You may have endometriosis if you experience one or more of these problems:
- Infertility
- Pain during sex
- Pain before and during periods
- Extreme fatigue
- Painful urination during your period
- Diarrhea or constipation
- Nausea
- Painful bowel movements
Some women with endometriosis develop allergies, frequent yeast infections and chemical sensitivities.
Patients are clinically diagnosed with endometriosis with a laparoscopy, a surgical procedure in which a camera notes the size, location and extent of the internal growths.
Doctors also can identify it with an external pelvic exam, wherein the doctor rubs areas in the abdomen and looks for abnormalities. This method is inexact because it is often impossible to find small areas of endometriosis unless cysts have already formed. Ultrasound, which uses high-frequency sound waves to create images, can be used to view reproductive organs and look for lesions and cysts.
Endometriosis Causes
Endometriosis occurs when a special tissue starts growing outside the uterus on the ovaries, fallopian tubes, ligaments that support the uterus and in other areas. It reacts to the menstrual cycle in the same manner as the uterine lining -- building up, breaking down and shedding.
This process causes internal bleeding, a breakdown of blood and tissue from the lesions, and painful inflammation because the tissue from the condition has no way to exit the body.
More than 6 million girls and women in the United States suffer from the disease. The cause is not known and there currently is no cure. Girls and women are equally affected, and the pain and complications can have a major impact on school, finances, careers, relationships, and general health and well-being.
Those likely to develop endometriosis include people who have never given birth, have close female relatives with the condition, have a past history of pelvic inflammation or uterine abnormalities, or have a condition that restricts the normal flow of menstruation.
Endometriosis usually develops a few years after the first period and can end temporarily with pregnancy. The chances of developing endometriosis usually end with menopause but can be extended with estrogen use.
Endometrium tissue can develop in several areas -- as lesions or growths on the abdomen near or on the ovaries; in the area between the vagina and rectum; in the lining of the pelvic cavity; and on the outer surface of the uterus itself.
It can also be found in the bowel, bladder, vagina, vulva and cervix, in any previous surgical scars, the arm, thigh, lung and other locations.
While the exact cause of endometriosis remains a mystery, there are several theories on how and why the disease develops.
1) Retrograde menstruation – During menstruation, tissue reverses through the fallopian tubes and implants in the abdomen. Because all women experience some form of tissue backup, researchers believe that an immune system disorder or hormonal issue promotes the tissue growth that results in endometriosis. This is sometimes referred to as the trans-tubal migration theory.
2) Lymph/blood system distribution – Endometrial tissue is distributed by the uterus through the blood or lymph system to other parts of the body. This cause is believed to be genetic, which would explain why this disease runs in families.
3) Surgical transplantation – Accidental transmission of endometrial tissue during surgery to correct other issues may be one means of transmission, according to this theory. It would explain why the endometrial tissue is found in abdominal scars, although how it develops in scars without surgery has not yet been explained.
4) Embryonic tissue – This theory believes that tissue developed when the woman was in utero later develops into endometriosis. One variation holds that adult tissues may retain a genetic ability from the embryonic stage to transform reproductive tissue.
5) Dioxin exposure – The Endometriosis Association has research that links endometriosis to exposure to dioxin (TCCD), the chemical byproduct of pesticide manufacturing, bleached paper and pulp, and medical and municipal waste incineration. In its research, the Endometriosis Association notes that rhesus monkeys developed endometriosis after dioxin exposure in 79 percent of the cases, with the more severely exposed monkeys getting more severe cases of endometriosis.
6) Immune system issues – This theory posits that the immune system somehow is unable to recognize endometrial tissue, allowing it to thrive outside of the uterus instead of being destroyed as an invader.
Endometriosis Treatments
Medication to relieve pain is usually the first order of business after an endometriosis diagnosis. These are usually over-the-counter medications like ibuprofen or naproxen.
Doctors may consider supplemental hormones as a means of pain reduction but only if the over-the-counter medications are ineffective. One of the side effects of hormone treatment is that endometrial lesions may thicken, bleed and break down, causing more problems. Hormone treatment also isn’t permanent, and endometriosis recurrence is possible after discontinuation.
Surgery is considered when medications don’t provide relief, or the patient has fertility problems and wishes to become pregnant. The surgery to remove endometriosis tissue growths can be done laparoscopically or with traditional surgery. However, there are no guarantees that the growths and subsequent pain won’t return.
Some women opt for in-vitro fertilization as a way to overcome the obstacles posed by endometriosis. This is typically done if surgery does not cure fertility issues.
If pain is severe from endometriosis, doctors may recommend removing the uterus, cervix and both ovaries. A total hysterectomy is considered a last resort and is only done when there are no alternatives for relieving severe pain.
Many women find relief in a combination of over-the-counter pain medications, warm baths and heating pads, and additional exercise, which seems to help manage pain. In some cases, acupuncture treatments, biofeedback and meditation have eased pain.