| SLIDESHOW |
| Symptoms of Endometriosis |
| We explain this painful condition, who gets it, and when and how it's mistaken for other conditions.
Slideshow: A Visual Guide to
Endometriosis
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What is Endometriosis?
Endometriosis happens
when tissue normally found inside the uterus grows in other parts of the body.
It may attach to the ovaries, fallopian tubes, the exterior of the uterus, the
bowel, or other internal parts. As hormones change during the menstrual cycle,
this tissue breaks down and may cause painful adhesions, or scar tissue. More than
5.5 million American women have symptoms of endometriosis.
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Endometriosis Symptoms
Pain just before,
during, or after menstruation is the most common symptom. For some women, this
pain may be disabling and may happen during or after sex, or during bowel
movements or urination. It sometimes causes ongoing pain in the pelvis and
lower back. Many women with endometriosis have mild or no symptoms, though. The
symptoms may be related to the location of the growths.
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Just Cramps or Endometriosis?
Most women have some
mild pain with their menstrual periods. They may get relief from
over-the-counter pain medications. If the pain lasts more than 2 days, keeps
you from doing normal activities, or remains after your period is over, tell
your doctor.
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Endometriosis and Teens
Endometriosis pain can
begin with the first menstrual period. If your menstrual pain is strong enough
to interfere with activities, you should consult your physician. The first step
may be tracking the symptoms and taking pain medication, but ultimately the
treatment options for teens are the same as for adults.
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Endometriosis and Infertility
Sometimes the first --
or only -- symptom of endometriosis is trouble getting pregnant. Infertility
affects about a third of women with the condition, for reasons that aren't well
understood. Scarring may be to blame. The good news is that medical treatments
can help someone overcome infertility, and pregnancy itself can relieve some
symptoms of endometriosis.
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Endometriosis or Fibroids?
Endometriosis is one
cause of severe menstrual pain. But the pain can be caused by another
condition, such as fibroids, which are noncancerous growths of the muscle
tissue of the uterus. Fibroids can cause severe cramps and heavier bleeding
during your period. The pain of endometriosis or fibroids can also flare up at
other times of the month.
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What Causes Endometriosis?
Doctors don't know why
endometrial tissue grows outside of the uterus, but they have several theories.
Heredity plays a role, and some endometrial cells may be present from
birth. Another theory suggests that
menstrual blood containing endometrial cells flows back through the fallopian
tubes and into the pelvic cavity instead of out of the body. These cells are
thought to stick to organs and keep growing and bleeding over time. Cells could
also move to the pelvic cavity other ways, such as during a C-section delivery.
A faulty immune system may fail to get rid of the misplaced
cells.
The
brown cells seen here are endometrial cells removed from an abnormal growth on
an ovary.
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Endometriosis: Who Is at Risk?
The condition is more
common in women who:
·
Are in their 30s and 40s
·
Have not had children
·
Have periods longer than 7 days
·
Have cycles shorter than 28 days
·
Started their period before age 12
·
Have a mother or sister who had
endometriosis
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Diagnosis: Tracking Symptoms
Your pattern of symptoms
can help to identify endometriosis, including:
·
When the pain happens
·
How bad it is
·
How long it lasts
·
A change or worsening of pain
·
Pain that limits your activities
·
Pain during sex, bowel movements, or
urination
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Diagnosis: Pelvic Exam
Your doctor will do a
pelvic exam to check your ovaries, uterus, and cervix for anything unusual. An
exam can sometimes reveal an ovarian cyst or internal scarring that may be due
to endometriosis. The doctor also looks for other pelvic conditions that could
cause symptoms similar to endometriosis.
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Diagnosis: Pelvic Scans
Although it isn't
possible to confirm endometriosis with scanning techniques alone, your doctor
may order an ultrasound, CT scan, or MRI to help with diagnosis. These may be
able to detect larger endometrial growths or cysts. The scans use sound waves,
X-rays, or magnetic fields with radiofrequency pulses to create the images.
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Diagnosis: Laparoscopy
Laparoscopy is the only
sure way to determine if you have endometriosis. A surgeon inflates the abdomen
with gas through a small incision in the navel. A laparoscope is a viewing
instrument that's inserted through the incision. The surgeon can take small pieces
of tissue for a lab to examine -- called a biopsy -- to confirm the diagnosis.
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Treatment: Pain Medicine
Pain medications, such
as acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs), like
ibuprofen or naproxen, often help relieve the pain and cramping that comes with
endometriosis. But these drugs only treat the symptoms and not the underlying endometriosis.
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Treatment: Birth Control Pills
Oral contraceptives
manage levels of estrogen and progestin, which make your menstrual periods
shorter and lighter. That often eases the pain of endometriosis. Your doctor
may prescribe pills to be taken continuously, with no breaks for a menstrual
period, or progestin-only therapy. Progestin-only therapy can also be given by
injection. Endometriosis symptoms may return after you stop taking the pills.
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Treatment: Other Hormone Therapies
These drugs mimic
menopause, getting rid of periods along with endometriosis symptoms. GnRH
agonists, such as Lupron, Synarel, and Zoladex, block female hormones from
being made. They can cause hot flashes, vaginal dryness, fatigue, mood changes,
and bone loss. Danocrine works mainly by lowering estrogen. Side effects can
include weight gain, smaller breasts, acne, facial hair, voice and mood
changes, and birth defects.
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Treatment: Excision
During a laparoscopy,
the surgeon may remove visible endometrial growths or adhesions. Most women
have immediate pain relief. A year after the surgery, though, about 45% of
women will have a return of symptoms. The likelihood of symptoms returning
rises over time. Hormone therapy after surgery may improve the outcome.
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Treatment: Open Surgery
Severe cases of
endometriosis may require laparotomy, or open abdominal surgery, to remove
growths, or a hysterectomy -- removal of the uterus and possibly all or part of
the ovaries. Although this treatment has a high success rate, endometriosis
still recurs for about 15% of women who had their uterus and ovaries removed.
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Getting Pregnant With Endometriosis
Many women with
endometriosis don't have trouble getting pregnant. But laparoscopic surgery can
improve the pregnancy rate of women who have moderate to severe endometriosis.
In vitro fertilization is an option if infertility persists. The sperm and egg
are combined in a lab and the resulting embryo is implanted into the uterus.
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Coping With Endometriosis
Although there is no way
to prevent endometriosis, you can make lifestyle choices that will help you
feel better. Regular exercise may help relieve pain by improving your blood
flow and boosting endorphins, the body's natural pain relievers. Acupuncture, yoga,
massage, and meditation also may help ease symptoms.
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An End to Endometriosis?
For most women,
endometriosis recedes with menopause. Some women find relief from endometriosis
during pregnancy. In some cases, symptoms may simply go away. About one-third
of women with mild endometriosis will find that their symptoms resolve on their
own
This tool does not provide medical advice.
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