We still have much to learn about this condition. It is not certain why it affects some women and not others, but it may be related to certain genes. Endometriosis is not contagious. Nor can it be passed like a cold virus or a sexually transmitted infection. Since endometriosis is benign, it is not life threatening and does not lead to cancer. Most women are successfully treated using medication and medical procedures.
The endometrium is a tissue that lines the inside of the uterus (womb). Normally, endometrial tissue only grows inside the uterus. In endometriosis, it spreads to places like the fallopian tubes, and the surface of the ovaries, bladder, or even bowels.
The normal endometrium thickens and swells during the menstrual cycle, preparing the uterus for pregnancy. If pregnancy does not happen, the lining is shed from the uterus and leaves the body as a period (menstrual flow). In endometriosis, the abnormal endometrial tissue goes through the same cycle of thickening and shedding. However, this tissue and blood does not leave the body in the usual fashion. Instead, it inflames, irritates and even scars the organs and surfaces on which it grows.
Pain is the most common symptom of endometriosis. It can appear anywhere in the pelvis as well as the lower back. Usually pain is worse around the time of menstruation. Endometriosis also may cause heavy periods and painful cramping. Some women have pain with intercourse, and even with passing urine or having bowel movements. The pain can be mild to severe, and can come back after treatment.
It may be difficult to get pregnant. General tiredness is possible, but this symptom is not as common. Most women have mild symptoms that do not get worse over time. Many women with endometriosis have no symptoms.
As this condition can cause many different symptoms, it is difficult to diagnose. Reaching a diagnosis may take months to years. No simple blood test can find it. For most women, doctors use reported symptoms and a pelvic exam to make a diagnosis. Doctors may also order an ultrasound, or a scoping procedure to look at the bowel or bladder, or even an MRI. These tests help with diagnosing, and make sure there are no other problems.
The only way to confirm endometriosis is by doing a laparoscopy. In this surgical procedure, the doctor makes a small opening near the belly button.
A small camera is inserted inside the abdomen to check for abnormal endometrial tissue patches. As well, a tissue sample may be collected. A pathologist can look at the tissue under a microscope to confirm the diagnosis.
Treatment of endometriosis depends on the symptoms and the woman’s needs. Many women only need information and reassurance that it is not dangerous. Fortunately, women who need treatment have many options. Most women can get relief from their symptoms. Symptoms may get better after pregnancy and disappear after menopause.
Most women with mild to moderate symptoms can get relief with simple, over-the-counter pain medication. These include acetaminophen (Tylenol® and others), anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin® or Advil® and others) or naproxen (Aleve®). Anti-inflammatory drugs take away pain by decreasing inflammation and so the irritation. Hormone therapy is a possibility for women who find that the first mentioned drugs do not work, or if they cannot take them for medical reasons.
Hormone therapy changes the body’s hormone cycle. By stopping natural periods, it also stops the abnormal endometrial tissue’s painful thickening and shedding. Hormone medications are a good option for women who do not wish to become pregnant. These therapies include a birth control pill with estrogen and progestin, a progestin pill or injection, a hormone patch, vaginal ring, or an intrauterine device with progesterone (such as Mirena®). These options have different side effects, which may limit their use depending on the woman’s needs.
Another hormone treatment is the gonadotropin-releasing hormone agonist (GnRH agonist). It also stops periods. It is given by injection or in a nasal spray. The GnRH agonist treatment may cause menopausal effects such as hot flashes, mood swings and vaginal dryness. To manage these side effects, some doctors prescribe ‘add-back therapy’ — a low dose of estrogen and progestin.
In the past, danazol was a routine treatment for endometriosis. Since it causes side effects like weight gain, acne and increased cholesterol, doctors use it only when other treatments fail to help. Danazol causes temporary menopause and so stops the thickening and swelling of the endometrial tissue.
Some doctors believe aromatase inhibitors may be a new, promising treatment option in the near future. These drugs still need more research. By controlling estrogen, aromatase inhibitors halt the painful growth and irritation of endometrial tissue.
Women with severe pain, or those that cannot take other treatments, may need surgery. Laparoscopy allows doctors to remove the abnormal tissue or burn it away with a laser. Surgery may help with infertility, as endometriosis drugs are not effective in that way. Sometimes abnormal endometrial tissue grows back after this treatment. In such cases, doctors may advise further surgery to remove the uterus, fallopian tubes and ovaries. This is a last resort, as it causes permanent infertility and menopause.
Some women find that alternative treatments, including acupuncture and nutrition supplements, help their symptoms. While current research has not found evidence of this, such treatments may improve overall quality of life.
A healthy lifestyle, with a healthy, well balanced diet, regular physical exercise, and using various relaxation methods, may help as well.
Endometriosis is very common. Much more research is needed to learn about why it happens and how it can be cured. However, up to 90 per cent of women with this condition can get the relief from symptoms they need. Since many women suffer with pelvic pain, infertility and other symptoms of endometriosis, support groups and information sources are available. They can be an important source of emotional support as well.