The month of March is dedicated to building awareness for Endometriosis. So what is endometriosis and how can we manage this diseases?
What is Endometriosis?
Endometriosis, also referred to as “Endo”, is an inflammatory condition that happens when endometrial tissue (tissue similar to the lining of the uterus) grows outside the uterus.
Image: The difference between a healthy uterus and an endometriosis uterus
Endometriosis is more than just a gynecological problem
Endometriosis affects about 200 million women worldwide; about 1 in 10 women suffer from this condition. Yet this disease is often misdiagnosed, or even missed altogether. Lack of education and public awareness is part of the reason that endometriosis goes undetected.
It is interesting to see how traditional methods and techniques are still lacking in today's healthcare system or a need for innovation. Many patients suffer from endometriosis, and some have been suffering for years. Sometimes the disease is so advanced that even the bladder or intestines are affected. Many couples cannot fulfill their dream to have children, to create a family as Endometriosis can cause infertility, with a rate ranging from 25% to 40%. Therefore, Endometriosis is more than just a gynecological problem.
Symptoms and signs
According to the Mayo Clinic, Endometriosis usually presents with the following symptoms:
- Extremely painful periods (Dysmenorrhea)
- Pain during sexual intercourse (dyspareunia)
- Chronic pelvic or abdominal pain
- Irregular bleeding
- Digestive problems
Causes of Endometriosis
The exact cause of endometriosis is not yet known; however, possible causes include:
- Retrograde menstruation – This occurs when menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where with time, they grow and continue to thicken and bleed over the course of each menstrual cycle.
- Transformation of peritoneal cells – Experts propose that hormones or immune factors promote the transformation of peritoneal cells (cells that line the inner side of your abdomen) into endometrial-like cells.
- Embryonic cell transformation – Hormones such as estrogen may transform embryonic cells (cells in the earliest stages of development) into endometrial-like cell implants during puberty.
- Surgical scar implantation – After a surgery, such as a hysterectomy or a C-section, endometrial cells may attach to the surgical incision.
- Endometrial cell transport – The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
- Immune system disorder – A problem with the immune system may make the body unable to recognize and destroy endometrial-like tissue that's growing outside the uterus.
The awareness and research of Endometriosis has improved in recent years
Tamer Seckin, MD, an endometriosis excision specialist, co-founder of EndoFound with Padma Lakshmi, and member of Everyday Health's Wellness Advisory Board, says: “Awareness is everything. In the '90s, when I first began seeing patients, I realized that the pain that women experience during their periods was not believed in by doctors or loved ones. When I realized that the disease, Endometriosis, was the reason behind these symptoms, I found a complete lack of information about it.”
He also added, “With timely intervention and early detection, patients can have a chance at attempting to manage their symptoms before turning to surgery. Timely intervention means a patient has enough time to try to manage their symptoms and know what's going on in their body, as opposed to the all-too-common horror stories of a patient being diagnosed with endo, or not diagnosed at all, and their doctor right away telling them that a hysterectomy is the only course of treatment.”
While more people are aware of the condition today, there is still a significant demand for better understanding, especially when it comes to diagnosis and treatment options.
Treatment plans for endometriosis differ from one patient to another. The approach you and your doctor choose will depend on how severe your signs and symptoms are, and whether you hope to get pregnant or not. Some patients require medication only, and in severe cases, or if medication fails, then surgery is their next step.
The following are some of the treatment plans that doctors tend to follow:
- Pain medication
Taking an over-the-counter pain medication, such as the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) to help ease painful menstrual cramps.
If you are not trying to get pregnant, then your doctor may recommend a combination of hormone therapy and pain medication.
- Hormone therapy
Supplemental hormones are sometimes effective in reducing, or even eliminating the pain produced by endometriosis. The rise and fall of hormones during the menstrual cycle causes endometrial implants to thicken, break down and bleed. Supplemental hormones aids in slowing down the growth of endometrial tissue and preventing new implants of endometrial tissue.
However, hormone therapy is not a permanent solution for endometriosis. Patients may experience a return of symptoms after stopping the treatment.
There are different types of hormone therapies that are used to treat endometriosis, these include:
- Hormonal contraceptives – Birth control pills, patches and vaginal rings help control the hormones that are responsible for the buildup of endometrial tissue during menstrual cycles. Many experience a lighter and shorter menstrual flow when using a hormonal contraceptive. Using hormonal contraceptives, especially continuous-cycle regimens, may reduce or eliminate pain in some cases.
- Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists – These drugs block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation, causing endometrial tissue to shrink. Because these drugs create an artificial menopause, taking a low dose of estrogen or progestin along with Gn-RH agonists and antagonists may decrease menopausal side effects, such as hot flashes, vaginal dryness and bone loss. Menstrual periods and the ability to get pregnant return when you stop taking the medication.
- Progestin therapy – A variety of progestin therapies, including an intrauterine device with levonorgestrel (Mirena, Skyla), contraceptive implant (Nexplanon), contraceptive injection (Depo-Provera) or progestin pill (Camila), can halt menstrual periods and the growth of endometrial implants, which may relieve endometriosis signs and symptoms.
- Aromatase inhibitors – Aromatase inhibitors are a class of medicines that reduce the amount of estrogen in your body. Your doctor may recommend an aromatase inhibitor along with a progestin or combination hormonal contraceptive to treat endometriosis.
- Conservative surgery
This type of surgery is considered when the patient wishes to get pregnant but suffers from endometriosis, where the surgery will remove the endometriosis implants while preserving the uterus and ovaries. Thus, a conservative surgery is usually the doctor’s go-to plan, as it may increase the chances of a successful pregnancy.
This surgery is also considered when patients suffer from severe pain from endometriosis. However, it is not a permanent solution as endometriosis and pain may return.
The surgery may be done laparoscopically, or less commonly, through traditional abdominal surgery in more-extensive cases. Even in severe cases of endometriosis, most can be treated with laparoscopic surgery. After surgery, your doctor may recommend taking hormone medication to help with relieving the pain.
- Fertility treatment
Endometriosis can make it really hard for a couple to conceive a baby and get pregnant. Depending on how severe a patient’s endometriosis is, a doctor may recommend fertility treatment supervised by a fertility specialist. Fertility treatment ranges from stimulating the ovaries to make more eggs to in vitro fertilization.
- Hysterectomy with removal of the ovaries
Surgery to remove the uterus (hysterectomy) and ovaries (oophorectomy) was once considered as the most effective treatment for endometriosis. But endometriosis experts now are moving away from this approach, and focusing on the careful and thorough removal of all endometriosis tissue instead.
Getting a hysterectomy and a oophorectomy results in early menopause. The lack of hormones produced by the ovaries may improve the pain created by endometriosis for some, but for others, endometriosis that remains after surgery continues to cause symptoms. Early menopause also carries a risk of heart and blood vessel (cardiovascular) diseases, certain metabolic conditions resulting in early death.
Removal of the uterus (hysterectomy) can sometimes be used to treat signs and symptoms associated with endometriosis, such as heavy menstrual bleeding and painful menses due to uterine cramping, in those who don't want to become pregnant. Even when the ovaries are left in place, a hysterectomy may still have a long-term effect on your health, especially if you have the surgery before the age of 35.
When to see a doctor
Book the nearest appointment with your doctor when you start experiencing symptoms, like the ones mentioned above, and express your concern regarding the possibility of Endometriosis.
Endometriosis can be a challenging condition to manage, but with an early diagnosis, a multidisciplinary medical team, and an understanding of your diagnosis, may result in a better outcome of managing your pain and symptoms.
This articles’ sources
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