KADE HAN, LMH HEALTH
photo by: Shutterstock
When the layer of cells that lines the inside of the uterus grows in areas it’s not supposed to, it causes a painful chronic condition known as endometriosis. It affects about one in 10 women, according to the American College of Obstetricians and Gynecologists, and it’s a common cause of more serious problems like infertility.
Normally, the layer of cells, called the endometrium, grows in the uterus each month to prepare for the possibility of implantation of a fertilized egg. When menstruation occurs, the endometrium is shed and a new layer grows back the following month.
However, in patients with endometriosis, this endometrial tissue can grow on the pelvic wall, fallopian tubes, ovaries and other nearby organs. This causes significant pain and discomfort.
“Very often people’s pain is brushed off as normal period cramping. This can lead to feeling not heard or helpless,” said Dr. Logan Kracht, an OB-GYN with Lawrence OB-GYN Specialists. “Unfortunately, endometriosis earned the reputation of being a commonly dismissed issue.”
Endometriosis is thought to be caused when a small amount of the uterus’ lining floats outside the fallopian tubes and implants somewhere outside of the uterus. The problem is that it continues to try to function outside of the uterus as it would if it were inside.
“When retrograde menstruation happens, the endometrial tissue is a lot like a dandelion seed floating around, looking for a place to sprout,” Kracht said. “Once it finds a spot, its goal is to shed, which causes problems.”
Endometriosis looks different from person to person. Even women with very little disease can present with a lot of pain. Common symptoms of endometriosis are:
• Pelvic pain
• Pain before and during menstruation
• Pain during sexual intercourse
• Infertility
• Heavy bleeding during menstruation
• Painful bowel movements and urination
“A lot of the problem is that the tissue tries to shed like it normally does, but it doesn’t have anywhere to go, so it flares up,” said Kracht. “This inflammation angers the nerves. When it happens over and over again, it creates scar tissue which causes long term problems.”
One of the most prevalent long-term issues of endometriosis is infertility, which is usually the result of scarring that surrounds and distorts the fallopian tubes. Kracht said almost a quarter of women who are infertile have endometriosis.
Women with endometriosis are also at a higher risk for depression and struggles with intimacy.
Diagnosis
Determining whether your pain and other symptoms is caused by endometriosis or some other problem isn’t always easy. If you have multiple symptoms of endometriosis or symptoms and a family history, talk to an OB-GYN provider about your concerns.
“You can definitely catch it early enough so that it will not cause as many problems,” Kracht said.
One important part of diagnosing the condition is identifying whether an ovary is involved. When endometriosis is present, the ovary can be damaged in such a way that it produces painful cysts filled with blood. These cysts, called endometriomas, are often identified using an ultrasound or during surgery.
“The most important features are size of the cyst and severity of pain — these things are what drive whether or not to treat,” Kracht said. “There are no definite size cut-offs that necessitate surgery, but if someone has a 5 cm endometrioma and pelvic pain interfering with quality of life, that would be an example of someone who could benefit from surgery.”
While physical exams, ultrasounds and endometrial biopsies are all ways to assess the likelihood of endometriosis, they don’t provide a definitive diagnosis.
“The only definitive way to diagnose endometriosis is to visualize it during surgery through a laparoscopy,” Kracht said. “It is a surgical technique where through the use of incisions less than an inch long, we use a camera to visualize operating with small instruments inside the abdomen. This way recovery is shortened, pain is less, and the risks of complications are reduced.”
Treatment
There are a variety of treatments for endometriosis, depending on the severity of the illness and the patient’s preferences.
First-line treatments include medications: anti-inflammatory drugs and progesterone-only medications such as pills, injections, implants, birth control pills, and even intrauterine devices. These methods can help decrease the effects of the body’s natural estrogen, which is the main catalyst of endometriosis. There are some other medications that work on the pituitary gland to stop estrogen at its source.
Other treatments require surgery, during which the tissue can be removed or cauterized. But Kracht warned that even after a successful surgery, symptoms can come back.
“There could be spots too small to be seen, and if you can’t see them, you can’t treat them.” Kracht said.
Some women have reported a positive change in their condition from lifestyle factors like changes in diet and exercise habits.
“While there is not a lot of data to show that lifestyle changes can help, I know plenty of people who have seen chronic problems improve after making strides to become healthier,” Kracht said. “Endometriosis is kind of like a bike wheel with many spokes; it will affect multiple areas of your life, so it often requires a multifaceted approach to make it better.”
Psychological well-being is also important, and people struggling with endometriosis can benefit from finding others who are going through the same thing and seeking support from them.
“Talking with others in your position and getting new ideas can really help,” Kracht said. “It’s not necessarily a one-size-fits-all approach, so I encourage my patients to not be afraid to lean on others for support.”
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