Question: After years of what I thought were extreme menstrual cramps, my doctor performed a laparoscopy and diagnosed me with endometriosis. Although I know there is no definitive cure for endometriosis, what are my options for treatment and pain management?
Endometriosis is a gynecological disease where the tissue that lines the inside of the uterus (the endometrium) grows outside of the uterus on the surfaces of pelvic and abdominal organs. Most often endometriosis occurs on or under the ovaries, behind the uterus, or on the bowels and bladder.
The exact cause of endometriosis is unknown however there are a few possible explanations
- Menstrual blood containing endometrial cells flows backwards up the fallopian tubes and into the pelvic cavity
- These displaced endometrial cells then stick to the pelvic walls and outsides of pelvic organs. They then behave like other endometrial cells, building up and shedding on a cycle.
Embryonic Cell Growth
- Embryonic cells that usually become the cells that make up the lining of the abdominal and pelvic cavities become endometrial cells.
Surgical Scar Implantation
- During a surgery like a C-section or a hysterectomy endometrial cells may attach to the surgical incision.
Endometrial Cells Transport
- Endometrial cells may travel to other parts of the body through blood vessels or the tissue fluid (lymphatic) system.
Immune system disorders
- If the immune system is impaired it may be unable to recognize and destroy endometrial cells growing outside the uterus.
- It has been strongly suggested that there is a connection between endometriosis and chemicals called dioxins, often called the most toxic chemicals made my humans.
- Dioxins accumulate in our food (90% of dioxins found in food are in meat, dairy products, fish, and shellfish).
- Dioxins come from environmental sources like pesticides, herbicides, industrial waste, and incineration.
The most common symptoms of endometriosis are:
- Pain in the abdomen, lower back, and pelvic areas.
- Pain may be associated with menstrual cramps or may be constant.
- pain during or after sex
- intestinal pain
- painful bowel movements or urination during menstrual periods
- heavy menstrual periods
- premenstrual spotting
- Bleeding between periods.
- Intestinal upset during periods (diarrhea, painful bowel movements, constipation)
- Yeast infections
- Can lead to infertility, though some women do not discover they have endometriosis until they try and fail to get pregnant
Symptoms can worsen over time though there is sometimes a pattern of remission and recurrence.
Some possible complications from endometriosis are:
- Formation and possible rupture of cysts that may spread endometriosis to new areas
- Intestinal bleeding or obstruction
- Interference with bladder function
If you are diagnosed with endometriosis you may be at a higher risk for other health issues like:
- Chronic fatigue
- Multiple Sclerosis
- Rheumatoid arthritis
- Sjögren’s Syndrome
You are not alone in your late diagnosis – according to the Endometriosis Research Center, it takes nine years on average for a woman to be diagnosed with endometriosis after the onset of her symptoms, during which time she is likely to visit five or more doctors in search of treatment for her pain, despite the estimation that 6 million girls and women have endometriosis. If you believe you have endometriosis talk to your healthcare provider but do not hesitate to get a second or even third opinion.
Definitive diagnosis requires a laparoscopy. Laparoscopy is an outpatient surgical procedure done under anesthesia. During this procedure the patient’s abdomen is distended with carbon dioxide and the abdominal organs are checked by using a laparoscope (a fiber optic tube with a light in it). Often if the surgeon finds endometrial lesions while conducting the laparoscopy they will destroy those that are visible.
Growths can sometimes be detected during a manual pelvic exam or ultrasound however endometriosis can often be confused with other conditions like Pelvic Inflammatory Disease (PID), ectopic pregnancy, cysts, appendicitis, diverticulitis, Irritable Bowel Syndrome (IBS), or even cancer.
Treatment and pain management options for endometriosis vary widely in their invasiveness. It is important for you to evaluate the severity of your individual symptoms before deciding on the appropriate treatment method for you.
For mild pain, try using over-the-counter NSAID pain medications and applying a heating pad to affected areas. Simple lifestyle changes such as exercising regularly and engaging in relaxation techniques like yoga and meditation may also be effective in relieving the pain associated with endometriosis. Some studies have also shown that acupuncture might be an effective treatment option.
Hormone treatments are another widely used treatment for endometriosis that you should consider before looking into more invasive surgical options. Using oral contraceptives (birth control pills) will regulate the growth of the tissue that lines the uterus and can also decrease your menstrual flow, giving you some relief from your symptoms. This therapy works for as long as you continue to take the pills. Some women will even take multiple packs in a row, skipping the placebo pills, in order to prevent their period from occurring at all and thus further reducing endometriosis-related symptoms. Using a birth control patch or vaginal ring will produce the same symptom-reducing effects as oral contraceptives.
A less invasive surgical alternative to hysterectomy, known as operative laparoscopy, can typically be done on an outpatient basis to remove endometrial growths and adhesions. During a laparoscopy, the surgeon will make a small cut in the abdomen and will examine areas of endometriosis with a viewing instrument. Then the surgeon may remove some of the areas of endometriosis growth through a process called excising (removing by cutting away with a scalpel) or may use intense heat to destroy areas of endometriosis and then seal the blood vessels through a process called cauterization.
If you are considering having a hysterectomy to treat your endometriosis, it is important that you remember that even having a hysterectomy does not guarantee that you are “cured” of endometriosis—there is a chance that endometriosis will recur even after hysterectomy. I urge you to visit the NWHN’s Hysterectomy Fact Sheet to review all of the risks and complications involved with this life-changing surgical procedure before considering hysterectomy. We at the National Women’s Health Network are very critical of physicians who do not explore other, less invasive treatment options first before resorting to hysterectomy.
For additional resoucres, please click on the following links.
- Endo-Online: The Voice of the Endometriosis Association
- Institute for the Study and Treatment of Endometriosis
- Frequently Asked Questions - Gynecologic Problems - Endometriosis
- The Endometriosis Research Center
- The Center for Young Women’s Health
- The American College for Obstetricians and Gynecologists
- The Mayo Clinic
- Our Bodies, Ourselves