Endometriosis

The name endometriosis comes from the word “endometrium,” which is the tissue that lines the inside of the uterus. Endometriosis occurs when tissue that looks and acts like endometrial tissue is found outside the uterus, usually inside the pelvic cavity.

Endometrial tissue that is found outside the uterus responds to the menstrual cycle in much the same way as the endometrium in the uterus responds. At the end of every cycle, when hormones cause the uterus to shed its endometrial lining, endometrial tissue growing outside the uterus will break apart and bleed. However, unlike menstrual fluid from the uterus, which is discharged from the body during menstruation, blood from the misplaced tissue has no place to go. Tissues surrounding the area of endometriosis may become inflamed or swollen. The inflammation may produce scar tissue around the area of endometriosis. These endometrial tissue sites may develop into what are called “lesions,” “implants,” “nodules,” or “growths,” The most common site for these growths is on a woman’s ovaries.

Mild forms of endometriosis are common, can be asymptomatic, and may not require treatment. But, endometriosis can also cause moderate to severe pain with your cydes (dysmenorrhea) as well as painful intercourse (dyspareunia) and also make it difficult for a woman to become pregnant.

What Causes Endometriosis?

The cause of endometriosis is unknown. Some experts believe that pieces of endometrium travel back through the fallopian tubes and pass out into the pelvic cavity the space inside the pelvis that holds their productive organs. Tiny pieces of tissue may lodge on surfaces of the reproductive organs. During menstruation, the tissue bleeds, just like the endometrium inside the uterus. Blood from these areas can cause irritation of the surrounding tissue which may become swollen and inflamed. Over time, scar tissue and blood filled cysts (endometriomas) can form.

What Are the Symptoms of Endometriosis?

Many times, endometriosis has no symptoms. When symptoms are present, they may include:

• Abdominal cramps or back pain during menstruation
• Very painful menstrual cramps
• Painful bowel movements
• Painful urination, especially during menstruation
• Abnormal or heavy bleeding during periods
• Painful sex
• Difficulty becoming pregnant

Medications for Endometriosis

For mild cases of endometriosis, your doctor may order a pill form of hormones that must be taken each day. Hormone treatment can reduce the size of tissue growths. Once hormone treatment stops, growths usually return to their original size. Hormones also reduce the amount of blood produced during menstruation, which gives tissues time to heal and reduces potential scarring of the inside tissues. Commonly prescribed hormones include:

• Birth control pills
• Progesterone (progestins)
• Gonadotropin-releasing hormone (GnRH) agonists -hormones which mimic menopause and can both treat and diagnose endometriosis.

Medications to reduce painful cramps include:

• Motrin
• Anaprox

Surgery for Endometriosis

For more severe cases of endometriosis, scar tissue may be removed during laparoscopy. This appears to improve pain symptoms and may increase the chances of pregnancy. Alternatively, a hysterectomy to remove the ovaries and uterus can be performed. Less-commonly performed procedures which may help with the pain from endometriosis include LUNA (Laparoscopic Uterosacral Nerve Ablation) and Presacral.