Endometriosis Awareness Month: Living healthy with endometriosis

Posted by Stephani Monhollon on Mar 8, 2022 7:00:00 AM
5 minute read

Throughout a woman’s life, she goes through many hormonal changes and cycles, from menstruating and bearing children to menopause later in life. While that’s a simple overview, the female reproductive system is quite complex, which means many issues can arise that often require some form of medical intervention. Endometriosis is one such issue. While diagnosis is challenging, there are many ways to improve the quality of life for those suffering from this common and sometimes-debilitating gynecological disorder.


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What is endometriosis?

Endometriosis, or “endo” to some, is a condition affecting approximately 10% (200 million) of reproductive-aged women worldwide where abnormal tissue (lesions or nodules) similar to the uterus lining (endometrium) grows beyond the uterus (ectopic). While endometriosis is commonly found in areas such as the ovaries, fallopian tubes, ligaments supporting the uterus and the external surface of the uterus, it can grow anywhere in the body.

“Endometriosis is typically found in reproductive organs within the abdominopelvic cavity,” said Jordan Rush, M.D., an obstetrician-gynecologist with Northside Women’s Specialists, part of Pediatrix® Medical Group, in Atlanta. “However, it can be found anywhere in the body, such as the recto-vaginal septum, bladder and bowel and, in rare cases, even in areas such as the lungs and nasal passage.”

In terms of the reproductive system, like a menstrual cycle where the lining of the uterus thickens, breaks down and bleeds, ultimately exiting the body, endometriosis tissue goes through the same process, but it has no way of leaving the body. When this happens, blood pools in the affected areas, causing thick bands of scar tissue (adhesions) to form, which, over time, can cause the affected organs to stick together.

Symptoms

Various symptoms of endometriosis may present, such as:

  • Painful menstrual periods (dysmenorrhea).
  • Prolonged pelvic pain.
  • Pain during or after sexual intercourse (dyspareunia).
  • Painful bowel movements (dyschezia).
  • Painful urination (dysuria).
  • Exhaustion/fatigue.
  • Anxiety or depression.
  • Bloating or swelling.
  • Nausea.
  • Infertility.

The amount and size of endometrial lesions and the acuteness or duration of symptoms have little association with one another. Some women may have numerous sizeable lesions but only experience mild symptoms, while others may have severe symptoms with only a few small lesions.

“Every woman and every case of endometriosis is unique,” said Dr. Rush. “Some may have symptoms that are severe and disruptive to everyday life. Others may have symptoms that are more annoying than incapacitating.”

Causes

Simply put, there is no known cause of endometriosis. The disease is highly complex, and a single root cause has yet to be discovered. Though, there are a few theories about how it materializes:

  • Retrograde menstruation — During the menstrual cycle, blood may contain endometrial cells that move in the wrong direction, traveling through the fallopian tubes and into the abdominopelvic cavity rather than exiting the body through the vagina. The cells can embed anywhere in the cavity. From there, they grow to form endometriosis.
  • Cellular metaplasia — This happens when endometrial-like cells outside the uterus mutate and begin to grow.
  • Stem cells — Stem cells are commonly known to regenerate and repair parts of the body. However, because the uterus lining is rich with various stem cell populations, there are significant opportunities for dislocated or aberrant stem cells to promote endometriosis growth and, in some cases, help the disease spread through the blood and lymphatic vessels.

Diagnosis

Diagnosing endometriosis isn’t as simple as running bloodwork or taking x-rays. It can only be officially diagnosed via laparoscopy, a minimally invasive surgery. Because this is the only method to prove the disease exists, a woman can have it for several years before it’s formally diagnosed. In addition, about 25% of women with endometriosis are asymptomatic, giving the disease more time to spread.

“A woman may have all the symptoms pointing to endometriosis, but it cannot be officially diagnosed without performing a laparoscopy,” said Dr. Rush. “This is when we make a small incision in the abdomen so a very tiny video camera called a laparoscope can be inserted, enabling us to inspect the external parts of organs, such as the uterus, ovaries and fallopian tubes. This allows us to take tissue samples and, in some cases, remove scar tissue.”

Addressing endometriosis symptoms

As with the cause of endometriosis, there is no known cure. However, there are several ways to treat the disease, ranging from over-the-counter medications, prescription medicines and non-invasive procedures to major surgery.

  • Non-prescription pain relievers — Over-the-counter pain relievers, such as nonsteroidal anti-inflammatories, may help reduce pain.
  • Hormone therapy — Various types of hormone therapy, such as oral contraceptives, may be used to control the fluctuating levels of estrogen and progesterone during the menstrual cycle, which cause bleeding and pain.
  • Natural therapies — Some women opt for natural treatments, such as herbal medicine, Chinese medicine, massage and nutritional remedies to help manage symptoms.
  • Surgery — Treatments may include non-invasive and major surgeries, such as:
    • Laparoscopic surgery — A non-invasive way to remove or burn endometrium-like cells, cysts, nodules and adhesions.
    • Laparotomy — If laparoscopy isn’t an option, a laparotomy may be performed, which is considered major surgery. However, there is a good chance that the endometriosis will return with either procedure.
    • Hysterectomy — A hysterectomy, which removes the uterus and both ovaries, is the only way to stop endometriosis from recurring and spreading.
  • In vitro fertilization (IVF) — Infertility is a devastating reality for women with endometriosis. It is estimated that between one-third and one-half of women with the disease have difficulty conceiving, many of whom cannot become pregnant. More than 55,000 women each year deliver a baby who was conceived via IVF, making it a viable option for many women with endometriosis.

“There are numerous ways we can help women facing endometriosis,” said Dr. Rush. “They shouldn’t have to suffer with excruciating pain or succumb to exhaustion, anxiety, depression, bloating or any of the various symptoms of the disease. Nor should they be denied parenthood. We have a long way to go in finding a cure for endometriosis, but there are many things we can do today to help women alleviate their symptoms, have children and live healthy, normal lives.”

Topics: Education, Maternal-Fetal Medicine, Health Observances, OB/GYN