Endometriosis (en-doe-me-tree-O-sis) is an often-painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus — the endometrium — grows outside the uterus. Endometriosis most commonly involves ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond pelvic organs.
With endometriosis, the endometrial-like tissue acts as endometrial tissue would — it thickens, breaks down and bleeds with each menstrual cycle. But because this tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other.
Endometriosis can cause pain — sometimes severe — especially during menstrual periods. Fertility problems also may develop. Fortunately, effective treatments are available.
Symptoms:
The primary symptom of endometriosis is pelvic pain, often associated with menstrual periods. Although many experience cramping during their menstrual periods, those with endometriosis typically describe menstrual pain that's far worse than usual. Pain also may increase over time.
Common signs and symptoms of endometriosis include:
• Painful periods (dysmenorrhea): Pelvic pain and cramping may begin before and extend several days into a menstrual period. One may also have lower back and abdominal pain.
• Pain with intercourse: Pain during or after sex is common with endometriosis.
• Pain with bowel movements or urination: One is most likely to experience these symptoms during a menstrual period.
• Excessive bleeding: One may experience occasional heavy menstrual periods or bleeding between periods (intermenstrual bleeding).
• Infertility: Sometimes, endometriosis is first diagnosed in those seeking treatment for infertility.
• Other signs and symptoms: They may experience fatigue, diarrhoea, constipation, bloating or nausea, especially during menstrual periods.
Treatments:
Treatment for endometriosis usually involves medication or surgery. The approach you and your doctor choose will depend on how severe your signs and symptoms are and whether you hope to become pregnant.
Doctors typically recommend trying conservative treatment approaches first, opting for surgery if initial treatment fails.
1. Pain Medication
The doctor may recommend to take an over-the-counter pain reliever, such as the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) to help ease painful menstrual cramps.
He may recommend hormone therapy in combination with pain relievers if they are not trying to get pregnant.
2. Hormone Therapy
Supplemental hormones are sometimes effective in reducing or eliminating the pain of endometriosis. The rise and fall of hormones during the menstrual cycle causes endometrial implants to thicken, break down and bleed. Hormone medication may slow endometrial tissue growth and prevent new implants of endometrial tissue. Hormone therapy isn't a permanent fix for endometriosis. You could experience a return of your symptoms after stopping treatment.
These therapies include:
• Hormonal contraceptives: Birth control pills, patches and vaginal rings help control the hormones responsible for the build-up of endometrial tissue each month. Many have lighter and shorter menstrual flow when they're 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 oestrogen levels and preventing menstruation. This causes endometrial tissue to shrink. Because these drugs create an artificial menopause, taking a low dose of oestrogen 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.
3. Conservative Surgery
If a person with endometriosis and are trying to become pregnant, surgery to remove the endometriosis implants while preserving the uterus and ovaries (conservative surgery) may increase the chances of success. If there is severe pain from endometriosis, that may also benefit from surgery — however, endometriosis and pain may return.
The doctor may do this procedure 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.
In laparoscopic surgery, the surgeon inserts a slender viewing instrument (laparoscope) through a small incision near the navel and inserts instruments to remove endometrial tissue through another small incision. After surgery, the doctor may recommend taking hormone medication to help improve pain.
4. Fertility Treatment
Endometriosis can lead to trouble conceiving. If you're having difficulty getting pregnant, your doctor may recommend fertility treatment supervised by a fertility specialist. Fertility treatment ranges from stimulating your ovaries to make more eggs to in vitro fertilization. Which treatment is right for you depends on your personal situation.
5. Hysterectomy with removal of the ovaries
Surgery to remove the uterus (hysterectomy) and ovaries (oophorectomy) was once considered the most effective treatment for endometriosis. But endometriosis experts are moving away from this approach, instead focusing on the careful and thorough removal of all endometriosis tissue.
Having the ovaries removed results in menopause. The lack of hormones produced by the ovaries may improve endometriosis pain 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 and 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 health, especially if the surgery is done before 35 years of age.
