Recognised as one of the top 10 most painful diseases, endometriosis is prevalent in one in eight women and girls. Especially women of reproductive age, struck down in the prime of their lives suffer with excruciating pain due to endometriosis. Despite of being a common disorder, sufficient awareness and care for this condition is lacking. Sometimes it takes as long as 10 years to diagnose this condition and seek medical attention accordingly.
Not all women are aware of symptoms, treatments and the impact it can have on their lives if left untreated. Especially preteens and teenagers are susceptible to misdiagnosis.
This article aims to promoting a greater awareness and understanding of the disease; highlighting the consequences of living with endometriosis for the sufferers, caregivers and all those affected by the disease; creating a greater awareness and understanding of endometriosis amongst the medical profession, education sector, employers, politicians and society in general; seeking a best practice and consistent care and treatment for everyone wherever they may live; providing an opportunity for those whose lives have been affected by endometriosis; and encouraging them to play an active part in helping to make a difference.
What is Endometriosis?
Endometriosis is a condition in which tissue similar to the lining inside the uterus (called “the endometrium”), is found outside the uterus, where it induces a chronic inflammatory reaction that may result in scar tissue. It is primarily found on the pelvic peritoneum, on the ovaries, in the recto-vaginal septum, on the bladder, and bowel.
Endometriosis affects an estimated 1 in 10 women, especially between the ages of 15 to 49. This accounts to approximately 176 million of women’s population in the world.
However, endometriosis can start as early as a girl’s first period, and menopause may not resolve the symptoms of endometriosis – especially if the woman has scar tissue or adhesions from the disease and/or surgery.
The cause of endometriosis is unknown, but researchers have several theories. One theory is that during menstruation, blood with endometrial cells flows back into the fallopian tubes, according to the Mayo Clinic. The cells are rooted there and grow a new lining. Another theory is that the bloodstream carries endometrial cells throughout the body.
It’s also possible that problems with the immune system contribute to the development of endometriosis, when the immune system does not properly detect and destroy endometrial tissue outside of the uterus.
Yet another theory is that abdominal cells that were present since a woman’s embryonic state retain their ability to become endometrial cells. Because endometriosis sometimes run in families, it’s theorized that a person’s genetics can contribute to the development of the condition.
The most common symptom of endometriosis is cramping during menstruation, which can get worse over time, and can be debilitating. The pain is due to internal bleeding from the lining being shed inside the body — in a place where it doesn’t belong — and can also lead to scar tissue formation, blocked fallopian tubes, and bowel problems.
Although many women experience some pain during their periods, women with endometriosis often say their menstrual pain is much worse than usual, and increases over time.
At first, some women with endometriosis experience pain just before the start of their period, but as the condition progresses, the pain may start in mid-cycle (during ovulation), and continue until after the woman’s period ends. Women with the condition may also experience pain while having sex, fatigue, painful urination or bowel movements during menstruation and gastrointestinal upset. Infertility and bleeding between periods are also symptoms of endometriosis. Some women don’t experience any symptoms at all, but realize they have the condition when they are unable to get pregnant.
The only way for endometriosis to be diagnosed for certain is through laparoscopy, which is a minor surgical procedure that involves your doctor putting a thin scope into your abdomen to view your pelvic organs. If the doctor sees the extra endometrial tissue during the laparoscopy, he or she can also remove it right there to treat the condition.
However, other basic medical tests are typically performed first, before a laparoscopy. These include a pelvic exam, where the doctor manually feels for abnormalities such as cysts, or an abdominal or vaginal ultrasound, which uses sound waves to create an image of the uterus and reproductive organs. Vaginal and abdominal ultrasounds can’t definitively diagnosis endometriosis, but they can test for cysts that may be caused by the condition.
Treatment for endometriosis can involve pain medication (for the severe cramping), hormone therapy to slow growth of the endometrial tissue and surgery to remove the tissue. A number of factors go into determining a woman’s treatment, including her age, the severity of her symptoms, and whether the patient wants to become pregnant.
For women who are not trying to become pregnant, administering the hormonal birth control pills is usually the first step in treatment.
For women who are trying to become pregnant, treatment may involve gonadotropin-releasing hormone (GnRH) agonist, which stops ovulation, according to the Office on Women’s Health. This treatment is usually recommended for only six months at a time, and pregnancy is possible once treatment is stopped.
For women whose symptoms are not relieved by medication, surgery is another treatment option. Laparoscopy and laparotomy are common forms of surgery used to treat endometriosis. They require going in through the abdominal region to remove the endometrial tissue.
Most women experience relief from pain after surgery, but the pain may come back within two years, according to ACOG. Birth-control pills and other medications may be used along with surgery to help extend the pain-free period.
However, if symptoms keep coming back after these surgical procedures, a hysterectomy, or total removal of the uterus, may be a “last resort” option, after which the condition is less likely to come back.
Our specialists at Milann will discuss the treatment options with you and outline the risks and benefits of each, with respect to your age, symptoms you would be facing and whether or not you want to conceive pregnancy.