Everything You Need to Know About Endometriosis

Exploring Symptoms, Treatment and Links to Infertility

Oct 2, 2009

Endometriosis causes severe pelvic pain during menstruation. Pregnancy, hormonal medications and surgery can counteract the growth of the endometrial cells.

Do you suffer from very long or heavy menstrual periods or nausea and/or vomiting right around menstruation? Is there extreme pain in your back, thighs or legs? Have you noticed that having intercourse hurts? If so, you may be suffering from a condition known as endometriosis. According to the American Academy of Family Physicians, about 1 in every 10 women during their reproductive years discover that they have endometriosis. For some women, endometriosis is a life-long struggle that may influence their ability to get pregnant.

One of the most important keys to treatment and management of endometriosis is early diagnosis. What can you do if you suspect you might have endometriosis?

What is Endometriosis?

Endometriosis is a health condition whereby the cells that line the uterine wall (endometrial cells) begin to grow in other parts of the woman's abdomen. Since these cells respond to female hormones such as estrogen, symptoms can worsen right around the time of menstruation.

The most likely places where endometrial cells grow outside the uterus include the ovaries, the front and back of the uterus, fallopian tubes, intestines and bladder.

Symptoms of Endometrosis

Diagnosing Endometriosis

If your care provider does a complete health history and suspects endometriosis, the only way to accurately diagnose it is to perform a laparoscopic biopsy. Ultrasounds and MRIs are sometimes used to identify larger areas of endometriosis such as cysts; however, they are not useful in diagnosing endometriosis in smaller areas.

Causes of Endometriosis

While many theories exist about where endometriosis might come from, the exact cause is not known. What is known about endometriosis is that there seems to be a genetic or inherited component. If any of your close female relatives have endometriosis, your chances of getting it are about 10 times greater.

Gynecologist John Sampson (who also coined the term endometriosis) theorized in 1921that endometriosis occurs as a result of what is called retrograde menstruation. Each month, when the woman menstruates, some of the endometrial tissue exits through her fallopian tubes. In most cases, a woman's immune system will fight off these cells to prevent them from implanting and growing as endometrial tissue. Sampson proposed that a woman with endometriosis cannot fight off these foreign invaders and that may be why the endometrial cells are able to grow in other places outside the uterus.

Perhaps this theory can lead researchers into taking a closer look at the immune system as being a large contributor of causing endometriosis. A 1988 survey published in Human Reproduction found that women who have endometriosis are much more likely to also suffer from allergies and autoimmune disorders such as fibromyalgia and hypothyroid disease.

Endometriosis and Links to Infertility

Approximately 20-50% of women with infertility issues also have endometriosis. Adhesions or chemicals caused by endometrial tissue may prevent the movement of the egg through the fallopian tubes. Women who have endometriosis also may not ovulate every month, making it harder to conceive.

Researchers from Stanford University have also discovered that women with endometriosis lack molecules that are needed in order for the embryo to attach to the uterine wall. This new research may identify another factor that makes it more difficult for women with endometrisis to become pregnant.

Treatment for Endometriosis

If you have endometriosis and are considering becoming pregnant, your care provider may recommend trying to conceive sooner rather than later since slowing the production of female hormones can slow the growth of endometriosis. Infertility treatment and birth control pills can also reduce pain and help to shrink the endometrial implants.

If you have no plans for pregnancy, stronger hormonal treatments can be a help. Progestin can be taken orally, injected or available as an IUD. Taking progestin creates a hormonal balance similar to pregnancy in that it suppresses estrogen production, which stops ovulation and menstruation in most women. Gonadotropin-releasing hormone agonist (GnRH-a) is available as injections or as a nasal spray and can help to stop menstruation and shrink sites of endometriosis.

Another treatment that is considered to be "off label" for use with endometriosis is aromatase inhibitors. Aromatase inhibitors are FDA approved as a treatment for breast cancer; however, they are not FDA approved to be used for endometriosis. Aromatase inhibitors are sometimes used when other hormonal suppressants do not work effectively.

Laparoscopic surgery to remove endometrial implants and scar tissue is the last step when hormonal treatments do not work. Unfortunately, the relief from pain after surgery may be temporary since most women are pain-free for only a year or two. About 15% of women continue to have pain even following laparoscopic surgery. Following surgery with various hormonal medications may increase the length of time a woman is pain-free.

Remember that, while there is no cure, treatments are available and there is no need to be in continuous pain from endometriosis. Be sure to consult with your primary care provider or gynecologist to determine which treatment for endometriosis is right for you.

References:

Wellberry C, (October 15, 1999)."Diagnosis and Treatment of Endometriosis". American Family Physician.

Kao LC et al (July 2003). "Expression Profiling of Endometrium from Women with Endometriosis Reveals Candidate Genes for Disease-Based Implantation Failure and Infertility". Endocrinology 144.

Attar E, Bulun SE (May 2006). "Aromatase inhibitors: the next generation of therapeutics for endometriosis?". Fertility and Sterility 85 (5)

Sinaii N, Cleary SD, Ballweg ML, Nieman LK, Stratton P (October 2002). "High rates of autoimmune and endocrine disorders, fibromyalgia, chronis fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis". Human Reproduction 17 (10): 2715–24

The copyright of the article Everything You Need to Know About Endometriosis in Gynecological Health is owned by Brenda Lane. Permission to republish Everything You Need to Know About Endometriosis in print or online must be granted by the author in writing.