What is Endometriosis

http://www.dhhs.tas.gov.au/healthyliving/womens/endometriosis.php

Endometriosis

Endometriosis is the second most commonly experienced gynaecological condition affecting women during their menstruating years.  It is thought that up to a staggering 10 percent of women will be affect by endometriosis at some stage. In women over the age of 25, endometriosis is also one of the leading causes of infertility and it is believed that approximately 30-40 percent of infertile women have some degree of endometriosis.

 

What is endometriosis?

Endometriosis is a condition in which the cells that make up the lining of the uterus (endometrium) are found in places outside the uterus.

 

What are the causes of endometriosis?

While the causes of endometriosis are not fully understood, our knowledge about its development and the factors that trigger it continue to be refined as research progresses.

 

The most popular theory of the cause of endometriosis is the theory of retrograde menstruation. This theory says that when the uterus sheds its lining through the vagina during the menstrual period, a small proportion of the menstrual fluid flows backwards through the fallopian tubes into the pelvic cavity. This menstrual fluid contains cells from the endometrial lining that are still living. When these living cells are deposited into the pelvic cavity they attach themselves onto the tissue on which they land. These implanted cells become endometrial implants or deposits.

 

This theory, like all the theories on the causes of endometriosis, explains how endometriosis develops but not why it develops. Finding out what triggers the development of endometriosis is the subject of much research around the world. Research suggests that oestrogen, environmental toxins and a genetic predisposition are some of the factors responsible for the development of endometriosis – but how these factors contribute is not understood as yet.

 

What are the symptoms of endometriosis?

The number, type and severity of symptoms experienced varies widely from woman to woman. The most striking feature of endometriosis is the cyclical nature of the symptoms. In other words, the symptoms usually come and go or vary in intensity with the menstrual cycle. Thus, symptoms are usually felt or are worse during ovulation and/or around the time of the period, usually 2–3 days before the period and the first 2–3 days of the period.

Dysmenorrhea (period pain)

Dysmenorrhea is the most common symptom. It may manifest as an ‘aching’, ‘cramping’ or ‘throbbing’ sensation that can be felt anywhere in the pelvic area. The pain may radiate into the lower back, buttocks and thighs.

Dyspareunia (painful sexual intercourse)

Dyspareunia is a common but often unacknowledged symptom. It may be felt during intercourse and/or for up to 48 hours afterwards.

Pelvic pain

Pelvic pain may be experienced constantly or intermittently and may or may not be related to the menstrual period. It may be provoked by certain activities such as sitting in a certain position or it may occur unpredictably.

Lower back pain

Lower back pain is another common but poorly recognised symptom that often accompanies period pain.

Ovulation pain

Ovulation pain is generally felt in only one ovary at a time. It usually begins 12–24 hours before ovulation and may last for up to five days. It results from the normal enlargement of the ovary during ovulation which causes stretching of endometrial implants and adhesions lying on the surface of the ovary. The pain is often described as ’stabbing’ and it may radiate throughout the pelvic area and into the buttocks and thighs.

Bladder symptoms

The most common bladder symptoms are pain in the bladder region, pain when urinating, frequent urination and blood in the urine. The symptoms are usually the result of endometriosis lying on the outside of the bladder or irritation from endometrial implants lying on the front of the uterus.

Bowel symptoms

The bowel symptoms of endometriosis are often overlooked or dismissed because many people think endometriosis affects only the reproductive organs. Bowel symptoms due to endometriosis include diarrhoea, constipation, alternating bouts of diarrhoea and constipation, painful bowel movements, abdominal bloating, nausea and vomiting.

Bleeding symptoms

Several bleeding symptoms including heavy bleeding, clotting and premenstrual spotting are associated with endometriosis. Blood loss is considered heavy if it interferes with normal lifestyle or requires changing of sanitary pads and tampons every three hours or less. Pre-menstrual spotting is the loss of small amounts of dark, brownish-red blood before the period itself begins.

Cyclical abdominal bloating

Cyclical abdominal bloating may be a symptom of endometriosis. It is thought to be due to inflammation in the pelvic cavity caused by the endometriosis.

Fatigue

Fatigue is often not recognised as a symptom of endometriosis but it can be one of the most debilitating aspects of the condition. Most women with endometriosis experience fatigue around the time of their period and some experience it throughout the month.

Infertility

Infertility is one of the better known symptoms of endometriosis even though it is one of the less common symptoms. Sometimes infertility is the result of damage to the ovaries and fallopian tubes caused by severe endometriosis. However, in most cases it is not understood how endometriosis may reduce a woman’s fertility. Many women with endometriosis who are infertile do not have any other symptoms of endometriosis so the possibility of endometriosis needs to be considered in any woman who is having difficulty conceiving.

How is endometriosis diagnosed?

The first step towards a diagnosis is an appointment with your GP. If your GP thinks you could have endometriosis he or she will refer you to a gynaecologist. If he or she will not give you a referral and you feel your symptoms warrant further investigation insist on a referral to a gynaecologist or find another GP.

 

The gynaecologist will take a history of your menstrual cycle and your symptoms. This may include information about when your periods commenced, when you began experiencing symptoms, the regularity of your cycle, and whether any other family members have had endometriosis.

 

It’s often helpful to make a list of your symptoms and when you experience them as well as a list of any questions you have before your appointment so you don’t forget anything important. It may also be worth considering taking a close relative or friend with you for support.

 

You may have a pelvic examination during your consultation. This may be uncomfortable and embarrassing but it can help to determine the likelihood of endometriosis. You may also be asked to have a vaginal ultrasound. An ultrasound cannot detect endometrial implants but it can detect endometriomas and other abnormalities that may be contributing to your symptoms. A vaginal ultrasound gives a clearer image than an abdominal ultrasound.

 

If your symptoms and menstrual history indicate you could have endometriosis you will be advised to have a laparoscopy to confirm the diagnosis because endometriosis cannot be diagnosed conclusively without one. A laparoscopy is an operation in which a thin telescope-like instrument called a laparoscope is inserted into the pelvic cavity through a small cut near the navel (belly button).

 

What could endometriosis mean for me?

Many women only ever experience one or two minor episodes of endometriosis so the disease has little effect on their lives. However, for some women endometriosis is a chronic condition that has a marked impact on all aspects of their lives.

Difficulties being heard

Many women with endometriosis seek help from doctors for several years before being diagnosed. During this time they experience many emotions, including fear, confusion and humiliation, particularly when told by their families, friends and GPs that their symptoms:

• Are ‘all in their head’.

• Are ‘normal’.

• Are part of ‘being a woman’.

• Are due to something else such as polycystic ovarian syndrome, irritable bowel syndrome or ovarian cysts.

Emotions

Many women with endometriosis experience depression and/or a ‘roller-coaster ride’ of emotions due to:

• Pain and tiredness caused by their endometriosis, especially around period time.

• Effects of hormonal treatments that can often cause depression, mood swings and irritability.

• Unsuccessful treatments and ongoing pain.

• Lack of support from partners, family, friends and work colleagues.

• Grieving for the life they planned and the life they once led.

• Their inability to have a child.

Restricted lifestyle

Pain and/or fatigue often limit what women with endometriosis can do, including:

• Restricting their leisure activities.

• Limiting the time they can work or study.

• Reducing the time they can spend with family and friends.

• Stopping or restricting sexual activity.

• Reducing their independence.

Financial difficulties

Endometriosis can lead to financial problems for many reasons, including:

• Having to take time off work.

• Having to limit the hours worked and/or career choices.

• Cost of treatment, especially surgery.

Coping with endometriosis

Many women find it easier to live with their endometriosis if they pay careful attention to their lifestyle. Here are some suggestions that women have found useful.

Stress management

• Try to plan ahead so times of high stress do not coincide with your period.

• Accept your limitations and remember you are only human.

• Let your partner, family, friends and employer know about endometriosis and its effects by giving them this leaflet and telling them about the effects it has on you.

 

Rest and relaxation

• Make sure you get enough sleep each night, particularly in the week leading up to your period.

• Find an activity that helps you relax, such as having a bath or reading a book.

• Use relaxation techniques such as controlled breathing or visualisation. Take a short course or find a good book on relaxation or meditation.

 

Diet

• Regular, well balanced meals are vital to good health. Avoid sugary foods, fatty foods and caffeine in particular.

• Vitamin, mineral and herbal supplements can be of immense benefit. Try vitamin B6 for fluid retention, bloating and breast tenderness; magnesium for cramps; and zinc and/or iron for fatigue.

 

Exercise

• Exercise produces endorphins or ‘happy hormones’. Regular exercise can ‘lift your mood’ and reduce your ‘flat days’ and depression.

• Exercising when in pain can be almost impossible. Try gentle exercise like walking and swimming rather than intense work-outs.

• Try yoga or pilates as an alternative to high intensity exercise as they involve a combination of stretching and balance exercises which can be quite relaxing.

 

Pain management

• Try a heat pack, gentle massage of the painful area or relaxation exercises before using ‘heavy’ painkillers.

• Wherever possible use simple painkillers or non-steroidal anti-inflammatory medications to control your pain. Avoid codeine-based painkillers as they cause constipation and can be addictive. Talk to your doctor about suitable pain medications if you cannot maintain adequate pain control.

• Keep a pain diary. It can be a useful tool to show your doctor. It can also help you to decide if your pain is increasing or decreasing.

• Seek advice about pain management from an alternative health practitioner.

Treatment options

There are many different treatments available, but unfortunately no magical cure. There is also no way of knowing which treatment will for work for you. The conventional treatments may eliminate or alleviate the symptoms in the majority of women but many women will have a recurrence of their symptoms following treatment. This section gives only a brief introduction to the treatments available.

Hormonal treatment

A range of hormonal drugs can be used to treat endometriosis. All the drugs aim to suppress the growth of the endometrial implants in some way. None of them are effective in treating endometrial nodules and endometriomas, which can only be treated surgically.

Unfortunately, many women experience side effects when taking them. With the exception of the oral contraceptive pills, all the drugs have much the same effectiveness so the main differences lie in the side effects associated with them.

 

Surgical treatment

Surgery aims to alleviate symptoms by removing as much endometriosis as possible. Even though most surgery for endometriosis is done via a laparoscopy it can be quite complex. Surgery usually involves destroying or removing any endometrial deposits; removing any endometriomas, endometrial nodules and problematic adhesions; and correcting any other abnormalities that may be causing symptoms. The time you will need to recover varies but generally the more complex the surgery the longer you will need – in general, you should allow yourself one to two weeks before returning to work or study. Occasionally, a hysterectomy will be needed if all other treatments have failed.

 

Complementary therapies

Alternative therapies are used by many women to supplement or replace their medical treatment. There are many different therapies and practitioners to choose from so it can be difficult to find the right therapy and the right practitioner for you. It may help to do some research into the different therapies in order to find the ones you feel most comfortable with. Similarly, you may need to visit several practitioners before you find one you like and trust. Complementary therapies women have found beneficial for their endometriosis include acupuncture, aromatherapy, Chinese herbs, chiropractic, homeopathy, massage and reflexology.