March is endometriosis awareness month and this month we will like to shed some light on all things Endometriosis, what it is, how to manage it and so first things first....

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What is Endometriosis? 

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Endometriosis is a common gynecological condition affecting an estimated 2 to 10 percent of American women of childbearing age. Endometriosis is commonly known as an inflammatory condition where the endometrium, the tissue that normally grows inside the uterus, grows outside of it. It typically involves the ovaries, fallopian tubes, and the pelvic lining. It rarely occurs outside of the pelvic region. 

Individuals with endometriosis will experience a thickening of the endometrial tissue that breaks down and bleeds during the menstrual cycle. But unlike a normal menstruation where the tissue exits the body, it will have no route for escape. It will become trapped causing cysts to form. 

It can also cause the surrounding tissue to become irritated, so scar tissue and adhesions form. The adhesions can cause pelvic tissue to stick to organs. 

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What are some causes of Endometriosis?

The main causes of endometriosis are still unknown. However there are a few theories;

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First theory - This suggests that during menstruation, some of the tissue backs up through the fallopian tubes into the abdomen, which is described as a reverse menstruation where it attaches and grows.

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Second theory - This suggests that endometrial tissue may travel and implant via blood or lymphatic channels which is pretty similar to the way cancer cells spread.

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Third theory - This suggests that cells in any location may transform into endometrial cells.

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Fourth theory - Endometriosis can also occur as a result of direct transplantation—in the abdominal wall after a cesarean section, for example.

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Additionally, it appears that certain families may have predisposing genetic factors to the disease.

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What are Endometriosis symptoms?

Endometriosis produces several unpleasant symptoms. These include: 

• Dysmenorrhea (painful periods) 
• Pain during sexual intercourse
• Pain during urination and bowel movements
• Excessive bleeding that can occur during and between periods
• Infertility
• Fatigue
• Digestive issues such as bloating, nausea, constipation, and diarrhea. These typically worsen during menstruation. 

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Where Endometriosis Can Occur

The most common sites of endometriosis include:

• The ovaries
• The fallopian tubes
• Ligaments that support the uterus (uterosacral ligaments)
• The posterior cul-de-sac, i.e., the space between the uterus and rectum
• The anterior cul-de-sac, i.e., the space between the uterus and bladder
• The outer surface of the uterus
• The lining of the pelvic cavity

Occasionally, endometrial tissue is found in other places, such as:

• The intestines
• The rectum
• The bladder
• The vagina
• The cervix
• The vulva
• Abdominal surgery scars

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How is Endometriosis Diagnosed?

Although endometriosis is treatable, it is largely shrouded in mystery and often misunderstood and misdiagnosed.  While it’s estimated that 10% of women suffer with endometriosis, it is believed the most are not aware of their condition. 

However, for a lot of women having a diagnosis of endometriosis brings relief and kickstarts a journey of learning how to manage symptoms. This involves a meeting with a gynecologist or other health care provider to evaluate a patient’s medical history and completing a physical examination, which includes a pelvic exam. A diagnosis of endometriosis can only be certain, though, when the doctor performs a laparoscopy, biopsies any suspicious tissue and the diagnosis is confirmed by examining the tissue beneath a microscope.

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What is a Laparoscopy?

This is a minor surgical procedure in which a laparoscope, a thin tube with a camera at the end, is inserted into the abdomen through a small incision. Laparoscopy is also used to determine the location, extent and size of the endometrial growths.

Other examinations that may be used in the diagnosis of endometriosis include:

• Ultrasound: A diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs
• CT scan: A noninvasive diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images — often called slices — of the body to detect any abnormalities that may not show up on an ordinary X-ray
• MRI scan: A noninvasive procedure that produces a two-dimensional view of an internal organ or structure

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How can you treat Endometriosis?

Endometriosis can be treated or managed in many ways which include;

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1. Pain medication to relieve severe menstrual cramps associated with endometriosis. 

2. Hormone Therapy: When there is a  variance in hormone levels, it causes endometrial implants to thicken and break down during the menstrual cycle. Hormone medications and therapies can slow the growth of endometrial implants and prevent new ones from forming. 

3. Conservative Therapy: Surgery can be performed to remove endometriosis implants. The surgery can usually be performed laparoscopically so it will be minimally invasive. It will also preserve the uterus and ovaries. However, in some cases, the condition will return after surgery is performed. 

4. Fertility: There are treatments that target infertility associated with endometriosis. These range from methods used to stimulate the ovaries, so they produce more eggs to in-vitro fertilization. 

5. Hysterectomy with Removal of Ovaries: A hysterectomy involves the removal of the uterus. In the past it was often combined with a removal of the ovaries (oophorectomy) in the treatment of endometriosis. However, doctors are now moving away from this type of surgery as endometriosis can continue causing symptoms after it is performed. The procedure also leads to its share of health risks. 

Endometriosis is a largely undiagnosed condition. Raising awareness regarding its symptoms and treatments can help women get the care they need. Here’s wishing you and yours the very best of health and happiness. It is important to discuss any or all of these treatments thoroughly with your health care provider, as some may conflict with the effectiveness of others.