Enduring Endometriosis

Going through that time of the month is part of being a female. But what if you dread those times because you experience such painful cramps that make you faint? Many women experience this type of debilitating pain and then some that is characteristic of a condition called endometriosis.

Endometriosis is a condition where the endometrial tissue that lines the uterus ends up appearing in places outside the uterus, usually the pelvis, and other places in the body like the abdomen. The misplaced tissue develops into growths or lesions that respond to the menstrual cycle in the same way that the tissue of the uterine lining does (meaning the tissue bleeds just like the endometrium inside the uterus).  

But unlike menstrual blood that flows out of the uterus and eventually leaves the body through the vagina, the blood and tissue from endometrial growths have no way of leaving the body.  This results in internal bleeding, inflammation, and breakdown of the blood and tissue from the lesions.

According to the World Health Organization, endometriosis affects 10 percent of reproductive age women and girls globally or 190 million women. The annual cost of endometriosis can be as much as $22 billion, 5.9 billion of which were indirect costs due to the loss of productivity. 

The cause of endometriosis is unknown. The belief is that pieces of the endometrium travel back through the fallopian tubes and pass into the pelvic cavity. This process is known as retrograde menstruation (some women may have this and not develop endometriosis). Scarring or adhesions from endometriosis cause internal tissue to bind the pelvic organs together.

There may be environmental factors that are associated with endometriosis. Dioxin, an environmental pollutant, may alter the action of estrogen and thereby throw the immune system out of whack. Some scientists theorize this might have something to do with the condition based on animal studies but it is still unclear.

Genetics may play a role in the development of the disease as well. Having one or more relatives with endometriosis may put you at greater risk for this condition. Other risk factors may be medical conditions that may prevent the passage of blood out of the body, never giving birth, starting your period at an earlier age, and low body mass index. But none of these are conclusive.

Common symptoms of endometriosis include pelvic pain, heavy or irregular bleeding, painful intercourse, fatigue, diarrhea or painful bowel movements during menstruation. But every woman’s endometriosis is different. Some women may have very little or no symptoms at all and still have this condition.

What’s more, many women go through years of struggling to find a diagnosis for this painful disease. In fact, endometriosis is often referred to as the “missed disease” with the average time between onset of pain and diagnosis is 12 years in the United States. Often times, a female patient can be misdiagnosed with other conditions such as appendicitis, ovarian cyst, ectopic pregnancy, pelvic inflammatory disease, and ovarian cancer.    

A woman’s chance of developing endometriosis may increase as the number of periods she has increases. Some experts believe that decades ago women had more children and fewer periods. Now, women are postponing childbirth to later ages, with more periods and more chances to develop the condition. But the disease can occur in younger women as well.

In order to be diagnosed with endometriosis, you will have to undergo a surgical procedure called a laparoscopy, where a thin tube is passed through an incision in your abdomen. During the procedure, endometrial implants will be biopsied and eventually removed.

Left untreated, endometriosis can cause pain, infertility, adhesions, and bowel problems. The condition is very difficult to treat because symptoms can return after a laparoscopy. But the earlier it is diagnosed, the better the outcome.

Treatment for the disease includes hormone therapy such as progestin, a synthetic form of progesterone, which prevents ovulation and halts growth of the endometrium and the implants. The drug Danazol stalls the stimulation of pituitary hormones and stops the menstrual cycle. Hormones called gonadotropin-releasing hormone (GnRH) agonists bring on a temporary state of menopause by affecting hormone production in the pituitary gland and stopping hormone production in the ovaries. Other treatment options are non-steroidal anti-inflammatory drugs (NSAID) and the Mirena IUD. Please note that even with these precautions, the condition can return.       

Because endometriosis is a chronic condition, self-care methods may be vital to effectively manage the disease. Such nonconventional treatments are deep muscle relaxation, biofeedback, and imagery to help women manage the pain and interact socially.

Know your body and if you experience any of these symptoms, please consult your physician. You shouldn’t have to live in fear of your menstruation cycle and you shouldn’t have to limit your life because of it either.