ENDOMETRIOSIS

What is endometriosis?

There are 3 layers of the uterus:

Outer layer called serosa
Middle layer called myometrium
Inner layer called endometrium

Every month when you have your period, the endometrium is shed. Sometimes the endometrial tissue grows in other places in the body. When this happens, you can get a condition called endometriosis. It is a lifelong disease.

If you have endometriosis, you can find endometrial tissue on:

Ovaries
Fallopian tubes
Surface of the uterus
Cul-de-sac (the space behind the uterus)
Bowel and rectum
Bladder and ureter (the tube that connects your kidneys to your bladder)

If you have endometriosis, when you have your period every month, these spots of tissue outside the uterus can also bleed a small amount. Over time, this can cause the pelvic organs (like the uterus, ovaries, tubes, bladder and rectum) to stick together or you might develop a cyst on your ovary called an endometrioma. Over time, this can become painful. For some women, this can also cause problems getting pregnant.

How do I know if I have endometriosis?

If you have endometriosis, you might experience:

Painful periods
Pain with sex
Pain or blood with bowel movements
Pain or blood with urination
Difficulty getting pregnant

How is endometriosis diagnosed?

Endometriosis can be suspected based on your symptoms and a physical examination. You can start treatment for endometriosis without doing any other tests or surgeries.

Your doctor might get you to do an ultrasound to see if there are cysts on your ovaries or if there are signs of endometriosis. Endometriosis is often not seen on ultrasound unless you have severe disease and/or endometriomas.

Surgery can be used to diagnose and treat endometriosis. Laparoscopy (also known as keyhole surgery) is performed by making small incisions on your abdomen. A thin telescope with a light (called laparoscope) is put into your abdomen through the small incisions. This lets your gynecologist to look at your pelvic organs.

The severity of your symptoms does not always equal the severity of the disease. You might experience a lot of pain but your doctor might only see mild disease. On the other hand, you might have only a little pain, but your doctor might see very severe disease.

I have endometriosis. What medications can I use to treat my symptoms?

Treatment of endometriosis depends on how bad your symptoms are and if you want to have children. Most women need long-term treatment to control symptoms because symptoms might come back if medications are stopped. You should talk to your doctor to see what medication is best for you and what the side effects are.

Here are some options for treatment:

(1) Birth control pills: these hormone-based drugs decrease pain that is caused by endometriosis and can stop your menstrual period from coming.

(2) Progestins: these hormone-based drugs decrease pain that is caused by endometriosis and can stop your menstrual period from coming.

(3) Gonadotropin-releasing hormone (GnRH) agonists and antagonists: these medications decrease your hormone levels to reduce the pain that is caused by endometriosis. They can also stop your menstrual period from coming.

(4) Progestin-releasing intrauterine device: this T-shaped device can stay in the uterus for up to 5 years. It releases a hormone called progesterone to decrease pain with periods. It may also stop or lighten your menstrual period.

(5) Non-steroidal anti-inflammatory drugs (NSAIDs): this non-hormonal medication can help to relieve pain.

I am having difficulty getting pregnant. What should I do?

There are many reasons why you might be having difficulty getting pregnant. A fertility specialist can help you figure this out.

If you have mild endometriosis, surgery to remove your endometriosis might help you get pregnant. If you have severe endometriosis, you might need in vitro fertilization (IVF) to help you get pregnant.

Can I have surgery to remove the endometriosis?

You should consider surgery if:

You have tried medication and it is not working
You have symptoms from your endometriosis but cannot take medication because you want to try to get pregnant
You have serious complications to your bowels, bladder, or ureters from endometriosis
You have infertility and your doctor recommends surgery

Surgery can be done to remove endometriosis and the scarred tissue around it. Surgery is usually done by laparoscopy. At this hospital, your gynecologist will usually use a tool called a laser to cut out the endometriosis.

After surgery, you may have relief from pain. But, for many women, the pain will return. There is a 50% chance of the pain returning within 5 years after surgery. Your doctor might recommend medications to prevent your endometriosis from coming back so you can have a longer time period without pain.

If you do not want children and your pain is severe, you can consider a hysterectomy. This is the removal of your uterus. This might help better control your pain.

What else can I do to control endometriosis?

Some believe that changing your lifestyle can help treat your endometriosis. There is no scientific evidence to support this but there are also no known harms. Exercise and dietary changes can be helpful.

Diet: a macrobiotic diet, such as eating whole grains, vegetables, beans and lentils, can help control the endometriosis. You can also have fish, seafood, seeds and nuts. You should avoid processed foods, milk, cheese, red meat, and refined sugar.

Qigong: this is a traditional Chinese practice of body movement, meditation, deep breathing and a calm state of mind. If it is not available, yoga and mindful meditation are good alternatives.