Women’s Health: Endometriosis: More than a monthly pain

  • Llewellyn Simons—©paul shoul

For the Gazette
Monday, March 12, 2018

One of the health awareness campaigns promoted during the month of March is National Endometriosis Awareness. Endometriosis is an often painful, potentially serious condition that affects roughly one in 10 women and girls in the U.S., and can increase the risk of infertility.

The disorder takes its name from the endometrium, the lining of the uterus that, in healthy menstrual cycles, is shed every month and replaced by a woman’s body in conjunction with monthly ovulation (egg production). Endometriosis occurs when endometrial tissue grows outside the uterus — anywhere from ovaries and fallopian tubes where they can cause cysts and scar tissue to (rarely) areas beyond pelvic organs, including the bladder, intestines, appendix, rectum or even lungs.

Endometriosis is often misdiagnosed or underdiagnosed, but can be characterized by intense pain and cramping during menstruation, heavy or longer-than-average menstrual periods or pain experienced during urination, bowel movements or sexual intercourse.

Its cause is largely unknown, though recent research points toward cellular transformations resulting from hormonal conditions that can cause other body cells to mutate into endometrial cells, or to immune system disorders that prevent the body from recognizing endometrial cells outside the uterus.

Whatever their origins, these exo-uterine endometrial cells behave just like their counterparts in the uterus, growing, shedding and bleeding every month as the hormonal cycle determines.

There are no lab tests for endometriosis; the condition is usually identified during pelvic exams or, if suspected, through diagnostic ultrasound or other imaging techniques, though definitive diagnosis may require a biopsy of abdominal tissue acquired through laparoscopic surgery.

However, not every woman needs surgery to confirm a diagnosis, as medical management can be initiated if endometriosis is suspected.

Many factors can contribute to a woman’s risk for developing endometriosis, including an early age of first menstruation, a late onset of menopause and never having given birth. Alcohol consumption and a low body mass index (BMI) — being underweight — are two other variables that can contribute to an increased risk, and genetics/family history of the disease is also a factor; girls who have a close female relative with endometriosis are five to seven times more likely to have it themselves.

Hormone-based contraceptives such as birth control pills, patches and vaginal rings, which generally produce lighter, shorter menstrual flows, can help to reduce or eliminate pain attributed to endometriosis. Lowering estrogen levels (which at a point will prevent menstruation entirely) typically shrinks endometrial tissue and can help resolve issues with monthly pain, and being pregnant can temporarily alleviate symptoms as well, thanks to elevated levels of another reproductive hormone, progesterone.

Birth control methods that employ progestin (a synthesized/altered version of progesterone), such as IUDs and injections, can also help manage endometriosis, though occasionally women experience weight gain or mood swings with some of these methods.

Because the condition’s symptoms are stimulated by estrogen, they tend to lessen when estrogen levels drop and disappear temporarily during pregnancy and permanently with the onset of menopause (unless you take estrogen to relieve other effects of menopause).

There is no cure for endometriosis, though symptoms can be managed or eliminated through medication or surgery. Providers usually recommend non-prescription anti-inflammatory medicines (ibuprofen or naproxen) for pain management, and might prescribe hormonal birth control if over-the-counter pain relievers are ineffective.

For those who require surgery, experiences may range from minor laparoscopic procedures to remove endometrial tissue to (in severe cases) total hysterectomy (removal of the uterus and cervix) and removal of the ovaries to ensure a cessation of estrogen production.

The treatment decisions a woman makes with her health care provider will largely depend on how severe symptoms are and whether she plans to become pregnant in the future.

Like many health conditions, endometriosis can be most effectively addressed when diagnosed early on, so don’t hesitate to see a women’s health provider if you’re someone who is experiencing a lot of monthly menstrual pain, especially if you don’t really know what’s causing it.

Some 30 to 50 percent of women with endometriosis may experience infertility, and some studies show an increased risk of developing ovarian cancer. Because the condition can cause infertility and tends to worsen over time, doctors will sometimes advise women with endometriosis not to delay pregnancy if they do plan to have children. “Assisted reproductive technologies” such as in-vitro fertilization (IVF) may be valuable to endometriosis sufferers who are trying to conceive.

The estimated number of women with endometriosis ranges from 5 to 15 million in the U.S. alone and more than 175 million globally — so remember that if you are identified as someone with “endo,” you’re not alone, and research is continuing to mount in a search for better treatments and/or a cure.

Dr. Ruth Pryor is an obstetrician gynecologist at Cooley Dickinson Women’s Health, and works at the Cooley Dickinson Childbirth Center in Northampton.

Women’s Health is written by health care professionals affiliated with Cooley Dickinson Hospital. It appears here monthly.