Endometriosis

Endometriosis is an often painful, progressive disorder in which the tissue inside the uterus—the endometrium—is found outside the uterus. This “rogue” tissue most often appears in and around the ovaries, fallopian tubes, bowel, bladder, uterus and uterine ligaments and in the lining of the pelvis, where it is subsequently called endometriosis. Rarely, it may be found beyond the pelvic area in other regions of the body.

Endometriosis can be very painful, because the extrauterine endometrial tissue acts as normal endometrial tissue would—it thickens, breaks down and bleeds in response to hormonal cues associated with the menstrual cycle. But because this tissue has no way to exit the body, it becomes trapped. This creates inflammation in the area surrounding the endometriosis, which can create pain as well as bowel and bladder symptoms. When endometriosis involves the ovaries, cysts, called endometriomas, may form. When endometriosis involves the uterine muscle, it forms adenomyosis. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions—abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other. Sometimes scar tissue and adhesions can affect the uterus and fallopian tubes, impacting fertility. Infertility may also be caused if the inflammation and chemicals secreted by the endometriosis affect implantation.
Behavior:
  • Try using a heating pad or taking a hot bath to ease pain associated with endometriosis.
  • Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs including ibuprofen and naproxen) can lessen the pain of endometriosis during your menstrual period, as well as block prostaglandins (natural body substances) that promote inflammation and uterine contractions.

Diet:
  • Limit your intake of alcohol and caffeine, as these can interact with the body’s production and release of estrogen and cause unpredictable spikes in estrogen that worsen endometriosis symptoms.
  • Consider limiting your intake of trans fats (e.g., baked goods, fried foods, highly processed foods, margarine and microwave popcorn). Some research indicates a link between high levels of dietary trans fats and increased risk of endometriosis.
  • Eat a healthy, balanced diet with adequate intake of essential vitamins and minerals, including magnesium, thiamine (vitamin B1), and vitamins A, C, D and E. A daily multivitamin can help offset any gaps in dietary intake, but the best, most supportive way to get these vitamins to the body is through food.

Exercise:
  • Regular exercise can help control estrogen and other hormones that fuel the growth and activity of endometrial tissue.

Lifestyle Factors:
  • Support your body’s ability to withstand pain by getting enough sleep—at least seven to eight hours a night.

Stress Management:
  • Relaxation techniques can curb stress that worsens endometriosis symptoms as well as assist with pain management when symptoms are at their worst. Some proven techniques include deep breathing, guided imagery, mindfulness meditation, progressive muscle relaxation and yoga.
Treating endometriosis depends on the progression of your condition, your symptoms and whether you want to have children. Targeted medicine is usually the first line of defense against endometriosis if you are not actively seeking pregnancy. Surgery may also be an option to relieve pain and/or improve fertility.

Treatments for Endometriosis
  • Medication: Hormone therapy, in combination with pain relievers, can often relieve pain associated with endometriosis. Hormone therapy may also slow endometrial tissue growth and prevent new extrauterine endometrial tissue from implanting. Different types of hormone therapy include:
    • Hormonal contraceptives: Hormonal contraceptives include birth control pills, patches and vaginal rings.
    • Progestin therapy: This synthetic progesterone is available in a variety of forms, including an intrauterine device with levonorgestrel, a contraceptive implant, a contraceptive injection, or a progestin pill. These medications can decrease or eliminate the flow of menstrual periods and suppress the growth of endometriosis.
    • Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists: These drugs block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation. These drugs also cause endometrial tissue to shrink. Because they create an artificial menopause, taking a low dose of progestin along with Gn-RH agonists and antagonists may decrease menopausal side effects and help prevent bone loss. Menstrual periods and the ability to get pregnant return when medication stops.
    • Aromatase inhibitors: This medication is sometimes used off-label (in a non-FDA-approved use) to reduce the amount of estrogen in your body in both reproductive-age and postmenopausal women.
  • Surgery: When medical options fail or cannot be used because of side effects or the immediate desire for pregnancy, surgery can help with the symptoms produced by endometriosis. Spectrum Health’s complex gynecologic surgeons are leaders in complex robotic and minimally invasive procedures. Your surgeon will discuss your personalized plan for medical and surgical treatment after evaluation and discussion of your risk factors, prior treatments or surgeries, stage of disease, and symptoms A variety of surgical procedures exist to treat endometriosis, including:
    • Conservative surgery: Surgery to remove (excise) endometriosis while preserving the uterus and ovaries using minimally invasive laparoscopic and robotic procedures. In cases of severe endometriosis, your gynecologic surgeon may sometimes collaborate with surgeons in other specialties, including colorectal surgeons, urologists, liver surgeons and cardiopulmonary surgeons.
    • Hysterectomy with or without removal of the ovaries: Minimally invasive surgery to remove the uterus, endometriosis, and sometimes the ovaries and/or the fallopian tubes.
  • Alternative Therapies: Some women, particularly young women, report lessening of endometriosis symptoms with acupuncture, electrical nerve stimulation, pelvic massage and other treatments.
How common is endometriosis?
Up to 10% of women of reproductive age have endometriosis—which translates to about 5 million women in the U.S.

Who gets endometriosis?
Endometriosis mainly affects women during their reproductive years—the years between the onset of menstruation (menarche) and a woman’s final period (menopause).

What are the symptoms of endometriosis?
The most common symptom of endometriosis is pain: pain before and during menstruation, pain during ovulation, pain associated with bowel movements, and pain during or after sexual activity. Over time, pain can become more constant and not just associated with the menstrual cycle. Some women also experience heavy periods that last longer than five to seven days, bleeding between periods, severe fatigue and difficulty getting pregnant. Other women have back pain; bloating; and bowel symptoms such as diarrhea, constipation or other intestinal upset with periods. Many women have symptoms for years before their endometriosis is diagnosed and effectively treated.

Isn’t it normal to have painful periods?
No, it is not normal. Normal periods may produce some cramping that causes discomfort relieved by over-the-counter pain medications, but periods should not be excruciatingly painful to the point of being curled up in a ball or missing school or work.

I have tried treatment for endometriosis in the past and it didn’t help my pain. Is there anything that can help me?
Endometriosis pain is often accompanied by other pain conditions, especially if the pain has been present for a long time. These other conditions can continue to cause pain even after endometriosis has been removed or treated. Other conditions that are frequently found in combination with endometriosis include pelvic floor muscle dysfunction and spasm, painful bladder syndrome/interstitial cystitis, fibromyalgia and chronic pelvic pain syndrome. There are treatments for these conditions that can help relieve symptoms and improve pain.

How often does endometriosis affect fertility?
An estimated 30%-40% of women with endometriosis will have at least some difficulty becoming pregnant. This, however, means that 60%-70% will likely have no problems. It is important to note that problems with fertility can occur even absent severe pain, and the presence of severe pain doesn’t necessarily indicate endometriosis is impacting fertility.

Will pregnancy cure endometriosis?
No, though some women find their pain symptoms are reduced during pregnancy. In most cases, endometriosis will return after giving birth and stopping breast feeding.

How is endometriosis diagnosed?
The only way to definitively diagnose endometriosis is during laparoscopy, a minor surgical procedure. However, many health care providers are able to infer an endometriosis diagnosis from a woman’s symptoms and start treatment on that basis. If treatment is not helping symptoms, surgical diagnosis is often recommended.

Is endometriosis a sexually transmitted disease or infectious?
No. Endometriosis cannot be transferred from one person to another. While the cause is unknown, genetics likely play a role. Research shows that women who have a first-degree relative with endometriosis (mother or sister) are seven times more likely to develop endometriosis themselves.

Is there a cure for endometriosis?
Unfortunately, no. However, endometriosis can be treated, and many women with endometriosis are able to successfully manage their symptoms through a combination of lifestyle changes, medication and/or surgery.