Endometriosis

I’m a 24-year-old, and I’ve always had extremely painful periods. My doctor told me that I might have endometriosis. What is it, and what can be done about it?

Endometriosis is defined by having cells and tissue normally confined to the uterus (the endometrium) elsewhere in the body, usually within the pelvis and abdomen. During a period, the endometrium is shed each month as menstrual flow. Unfortunately, when this tissue is elsewhere, it does not get shed – but can cause inflammation and scarring.

How does this tissue get outside of the uterus?

A few theories exist; one is “retrograde menstruation”–endometrium that backs up the fallopian tubes during a period. Another is a change from the normal cells that line the abdominal cavity to endometrial cells–a process called metaplasia. In any case, when looked at under the microscope, endometriosis appears just like normal endometrial tissue.

What symptoms do women with endometriosis usually have?

For many, it means very painful menstrual periods refractory to over-the-counter medications. Endometriosis responds to hormones much like normal endometrium, and this can cause cramping and pain. Sometimes this results in chronic inflammation leading to pelvic pain outside of periods and painful intercourse. Occasionally, endometriosis is not painful, but still causes scarring of the ovaries and fallopian tubes and infertility.

Health providers often presumptively diagnose endometriosis on the basis of symptoms and physical exam. Laparoscopy (introducing a camera within the abdomen) with biopsy confirms the diagnosis. Since endometriosis responds to hormones, treatment is often directed there. Birth control pills, Depo-Provera, and Depo-Lupron (a medication that shuts off ovarian hormone production) are all commonly used. Endometriosis can also be ablated directly using the laparoscope and cautery or laser. Occasionally it is severe enough that hysterectomy is required.

Who should talk to their healthcare provider about endometriosis?

Women with:

1. painful periods that are unresponsive to routine medications (like Pamprin, Midol, Advil, Motrin);
2. chronic pelvic pain; or
3. painful sexual intercourse. Don’t accept these symptoms as normal! Even if endometriosis is not the cause, usually these symptoms can be improved with evaluation and treatment.