Endometriosis is an often overlooked yet serious issue that affects one in ten women of reproductive age. While you may know someone diagnosed with it, or suffer from endometriosis yourself, it’s important to remember that diagnosis can take seven to ten years from when you first experience symptoms.
Many women who actually have endometriosis may have been dismissed or gaslighted over their symptoms in the past – but the pain and complications that come with it are very much real. Read on to learn more about endometriosis and what the treatment options are.
What is endometriosis?
The uterus is lined with endometriosis tissue called the endometrium. Every menstrual cycle, your body grows a new endometrium in preparation for a fertilized egg. When you have endometriosis, this tissue grows outside the uterus on other parts of the body.
Because the endometriosis tissue grows elsewhere and in the wrong areas, you experience pain and discomfort. Endometriosis tissue can grow on or around your abdomen, pelvis, fallopian tubes, ovaries, vagina, bladder, intestines, diaphragm, rectum, intestines, and peritoneum. The tissue can become more inflamed during your menstrual cycle, causing adhesions, ovarian cysts, deep nodules, superficial lesions, and scar tissue.
During your menstrual cycle, endometrial tissue growing in these places does not shed the way it would inside the uterus, causing pain or scarring. It can also be accompanied by heavy or irregular periods, issues with bowel movements during periods (whether diarrhea or constipation), fatigue, spotting between periods, or pain while urinating.
Some women who suffer from endometriosis may also have issues with fertility – in fact, it’s actually one of the most common conditions associated with infertility. Depending on the severity of your endometriosis, infertility may be temporary or permanent. There is no exact cause explaining this, but one reason it may happen is due to scar tissue that affects ovulation, preventing eggs from moving through the fallopian tubes to the uterus. This condition may also damage fertilized eggs and sperm before implantation.
How can endometriosis be treated?
Endometriosis is an idiopathic condition, which means that there is no determined cause – although there are some risk factors. Some of these include: family history of endometriosis, early menstruation, a diagnosed abnormal uterus, heavy and long menstrual cycles, and even shorter menstrual cycles.
The treatment for endometriosis is more about management, and working with an OBGYN can help you best determine what works for your needs and lifestyle. You can either go through the nonsurgical or surgical route, or a combination of both.
Nonsurgical treatment options
Estrogen facilitates the growth and shedding of endometriosis tissue, which is what can exacerbate the pain. Doctors may suggest hormone therapy or treatment which inhibits or lessens estrogen production, therefore shrinking endometriosis tissue. There are several different types of hormone therapy for endometriosis, including the following:
1. Combined oral contraceptive pills
These contain estrogen and progestogen, and stop ovulation from occurring. Combined oral contraceptives can lighten periods, make them less painful, and manage symptoms of endometriosis. They can also be used over long durations of time.
These are synthetic hormones that function like progesterone, which hinder the growth of endometriosis tissue and womb lining. Common progestogens include contraceptive implants, contraceptive injections, intrauterine systems (IUS), progesterone-only pills, or progesterone tablets.
3. Gonadotropin-releasing hormone (GnRH) analogues
GnRH analogues are synthetic hormones, which lessen estrogen production but can result in temporary menopause. Sometimes, these are given for a period following a laparoscopy or when other hormone treatments do not work.
Although hormone therapy is effective in treating endometriosis, there are some side effects as well. In addition, hormone therapy does not make you more fertile or have an effect on the adhesions or parts of tissue that may make organs stick together.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen sodium, or paracetamol may be given by your doctor for management of painful menstrual cramps.
Surgical treatment options
Surgery can improve symptoms of endometriosis by removing endometriosis tissue. Depending on how much endometriosis you have and where it is located, the types of surgery will differ. Some options for surgery include:
Hysterectomies may be recommended if you do not intend to get pregnant, as it involves the removal of the womb. This is a major decision as you will be unable to reverse a hysterectomy. There is no 100% guarantee that endometriosis symptoms will not return, especially if the cervix and ovaries are left behind.
Laparoscopies or keyhole surgeries are less invasive as only small incisions are made on your stomach to remove endometriosis tissue. Using a laparoscope, which has a light and camera, your surgeon will be able to view images of your pelvis and stomach. Small instruments can cut endometrial tissue through excision, and apply heat to destroy this tissue through ablation. They can also remove other adhesions or ovarian cysts, as well as built-up scar tissue. In some cases, a laparoscopy can improve fertility and ultimately relieve you of endometriosis symptoms.
Oophorectomies involve the removal of the ovaries, and can be done with or without a hysterectomy depending on what your doctor advises. While this stops the release of hormones, decreases estrogen levels, and slows down the growth of endometrial tissue, it will put you into early menopause. In the event that you still have your uterus, you may still try to get pregnant through IVF.
With the right treatment, you may experience relief from endometriosis symptoms. Coupling your chosen treatment with a change in lifestyle may also help with endometriosis management. This may include eating a diet rich in fiber, iron, antioxidants, and essential fatty acids to help combat inflammation and pain. However, it is still important to schedule regular check-ups with your OBGYN to ensure that these do not return or that endometriosis tissue does not grow back.
Your OBGYN can give you peace of mind and help you feel validated, especially as endometriosis can take a physical, mental, and emotional toll.
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