertility. In fact, it’s one of the top three causes of infertility. We caught up with Dr. Sarah Whitehead, an OBGYN at Brookwood Baptist Medical Center, to answer the most frequently asked questions about this heart-breaking disease.
Q: What is endometriosis?
Endometriosis is a condition where tissue normally found in the lining of the uterus begins to grow in other areas of a woman’s abdomen. It is normal tissue, not a cancer, but it can still cause great discomfort and other medical problems. Endometriosis is very common, affecting about one in ten women.
The misplaced endometrial tissue can become attached to the ovaries, fallopian tubes, the outside surface of the uterus, the bladder, bowel or other places in the pelvis.
Q: What problems does endometriosis cause?
Endometriosis causes pain. When a woman tells me her periods cause significant pain that interferes with her daily activities, I consider the possibility of endometriosis. Commonly, women describe very painful menstrual cramps, but symptoms can also include pain during intercourse, pain associated with bowel movements or urination, and very heavy periods.
Just like the lining of the uterus, endometrial tissue outside the uterus responds to a woman’s hormones by growing thicker and then bleeding each month. This irritates the surrounding tissues in the pelvis. Scar tissue can develop, causing organs in the pelvis to become stuck together. The inflammation and scarring causes pain especially before and during the period.
Various studies estimate that 30 to 50% of women with endometriosis have difficulty getting pregnant. The causes of infertility are complex, so an accurate estimate is difficult. Endometrial tissue and the adhesions it produces can interfere with the path of an egg from the ovary to the fallopian tube and onward to fertilization. Inflammation in the pelvis causes other changes that may also reduce fertility.
Q: What are the risk factors for endometriosis?
Endometriosis can affect any woman who has periods, but it is most often diagnosed the in women in their 30’s or 40’s. It is more likely to develop in women who:
- have not had a child
- have very heavy periods
- have periods lasting longer than 7 days
- have short menstrual cycles (less than 27 days)
- have a mother, sister, daughter, with endometriosis
- began their periods early (before age 11)
Q: How can my OBGYN determine if I have endometriosis?
We will discuss your symptoms and do a pelvic exam. A surgical procedure called laparoscopy is the only sure way to diagnose endometriosis. This minimally-invasive procedure allows us to look for misplaced uterine tissue inside the pelvis. We generally recommend a laparoscopy only if conservative treatment like medication does not manage your menstrual pain.
Q: What treatments are available?
Our recommendations will depend on how severe your symptoms are and whether you want a future pregnancy. Medications like ibuprofen can relieve mild to moderate pain. We also use hormonal medications, primarily birth control pills, to treat endometriosis. These medications suppress the growth of endometrial tissue and may therefore ease symptoms.
We consider surgery when these more conservative treatments are not sufficient or when a woman with more severe endometriosis is experiencing infertility. We are able to remove areas of misplaced endometrial tissue using laparoscopy or robotic surgery. Endometriosis often returns after a time, although the period of improvement may be longer if hormone therapy follows surgery. For this reason, we consider a medication to suppress the function of the ovaries for six months.
For severe endometriosis, your doctor may recommend a hysterectomy (surgery to remove the uterus). Your doctor will also remove as much endometrial tissue as possible. Whether we recommend removing or leaving the ovaries depends on a woman’s age and the severity of her endometriosis. Removing the ovaries does reduce the chance that endometriosis will return.
Many options are available to help women with endometriosis achieve a successful pregnancy. Your doctor, along with an infertility specialist, will help you to choose a treatment plan considering your individual situation, age, and the severity of your endometriosis.
I encourage you to talk with your gynecologist if your periods are painful. More study is needed to know for sure whether early treatment improves the future course of the disease, but early treatment can very much improve your quality of life.
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