Have you ever heard of the medical term Endometriosis? It is a perplexing and complicated medical problem that affects nearly 2-10% of American women of childbearing age (www.hopkinsmedicine.org). It is also a known cause of infertility affecting 24-50% of infertile women (hopkinsmedicine.org). Endometriosis is a medical problem where tiny pieces of tissue similar to the tissue we find within the uterine lining begin to implant over the pelvic and abdominal organs. The implants then become stimulated by a woman’s menstrual cycle which on a cellular level leads to inflammation, adhesions, and creation of further implants (Dechernet et al, 2007). This cascade of events then produces variations 0f pelvic pain.
What causes Endometriosis? Although an excellent question, the cause still remains unknown (Dechernet et al, 2007). One prominent theory is that during a woman’s menses small pieces of tissue travel backwards through the fallopian tubes and out into the pelvic cavity instead of, or in conjunction with, a regular period.
Symptoms of Endometriosis: The main symptom is pelvic pain. Interestingly enough, every woman’s degree of pain is different and it doesn’t necessarily correlate with how many endometrial implants someone has. A woman may have only a few implants and have horrific pain and someone else may have a large number of implants and be pain free. Therein part of the mystery of the disorder. Pain can be diffuse over the whole pelvis, only the week prior to menses, and with deep penetration during intercourse. It may also manifest with symptoms that correlate with where the implants are attached i.e. the bowel (pain with defecation) or bladder (pain with urination, urgency, incontinence). Pain can also be experienced by issues endometriosis creates like adhesions. Adhesions are scar tissue or areas that have stuck together like an adhesive. The pulling at this tissue creates pain.
Diagnosing Endometriosis? Diagnosing endometriosis can be a bit frustrating, as the only way to diagnosis it is to see it during a laparoscopy or open surgical abdominal procedure. Often in a clinical setting, endometriosis is presumed and treated as such until it is confirmed surgically or symptoms are managed with medications.
Treatment of Endometriosis: There are many treatments for endometriosis. The main goal of treatment is alleviation of pain and suppression of new endometrial growth. Contraception is often used as it thins the endometrial lining and suppresses surges in our hormonal cycle. Pain medications are also utilized to treat the intense pelvic pain that accompanies the disorder. Ideally, if a laparoscopy is performed, endometriosis can be destroyed with a laser minimizing ongoing pain. Once the scope is completed, a medication called Depo-Lupron is an excellent medication that suppresses new growth and is typically used for about a year. Unfortunately, it can produce menopausal symptoms which can be stressful to patients. However, add-back therapy can be used to assist with symptoms.
I bring this topic up because I want you to know that pelvic pain is not normal and deserves your attention. If it is something you’re struggling with, it is important to have it evaluated. Although it may not be endometriosis, treatment is available which will help increase you quality of life.
Until next time,
Elizabeth Schalliol RNC WHNP