Submitted by Dele Ogunleye, MD
Endometriosis occurs when tissue that is normally on the inside of the uterus grows outside of the uterus where it doesn’t belong. It is a common condition, especially among women in their 30s and 40s. The primary symptom is pain – sometimes severe pain — that happens most often during a woman’s period. Endometriosis may also make it harder to get pregnant.
There is currently no “cure” for endometriosis — in other words, there are no treatments that can fight what is causing it. But there are several different treatment options that can help manage the symptoms and improve the chances of getting pregnant.
Treatments fall into three general categories: pain medicine, hormone based treatments, and surgery. Pain medication may work well for mild symptoms. These range from over-the-counter pain medicine such as ibuprofen (Advil and Motrin) or naproxen (Aleve) to stronger prescription pain relievers. Any sort of pain medicine only relieves the symptoms and doesn’t affect the endometrial tissue that is causing the pain.
Hormone based treatments may reduce the pain and also slow down the growth of endometrial tissue. If you are not trying to get pregnant, there are many different types of hormone treatments, including oral contraceptives and hormonal IUD. Some hormone treatments help make your period lighter, shorter, and more regular, and help with pain relief. Other hormone treatments stop the ovaries from producing estrogen, and usually prevent ovulation. This may help slow the growth and local activity of both the endometrium and the endometrial lesions. Treatment may also prevent the growth of new areas and adhesions, but it will not make existing adhesions go away. Hormonal treatment works only as long as it is taken and is best for women who do not have severe pain or symptoms.
Surgery is usually recommended for severe symptoms, when hormones are not providing relief or if there are fertility problems. Laparoscopy is the most common surgical procedure. This involves making a very small incision and then inserting a small viewing instrument with a light, called a laparoscope, into the abdomen to see the growths. To remove the endometriosis, the surgeon makes at least two more small cuts in the abdomen and inserts lasers or other surgical instruments to either remove the lesions, or destroy the lesions by cauterizing or vaporizing. Scar tissue might also be removed at this time because it may be contributing to pain. The goal is to treat the endometriosis without harming the healthy tissue around it.
A hysterectomy to remove the uterus and, possibly, the ovaries and fallopian tubes may be considered as a last resort. Advancements in medical technology have made hysterectomies much less invasive with a much shorter recovery time.
A diagnosis of endometriosis doesn’t necessarily mean that you can’t get pregnant, but it is often harder. No one knows exactly how endometriosis might cause infertility. Some possible reasons include:
- Patches of endometriosis block off or change the shape of the pelvis and reproductive organs. This can make it harder for the sperm to find the egg.
- The immune system, which normally helps defend the body against disease, attacks the embryo.
- The endometrium (the layer of the uterine lining where implantation happens) does not develop as it should.
If you are having trouble getting pregnant or having unusual pain, talk to your doctor. Endometriosis can affect many key areas of a woman’s life – ranging from her self-esteem as a woman to her relationships, as well as her family planning and general plans in life. Chronic pain may lead to tiredness, irritability, depression, and inability to carry out everyday activities. Several different factors — including your age, how severe the symptoms are, how severe the disease is and whether you want children — must be considered before determining the best treatment for endometriosis symptoms. The most important thing is to be informed, know your options, and determine the best way to manage your individual symptoms.
If you missed last month’s article on the diagnosis and causes of endometriosis, you may read it online at HealthyCellsBN.com or call Cheryl at 309-664-2524 to request a copy.
Dele Ogunleye, MD, provides a full range of obstetric and gynecologic services. He is subspecialized in urogynecology so he has particular expertise in treating pelvic floor disorders. You may contact Dr. Ogunleye at Advanced Women’s Healthcare at 309-808-3068 or awhcare.com. His office is located at 2111 East Oakland Avenue (Next to the Jewel-Osco Plaza).