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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Illustration
Endometriosis
What is endometriosis?
The tissue that normally lines the inside of the uterus is
called the endometrium. (The uterus is the organ at the top
of the vagina. Babies develop in the uterus, and menstrual
blood comes from the uterus.) In some women endometrium
grows outside the uterus. When this happens a woman has a
condition called endometriosis. The most common areas for
this abnormal growth of endometrium are the reproductive
organs (ovaries, fallopian tubes, uterus). Endometrium may
also grow on the intestines, bladder, rectum, and the lining
of the pelvic area and abdomen.
This misplaced tissue responds to the hormones of the
menstrual cycle and bleeds each month in the same way the
lining of the uterus responds to hormones. However, if the
tissue is not in the uterus, the blood shed from the tissue
has no way to leave the body. When the tissue bleeds,
cysts, adhesions, and scar tissue form and the area around
the endometriosis thickens. Very rarely, endometriosis
becomes cancerous.
How does it occur?
Why some women develop endometriosis is not known. There
are many theories, but none of them explains all cases. One
theory suggests that in some women some of the endometrial
tissue flows backward during menstrual flow into the
fallopian tubes and abdomen, where it attaches and grows.
Another theory suggests that some endometrial tissue in the
uterus backs up in all women. The immune system may then
destroy the misplaced tissue. Women who develop
endometriosis, however, may have an immune system that is
not able to destroy the misplaced tissue.
What are the symptoms?
Some women have no symptoms. If symptoms occur they may
include:
- abnormal or heavy menstrual flow
- back or flank pain before or during the menstrual
period
- very painful menstrual cramps
- painful intercourse
- pelvic pain, especially before or during the menstrual
period
- painful bowel movements, diarrhea, constipation or
other intestinal upsets during the menstrual period
- painful urination or feeling the need to urinate often
during the menstrual period
- difficulty becoming pregnant.
How is it diagnosed?
First, your health care provider will ask you about your
symptoms. You will need a pelvic exam to check for cysts or
nodules or any abnormal tenderness or thickening in your
pelvic area.
You may need a 1-day surgical procedure called a
laparoscopy for diagnosis. You are given an anesthetic
before the procedure so you will not feel any pain. Then a
small cut is made near the navel and your abdomen is filled
with a gas (carbon dioxide). The surgeon inserts an
instrument called a laparoscope through the cut and into
your abdomen to look at the organs and the pelvic cavity.
With laparoscopy, the surgeon can see the size, location,
and number of endometrial growths. Sometimes a piece of
tissue is removed (a biopsy) to help make a diagnosis.
How is it treated?
There is no cure for endometriosis. It is a disease that
can get more severe as you grow older. However, there are
many ways to lessen the symptoms and complications. The
treatment depends on the severity of the symptoms, the
location and degree of endometriosis, your age, and your
plans for childbearing.
If the only symptom is mild premenstrual pain, the only
treatment necessary may be a medication such as aspirin or
ibuprofen to relieve the pain.
If you have a diagnostic laparoscopy, your surgeon may use a
laser to remove the abnormal tissue at the time of the
laparoscopy, especially if you have a mild case of
endometriosis.
Your health care provider may prescribe birth control pills,
progesterone pills, or other drugs to control your hormones.
The purpose of these medicines is to control the hormone
stimulation of the endometriosis areas. These are usually
prescribed for 6 months, but the length of time varies with
individual circumstances.
If you take a drug to control your hormones, both the lining
of the uterus and the misplaced endometrial tissue will
decrease or stop bleeding each month. This should stop the
buildup of cysts and scar tissue and swelling outside the
uterus. The best and most effective drug treatment allows
your body to heal the endometriosis as much as possible by
stopping your menstrual periods for about 6 months. There
are several medications that can be used for this treatment.
Some of the drugs used for treatment of endometriosis are
very expensive. They are mainly used if you have
endometriosis and are also trying to become pregnant.
In many cases, combined treatment, conservative surgery
(removing or burning off the areas of endometrial tissue)
along with medications, is very helpful.
How long will the effects last?
No treatment has been found yet that is 100% effective. All
current therapy offers at least some relief from the
symptoms but not a cure. Endometriosis may recur or
progress after hormone therapy or surgery.
In severe cases, possible treatment is to surgically remove
the organs containing the growths (such as the fallopian
tubes, uterus, and the ovaries). If your uterus is removed,
you can never become pregnant.
How can I take care of myself?
Keep a careful record of your symptoms. The easiest way to
do this is to assign a number to each of the symptoms you
have and record them by number on your calendar for three
months. Record all symptoms, including any time lost from
work and leisure activities. Report the symptoms to your
health care provider. Take your calendar with you to your
appointment. If you have not yet been diagnosed with
endometriosis, your provider may not suspect endometriosis
without this information.
Try the following recommendations for easing your pain:
- Take warm baths.
- Rest.
- Wear loose clothing.
- Use a hot water bottle or heating pad on your abdomen.
- Avoid constipation by increasing the fiber in your
diet.
- Do relaxation exercises.
- Listen to soft music and breathe slow, deep breaths.
- Take pain medication as recommended by your health care
provider.
You may want to join a chapter of the Endometriosis
Association. This organization is a support group run by
women with endometriosis.
Endometriosis Association International Headquarters
8585 North 76th Place
Milwaukee, WI 53223
(800) 992-3636
http://www.endometriosisassn.org
What can be done to help prevent endometriosis?
Endometriosis is a condition that cannot be prevented or
cured. However, treatment can help control the symptoms.
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