Submitted by Dele Ogunleye, MD, Advanced Women’s Healthcare
Endometriosis is a common health problem for women. It occurs when the kind of tissue that normally lines the inside of the uterus also grows outside it. This can happen without being aware of it, as it may not cause any symptoms. In other cases, endometriosis is a chronic disease associated with severe pain and fertility problems. It often takes years for endometriosis to be diagnosed as the cause of these problems. Until the diagnosis is made, many women try to cope with their pain. Some think that the pain — even very bad pain — is a normal part of their menstrual cycle.
Symptoms
The primary symptom of endometriosis is pain and infertility. Women with endometriosis may have many different kinds of pain, depending on where in the abdomen the endometrial tissue has grown. Types of pain include:
- Painful — even debilitating — menstrual cramps, which may worsen over time.
- Chronic, long-term pain in the lower back and pelvis
- Pain during or after sex. This is usually described as a “deep” pain and is different from pain felt at the entrance to the vagina when penetration begins.
- Intestinal pain
- Painful bowel movements or pain when urinating during menstrual periods.
Other common symptoms of endometriosis include:
- Heavy menstrual periods
- Premenstrual spotting or bleeding between periods
- Digestive problems such as diarrhea, constipation, bloating, or nausea.
- Fatigue or lack of energy
- Infertility
Cause
The exact cause of endometriosis is not known, but it is likely caused by problems with menstrual period flow. Some of the tissue shed during the period flows through the fallopian tubes into other areas of the body, such as the pelvis, instead of leaving the body. Many women do not notice anything because this tissue is broken down by their bodies. In other women, though, the shed tissue sticks together and forms adhesions, becomes inflamed, or develops into cysts. Other possible causes include:
- Genetic factors. Because endometriosis runs in families, it may be inherited in the genes.
- Immune system problems. A faulty immune system may fail to find and destroy endometrial tissue growing outside the uterus.
- Hormones. The hormone estrogen appears to promote endometriosis. Research is looking at whether endometriosis is a problem with the body’s hormone system.
- Surgery. During surgery in the abdominal area, such as a Cesarean (C-section) or hysterectomy, endometrial tissue can be picked up and moved by mistake. For instance, endometrial tissue has been found in abdominal scars.
Diagnosis
In women who do not have any symptoms, endometriosis is often discovered by chance when they see a doctor because they are unable to get pregnant. There are several things doctors can do, including a pelvic exam, imaging tests (ultrasound or MRI), and hormonal medicine, to see if endometriosis or endometriosis-related scar tissue or adhesions might be the cause of infertility and to rule out other causes of abdominal pain. However, surgery is often the only way to be certain that endometriosis is present. A physician will perform Laparoscopic surgery, which looks inside the pelvic area by making a very small incision and using a laparoscope to see endometrial tissue. Sometimes endometriosis can be diagnosed just by seeing the growths. Other times, a small sample of tissue is taken and examined under a microscope to confirm.
There is currently no cure for endometriosis, but once the correct diagnosis is made, there are many treatment options that can reduce or eliminate the pain and help alleviate infertility problems. If treatment is individualized for each woman’s personal circumstances and the severity of their endometriosis, most are able to cope quite well with the disease.
Next month: Treatment for Endometriosis.
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 www.awhcare.com. His office is located at 2111 East Oakland Avenue (Next to the Jewel-Osco Plaza).
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