Endometriosis

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What is endometriosis?

The name endometriosis comes from the word “endometrium.” This is the tissue that lines the inside of the uterus. Endometriosis occurs when this tissue grows outside the uterus. These are called implants.

The female hormone estrogen causes these implants to grow, bleed and break down, causing pain and swelling. This may or may not happen at the same time as your period.

Unlike the tissue shed by the uterus during your period, these implants outside the uterus have no way to leave the body. The implants become inflamed and swollen. The inflammation causes scar tissue around nearby organs that can interfere with their normal functioning and cause pain.

Endometriosis is a common health problem in women. It generally appears between the ages of 15 and 50.

What causes endometriosis?

No one knows for sure what causes endometriosis or why some women have this condition, but it can run in families. There are a number of theories about how endometriosis actually develops. One theory is based on the belief that menstrual fluid that normally flows out of the vagina moves backwards up into the uterus (retrograde menstruation). Pieces of the uterine lining in this fluid attach themselves and grow on other organs.
Since retrograde menstruation is fairly common, others have suggested that endometriosis may be caused by problems with the immune system.

Another theory is that endometrial cells are transported through the blood. Environmental causes, such as exposure to dioxins, are also being investigated.

What are the signs and symptoms?

The following symptoms are common with endometriosis:

  • painful periods (secondary dysmenorrhea);
  • pain between periods;
  • lower abdominal pain;
  • lower back pain;
  • painful intercourse especially with deep penetration (dyspareunia);
  • menstrual irregularity;
  • infertility;
  • nausea, vomiting, dizziness and fainting; and
  • pain with bowel movements and/or urination.

Your experience of endometriosis is unique to you. Symptoms can start very shortly after your first period or show up years later. One-third of women diagnosed with endometriosis have no symptoms at all. The remaining two-thirds will experience any number of complaints that may or may not be linked to the menstrual cycle.

As mentioned, pain is a common symptom of endometriosis. The severity of pain does not appear to be linked exclusively to how severe and extensive your endometriosis is. You may have a few tiny spots and suffer excruciating pain, while another woman with severe endometriosis can be entirely pain-free.

How is endometriosis diagnosed?

Endometriosis is a puzzling disease. There are many roadblocks to diagnosing endometriosis. These range from professional ignorance of endometriosis, how the disease presents itself and the myths associated with the disease.

There is no simple, accurate, noninvasive way to diagnose endometriosis. Certain symptoms may suggest to a doctor that a diagnosis is needed. A physical and internal examination may suggest the possibility of endometriosis, but a definitive diagnosis requires looking through a laparoscope at the internal organs as well as doing an endometrial tissue analysis. This is also referred to as an endometrial biopsy and involves removing tissue from the uterus for microscopic examination. An endometrial tissue analysis is done for one of three purposes: to determine why a woman may be experiencing heavy or irregular menstrual periods, to determine if a woman's endometrium is able to sustain and nourish a fertilized egg or to test for uterine cancer. This procedure can be done in hospital or on an outpatient basis and can be performed by a general practitioner or a gynaecologist.

For more information on diagnosis issues, please read our article, Endometriosis: Diagnosis and Treatments .

How is endometriosis treated?

There are a number of treatment options available and success rates vary. In all cases, endometriosis can reoccur.

There are a number of treatment options available and success rates vary. In all cases, endometriosis can reoccur.

  1. Drug therapy: This is usually your doctor's first course of action. Medications may be prescribed to reduce inflammation, control pain or regulate your hormonal levels.
  2. Surgical treatments: Doctors can operate to reduce pain and the number of implants and adhesions. These are bands of scar tissue that normally separate organs, usually as a result of surgery. Types of surgery include laparotomy, hysterectomy, and oopherectomy.
  3. Laparoscopy as a treatment: Laparoscopy can sometimes be used to remove or destroy endometrial implants. If your desire is to become pregnant, this treatment may make it possible providing there are no other causes for your infertility. Not all doctors are trained to use the laparoscope as a treatment for endometriosis. You will need to discuss this with your doctor.
  4. Complementary therapies and lifestyle changes: Complementary therapies are based on the belief that all illnesses impact upon your emotional and physical well-being. Most complementary therapies are holistic - they treat the whole person rather than a specific ailment or body part. This can be a welcome approach for women with endometriosis.
  5. Complementary therapies are those not normally offered by the general medical system. They include a wide range of therapies such as:
    • nutrition and herbal medicine;
    • homeopathy;
    • acupuncture;
    • chiropractic;
    • osteopathy; and
    • naturopathy.

For more information on treatment issues, please read our articles Endometriosis: Diagnosis and Treatments and Endometriosis and Complementary Therapies.

Where can I go for more information?