Endometriosis

A quick look at endometriosis

Endometriosis may cause pelvic pain in some women. Those with the condition may experience no symptoms or symptoms that include pelvic pain at specific times, such as around menstruation.

Endometriosis is caused when tissue from the lining of the uterus, or the endometrium, spreads outside of the uterus and either grows there or on other organs and tissue.

Endometriosis affects 1 in 10 women of reproductive age and can contribute to difficulty in becoming pregnant, for some women.

There is no test for endometriosis. Diagnosis is typically made from patient history, physical exam and, occasionally, surgical diagnosis.

While there is no cure for endometriosis, we can successfully treat the symptoms with medication, hormonal birth control or surgery. Treatment options are individualized based on the level of symptoms and the patient’s desire to become pregnant.

CU Medicine OB-GYN East Denver (Rocky Mountain) regularly works with the CU Pelvic Pain Clinic to help patients with endometriosis.

What is endometriosis?

Endometriosis is a condition that causes the tissue lining a woman’s womb, known as the endometrium, to spread outside of the uterus, attaching on pelvic organs. The endometrial tissue continues to behave as if it were in the womb, meaning the tissue thickens, breaks down and bleeds, as it would during the menstrual cycle. This can cause swelling, inflammation and irritation in the affected areas.

Because of this continual breaking down of endometrial tissue, scar tissue can form on the affected areas over time. Endometrial tissue growth typically occurs in the ovaries and fallopian tubes. The condition can also affect the bowels, bladder and other tissue in the abdomen and pelvis. This process can cause pain or fertility complications for some women, while others may experience no symptoms at all.

According to The American College of Obstetricians and Gynecologists, this disorder affects approximately 1 in 10 women of reproductive age and is most often diagnosed in women in their 30s and 40s. While it is a fairly common condition in that respect, many women we see have misunderstandings about endometriosis causing symptoms that could be caused by other issues. We seek to educate our patients about the condition so they have a better understanding as to whether their symptoms are truly due to endometriosis and, if so, how it may be affecting their health.

What are the causes of this disorder?

Currently, the cause of endometriosis is not known. What we do know is that the condition is stimulated by the hormone estrogen. There is ongoing research into the cause, but the most common thinking is called the retrograde menstruation theory. According to this theory, some of a woman’s menstrual blood and endometrial tissue flows backward from the uterus during menstruation landing in the fallopian tubes and pelvis, where it then grows.

The Endometriosis Foundation of America says there may be a genetic component to the condition. Women with a close female relative who has the disorder are 5 to 7 more times as likely to have it themselves than women without a family connection.

What are endometriosis symptoms?

Endometriosis affects each woman differently. Some women may experience severe symptoms while others may have no symptoms at all.

Symptoms may include:

• • Chronic pelvic pain.
  • Pelvic pain before or during a woman’s period.
  • Pain during or after intercourse.
  • Pain with bowel movements and sometimes with urination.
  • Bleeding or spotting between periods.
  • Digestive or gastrointestinal issues.
  • Fatigue or lack of energy.
  • Lower back pain.
  • Ovarian cysts, called endometriomas, which contain endometrial tissue (in some cases).
  • Infertility.

Endometriosis and infertility

Infertility is one of the main complications of the disorder. Of the women who have been diagnosed with it, half of them struggle with infertility.

For a successful pregnancy, a woman’s egg must be released and travel through the fallopian tube to become fertilized by a man’s sperm. Then the resulting embryo travels through the fallopian tube and attaches to the uterine wall.

Endometriosis can cause scarring of the fallopian tubes, which can then block and stop this process from occurring correctly. Despite these issues, women with endometriosis who do conceive CAN carry a pregnancy to full term, and the condition does not affect the baby.

How is endometriosis diagnosed?

A woman experiencing symptoms of endometriosis should be evaluated for all conditions related to pelvic pain. A detailed discussion with a physician regarding the patient’s pain is often the most important step in diagnosing endometriosis.

A pelvic exam and, possibly, imaging testing can help the physician determine the cause of some symptoms, but, unfortunately, endometriosis cannot typically be seen with imaging testing techniques. However, a transvaginal ultrasound can help determine some other causes of pelvic pain.

The only definitive way to diagnose endometriosis is by surgical means, typically a laparoscopy with a tissue biopsy. Through this minimally invasive surgery, a physician will be able to see the endometrial tissue outside of the uterus and biopsy that tissue.

In most cases, a physician may recommend medication before a laparoscopy. This often includes a hormonal birth control or pain medicine, such as ibuprofen (more details below).

How is endometriosis treated?

While there is no cure for endometriosis, there are many options to treat or manage the symptoms and problems the condition can cause. Treating endometriosis depends upon the extent of the condition, severity of symptoms and if the woman wants to have children in the future. The condition may be treated with medication, surgery or sometimes both.

Pain medication

Over-the-counter pain medication is often the first step to manage pain associated with endometriosis. These medicines include nonsteroidal anti-inflammatory medication such as Advil, Aleve, Motrin or ibuprofen. These pain relievers can help women ease painful menstrual cramps.

Hormonal birth control

Birth control can be very beneficial in treating the pain of endometriosis. These medications can reduce heavy bleeding and minimize pelvic cramping associated with the condition. Birth control is often the first approach to treating endometriosis. Hormonal birth control can also minimize retrograde menstruation.

Many types of birth control can help lessen the symptoms of endometriosis, including:

• Oral combination birth control pills.
• Progesterone-containing intrauterine devices (IUDs).
• Long-acting progestin implants.
• Progesterone pills.
• Progesterone shots.
• Vaginal rings.

Surgery

If medication and hormonal birth control do not address the symptoms, surgery may be recommended. The goal of surgery is to remove the endometrial tissue that has moved outside of the womb. Removing this tissue does not cure endometriosis but can help some women have less pain and can sometimes improve fertility.

However, unless the woman continues treatment in some form, such as taking birth control, the pain will likely come back. Currently, the only form of permanent treatment available is a hysterectomy, which is removing the uterus.

Infertility treatments

Addressing the symptom of infertility caused by endometriosis depends on the woman’s age and severity of the condition. Laparoscopy with the removal of tissue can improve fertility outcomes for women with endometriosis. More advanced options for treating infertility caused by fallopian tube scarring include in vitro fertilization (IVF).

Causes of menstrual pain & bleeding problems other than endometriosis

Pain and heavy or unusual bleeding during a woman’s period are due to factors other than endometriosis in more than half of such cases. To determine the exact cause of a woman’s menstrual issues, our OB-GYNs will discuss symptoms with the patient and possibly perform a physical examination, an ultrasound to check for uterine and ovarian abnormalities and/or blood tests. We have several means of treating these conditions.

• Dysmenorrhea. This is the medical term for painful periods, which is one of the most common issues women have. Usually beginning within five years of a woman’s first period, dysmenorrhea is due to the chemical prostaglandin that forms at menstruation and can cause uterine muscles to contract.
• Abnormal uterine bleeding. This is bleeding that is not normal for a particular woman’s period. Bleeding that is prolonged and heavy is a common form of abnormal uterine bleeding.
• Uterine fibroids, ovarian cysts & endometrial polyps. These different structural abnormalities can contribute to chronic pelvic pain and abnormal uterine bleeding.
• Pelvic inflammatory disease. An intense infection involving the uterus, fallopian tubes and/or ovaries. It is usually acquired through sexual contact.
• Pelvic floor dysfunction. This is when the muscles of the pelvic floor are no longer providing proper support, which can result in pelvic pain.
• Adenomyosis. This is when endometrial tissue grows inside the wall of the uterus enlarging it. This can cause heavy bleeding and painful periods.
• Bladder pain syndrome and interstitial cystitis. This is a cause of bladder and pelvic pain due to inflammation of the bladder.
• Irritable bowel syndrome. A gastrointestinal condition causing pelvic pain and altered bowel function.