Many women live with the pain of endometriosis for years before getting a diagnosis. Sometimes, women who are incapacitated during their period don’t recognize that this is not normal. More often, however, women tell their ob/gyn about pain, and their complaints are not taken seriously. If you believe you are suffering from endometriosis, seek the care of a specialist at our Long Island gynecology practice. To help you learn more about endometriosis and related conditions, we have provided answers to some frequently asked questions.
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What is endometriosis?
The inner lining of the uterus which gets shed every month during your period is called the endometrium. Endometriosis refers to the growth of endometrial tissue outside of the uterus. Growth of this tissue outside of the uterus can cause endometriosis lesions or implants on the ovaries, fallopian tubes, and on the bladder or intestines. Rarely, endometriosis can occur at distant sites like the lung or the liver.
Endometriosis lesions respond to your body’s estrogen secretions just like the normal endometrium inside the uterus responds: The tissue thickens all month long, and then bleeds and sheds during your menstrual period. The bleeding from endometriosis lesions occurs internally, and does not get expelled through the vagina. Over time, this ongoing cycling can cause pain, inflammation, infertility, and even the formation of scar tissue called adhesions.
What are the symptoms of endometriosis?
Common symptoms of endometriosis include:
- Extremely painful periods that aren’t relieved with over-the-counter medications or birth control pills
- Painful sexual intercourse
- Heavy periods that require a change of tampon or pad every 1 to 2 hours
- Spotting or bleeding between periods
Many women with endometriosis do not have symptoms, and the severity of symptoms does not always reflect the severity of the condition. Some women with mild endometriosis have severe pain, while other women with advanced endometriosis have little or no discomfort.
What causes endometriosis?
A definite cause of endometriosis is not known, but there are multiple theories:
Retrograde menstruation: There is strong circumstantial evidence that endometriosis, at least in some cases, is caused by retrograde menstruation: Instead of menstrual blood being expelled through the vagina, it can travel backwards through the fallopian tubes into the abdominal cavity. For example, girls are occasionally born with a blocked vagina that does not permit blood to exit; these young women are very prone to endometriosis. This suggests that obstruction of blood flow causes menstrual blood to “back up” until it spills retrograde into the abdominal cavity.
Metaplasia: The transformation of one normal type of tissue into to a different type of tissue is called metaplasia. There is evidence that the cells which line the pelvic and abdominal cavity can undergo metaplastic change, transforming into endometrial cells.
Immune response: Some evidence suggests that women with endometriosis have an altered immune response, such that their bodies don’t recognize and destroy endometrial cells that make their way into the peritoneal cavity.
Post-surgical endometriosis: In rare cases, endometriosis can be deposited outside of the uterus as a result of surgery on the uterus. Occasionally, for example, women who have had a cesarean section can have endometriosis in their c-section scar.
When should I see a doctor?
Many women have cramps during their period; most of them don’t have endometriosis. If you have ongoing cramps or pelvic pain which does not respond to over the counter medications like ibuprofen (Motrin or Advil) or naproxen (Aleve), you should be evaluated. If you regularly call in sick because of period cramps or you frequently notice pain during intercourse, you should likewise be seen. If your periods are unusually heavy or you have noticed bleeding between periods, evaluation by a skilled gynecologist is essential.
How is it diagnosed?
Endometriosis cannot be diagnosed with a blood test, or seen with ultrasound or X-ray. The only reliable way to determine if a woman has endometriosis is to perform laparoscopy, a procedure in which a slender telescope is inserted into the abdomen under anesthesia to look directly at the pelvic organs.
How is it treated?
When endometriosis is discovered during laparoscopy, many lesions can be laparoscopically ablated (destroyed with an energy source) or resected (removed). Occasionally, lesions affect organs and areas in which ablation is not advisable: Ablation of endometriosis on the bowel or bladder, for example, can result in injury to that organ. In these cases, women may be treated with medication, or an advanced procedure to resect (cut out) the endometriosis may be planned. Since endometriosis responds to estrogen, the mainstay of medical treatment is medication that temporarily suppresses estrogen levels. We commonly use a medication called Lupron Depot® (leuprolide acetate) to suppress estrogen production for up to 6 months. Lupron is not suitable for long-term use in most women because chronic estrogen suppression causes unwelcome metabolic side effects such as heart disease and bone loss.
Endometriosis is a chronic condition: Once treated, it recurs in about 10% of women per year if not suppressed. Birth control pills are commonly used to prevent recurrence of endometriosis. Other options for long-term suppression include Depo-Provera or a progesterone-containing IUD.
Does endometriosis cause cancer?
Endometriosis does not cause cancer, but there is some evidence that women with endometriosis have a higher risk of certain types of cancer, particularly ovarian and breast cancer.
Is it contagious?
No. Endometriosis is not an infection and cannot be passed between people
My mother had endometriosis. Should I be concerned?
Maybe. Studies indicate that if your first-degree relative (i.e., your mother, daughter, or sister) has endometriosis, you have a roughly 7% chance of developing the condition yourself. If you have a family history of endometriosis and suggestive symptoms, you ought to be evaluated.
Can endometriosis make it difficult to get pregnant?
Yes. Mild endometriosis causes inflammation, which can interfere with the function of women’s reproductive organs, and can make it hard for sperm to survive. Severe endometriosis can cause scarring and adhesions that damages or blocks the fallopian tubes or covers the ovaries.
Does treatment of endometriosis increase a woman’s chances for becoming pregnant?
Surgical treatment of endometriosis does improve fertility rates.
My daughter is 17. Is she too young to have endometriosis?
She is not too young. While endometriosis is most common in women in their 30s to 40s, teenagers can get it as well. If your daughter suffers from severe menstrual cramps which are not relieved by birth control pills and/or over the counter medications (NSAIDs like ibuprofen or naproxen), bring her in for a consultation with one of our specialists.
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