CW GA-BAMA – Your CW station in Georgia and AlabamaEndometriosis: what you should know

Millions of women suffer from chronic pelvic pain. If your pelvic pain coincides with your menstrual periods, your doctor may suspect endometriosis.

One out of five women with chronic pelvic pain has endometriosis. The pain can range from bothersome to disabling. Endometriosis can also cause infertility. It is found in one fourth to one half of women who are unable to get pregnant.

The endometrium is the tissue that lines the uterus. Normally, the tissue sheds during a woman's period each cycle (unless she gets pregnant.) But endometrial tissue can sometimes implant and grow outside of the uterus, usually within the pelvis or abdomen.

During your period, this misplaced endometriosis tissue responds to the shift in hormones by bleeding. This can cause pain and can irritate nearby tissue. Scar tissue and cysts form, and they can sometimes block the fallopian tubes and ovaries. This prevents the egg from being released and is a common cause of infertility.

Risk factors

Any woman of childbearing age can get endometriosis. Your risk goes up if you:

• Have a mother, sister or daughter who has endometriosis
• Have never been pregnant
• Are in your 30s or 40s
• Have short menstrual cycles (fewer than 27 days between periods)
• Have periods that last for seven days or longer
• Had a pelvic infection such as pelvic inflammatory disease (PID)

Common symptoms

Many women with endometriosis have no symptoms. The most common sign of it is pelvic pain before and during your period. Other symptoms may include:

• Chronic lower pelvic or back pain
• Discomfort during or after sex
• Painful urination or bowel movements
• Stomach pain
• Spotting (bleeding between periods)
• Diarrhea, constipation, nausea or bloating during your period
• Fatigue

These symptoms can also have many other causes.

Symptoms of endometriosis often go away during pregnancy and after menopause, when a woman no longer has her period.

How much pain you have does not point to how severe the endometriosis is. Women with minimal endometriosis can have extreme pain and women with severe endometriosis may have no pain at all. Not all women have symptoms. For many women, the first sign of endometriosis is their inability to get pregnant. Severe endometriosis, whether it causes severe symptoms or not, is strongly linked with infertility.

Diagnosis

Only your doctor can tell if your pelvic pain is caused by endometriosis.

First, your doctor will do a pelvic exam and possibly an ultrasound to check for cysts. If your doctor still suspects endometriosis, he or she will likely recommend a laparoscopy to confirm the diagnosis. During this procedure, your doctor makes one or more small incisions in your abdomen and inserts a lighted viewing tool. The doctor can see any scar tissue or endometrial tissue in your pelvis and abdomen. Your doctor may try to remove the tissue during the same procedure.

Because laparoscopy is invasive, your doctor may first try treatment or more testing to rule out other causes of symptoms.

Managing the condition

The goal treatment is to control pain. Your doctor may suggest these treatments.

Lifestyle changes. Regular exercise and relaxation techniques help ease pain in some women. Talk to your doctor first before you increase your activity level.

Pain medication. Your doctor may suggest an over-the-counter pain medicine such as ibuprofen (a nonsteroidal anti-inflammatory drug, or NSAID) or prescribe a stronger pain reliever to temporarily ease pain. Ask your doctor what medicine is right for you before you take any over-the-counter medicines.

Hormones. Hormone therapy helps four out of five women with endometriosis. Hormones control pain, slow the growth of new endometrial tissue and stop new scar tissue from forming. Hormones will not get rid of existing scar tissue.

Your doctor may prescribe birth control pills, gonadotropin-releasing hormones (GnRH) or progestin. These drugs work by keeping menstrual periods light and short or by stopping periods altogether. Each of these drugs comes with risks and side effects, so they are not for everyone. Pain often comes back once hormones are stopped.

Surgery. Surgery can be used to remove endometriosis tissue:

• Laparoscopy. During this procedure, tissue is either removed or burned away. If endometriosis is causing infertility, you may be able to get pregnant after this procedure. Symptoms return within one year in half of women who have the surgery.
• Hysterectomy. A hysterectomy is surgery to remove your uterus. The ovaries may also be taken out. After this procedure, you will no longer be able to get pregnant and will no longer have your period. This is only done as a last resort for women with severe endometriosis. There is a slight chance that symptoms will return after surgery.