Symptoms and treatment of Endometriosis

Description

Endometriosis (en-doe-me-tree-O-sis) is an often-painful condition in which tissue that is similar to the inner lining of the uterus grows outside of the uterus. Often affects the ovaries, fallopian tubes and the tissue lining the pelvis. Rarely, endometriosis, tumors can be found beyond the area where the organs of the pelvis is located.

The Endometriosis tissue acts as the inner lining of the uterus applicants that thickens, breaks down and bleeds with each menstrual cycle. But it grows in places where it doesn't belong, and it doesn't leave the body. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated and form scar tissue. Bands of fibrous tissue called adhesions can also form. These can cause pelvic tissues and organs to stick to each other.

Endometriosis can cause pain, especially during menstrual periods. Fertility problems also may develop. But treatments can help you take charge of the disease and its complications.

Symptoms

The main symptom of endometriosis is pelvic pain. It is often linked to the menstrual periods. Although many people have cramps during their period, those with endometriosis often describe menstrual pain that is much worse than usual. The pain may also worsen with time.

The common symptoms of endometriosis include:

Painful periods. Pelvic pain and cramping may begin before a menstrual period and the last one for the day in it. You may also have lower back and stomach pain. Another name for painful periods is dysmenorrhea.
The pain with sex. Pain during or after sex is common with endometriosis.
Pain with bowel movements or urination. It is very likely that you have these symptoms before or during the menstrual period.
Excessive bleeding. Sometimes, you may have heavy menstrual periods or bleeding between periods.
The infertility. For some people, the endometriosis was found for the first time during testing for the treatment of infertility.
Other symptoms. You may have fatigue, diarrhea, constipation, bloating, or nausea. These symptoms are more common before or during menstrual periods.

The severity of your pain may not be a sign that the number or extent of the endometriosis tumors in your body. You may have a small amount of tissue with a lot of pain. Or you may have a lot of endometriosis tissue with little or no pain.

Even so, some people with this disease do not have symptoms. Often, they find out they have the disease when they can't get pregnant or after you receive the surgery for another reason.

For those with symptoms of endometriosis can sometimes look like other conditions that can cause pelvic pain. These include pelvic inflammatory disease or ovarian cysts. Or may be confused with irritable bowel syndrome (IBS), which causes outbreaks of diarrhea, constipation and stomach cramps. IBS can also occur along with endometriosis. This makes it more difficult for your health care team to find the exact cause of the symptoms.

When to see a doctor

See a member of your health care team if you think you might have symptoms of endometriosis.

Endometriosis can be a challenge to manage. You may be more able to take charge of the symptoms if:

Your care team is the disease sooner rather than later.
Learn as much as you can about endometriosis.
You get treatment from a team of health professionals from different fields of medicine, if necessary.

Causes

The exact cause of endometriosis is not clear. But some of the possible causes include:

Retrograde menstruation. This is when the menstrual blood flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. The blood containing endometrial cells of the inner layer of the uterus. These cells can stick to the walls of the pelvis and of the surfaces of the pelvic organs. There, they can grow and continue to thicken and bleed over the course of each menstrual cycle.
Transforms the peritoneal cells. Experts suggest that hormones or immune factors could help to transform the cells that line the inner part of the abdomen called peritoneal cells, in cells that are like those that line the inside of the uterus.
Embryonic cells changes. Hormones such as estrogen can transform cells embryonic cells in early stages of development — in the endometrium, such as cell growth during puberty.
The surgical scar complication. Endometrial cells may attach to the tissue of the scar from a cut made during surgery to the stomach area, such as a cesarean section.
The endometrial cells of transport. The blood vessels or fluid of the system you can move the endometrial cells to other parts of the body.
Condition of the immune system. A problem with the immune system can make the body unable to recognize and destroy endometrial tissue.

Risk factors

The factors that increase the risk of endometriosis include:

Never give birth.
Starting your period at an early age.
Going through menopause at an older age.
Short menstrual cycles — for example, less than 27 days.
Menstrual periods that last longer than seven days.
Have higher levels of estrogen in your body or in a greater lifetime exposure to estrogen your body produces.
Low body mass index.
One or more relatives with endometriosis, as a mother, aunt or sister.

Any health condition that prevents the blood from flowing out of the body during menstruation may also be endometriosis risk factor. So you can to the conditions of the reproductive tract.

The symptoms of Endometriosis often occur years after the onset of menstruation. The symptoms may improve for a time with the pregnancy. The pain may become softer over time with the menopause, unless you take estrogen therapy.

Complications

Infertility

The main complication of endometriosis is difficulty in getting pregnant, which is also called infertility. Up to half of people with endometriosis have difficulty conceiving.

For pregnancy to occur, an egg must be released from the ovary. The egg has to travel through the fallopian tube and to be fertilized by a sperm. The fertilized egg will then need to adhere to the uterine wall to begin development. Endometriosis can block the tube and keep the egg and sperm from uniting. But the problem also seems to affect fertility in a direct way. For example, it may damage the sperm or egg.

Even so, many of them with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Health professionals sometimes advise those with endometriosis not to delay having children. That's because the condition may worsen with time.

Cancer

Some studies suggest that endometriosis increases the risk of ovarian cancer. But overall, the lifetime risk of ovarian cancer is low, to begin with. And is kept quite low in people with endometriosis. Although rare, another type of cancer called endometriosis-associated adenocarcinoma can occur later in life that I had endometriosis.

Diagnosis

To find out if you have endometriosis, your doctor is likely to start by giving you a physical exam. You are asked to describe your symptoms, how, where and when you feel the pain.

Tests to check the tracks of endometriosis include:

Pelvic exam. Your health care professional feels areas in your pelvis with one or two gloved fingers to check for any unusual changes. These changes can be cysts in the reproductive organs, painful spots, irregular growths called nodules and scars behind your uterus. Often, small areas of endometriosis can not be felt unless the cyst has formed.
Ultrasound. This test uses sound waves to create pictures of the inside of the body. To capture the images, a device called a transducer can be pressed against the stomach area. Or it can be placed in the vagina in a version of the test that is called a transvaginal ultrasound. Both types of test can be done to get the best view of the reproductive organs. A standard ultrasound, do not confirm if you have endometriosis. But you can find cysts associated with the condition called endometriomas.
Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to produce images of the organs and tissues within the body. For some, a magnetic resonance imaging helps with surgical planning. Gives your surgeon detailed information on the location and the size of the endometriosis tumors.
The laparoscopy.In some cases, you may be referred to a surgeon for this procedure. Laparoscopy allows the surgeon to check on the inside of your abdomen for signs of endometriosis, the tissue. Before the surgery, you will receive medications that puts you in a state similar to sleep, and avoids the pain. Then, the surgeon makes a small incision near the navel and inserts a thin viewing instrument called a laparoscope. A laparoscopy can provide information on the location, extent, and size of the endometriosis tumors. Your surgeon may take a tissue sample called a biopsy for further testing. With proper planning, a surgeon can often the treatment of endometriosis during laparoscopy for that you only need a surgery.

The laparoscopy. In some cases, you may be referred to a surgeon for this procedure. Laparoscopy allows the surgeon to check on the inside of your abdomen for signs of endometriosis, the tissue. Before the surgery, you will receive medications that puts you in a state similar to sleep, and avoids the pain. Then, the surgeon makes a small incision near the navel and inserts a thin viewing instrument called a laparoscope.

A laparoscopy can provide information on the location, extent, and size of the endometriosis tumors. Your surgeon may take a tissue sample called a biopsy for further testing. With proper planning, a surgeon can often the treatment of endometriosis during laparoscopy for that you only need a surgery.

Treatment

The treatment for endometriosis often involves medication or surgery. The approach that you and your health care team to choose will depend on the seriousness of the symptoms and if you hope to become pregnant.

Usually, the medication is recommended in the first place. If this doesn't help enough, the surgery becomes an option.

Pain medications

Your health care team may recommend painkillers that you can buy without a prescription. These drugs include the nonsteroidal anti-inflammatory drugs (Nsaids), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve). They can help to relieve painful menstrual cramps.

Your health care team may recommend hormone therapy, along with pain relievers if you are not trying to get pregnant.

Hormone therapy

Sometimes, hormone medicine to help relieve or eliminate the pain of endometriosis. The rise and fall of hormones during the menstrual cycle of the causes of endometriosis tissue to thicken, break down and bleed. Laboratory versions of hormones can slow the growth of this tissue and prevent the formation of new tissue.

Hormone therapy is not a permanent solution for endometriosis. Symptoms may return after you stop treatment.

Therapies used for the treatment of endometriosis include:

Hormonal contraceptives. Birth control pills, injections, patches, and vaginal rings that help control the hormones that stimulate endometriosis. Many have lighter and shorter menstrual flow when using hormonal contraceptives. The use of hormonal contraceptives can alleviate or eliminate pain in some cases. The possibilities of relief seem to go whether the use of birth control pills for a year or more without a break.
The gonadotropin-releasing hormone (Gn-RH) agonists and antagonists. These drugs block the menstrual cycle and lower estrogen levels. This makes the endometriosis, the tissue is reduced. These drugs create an artificial menopause. Taking a low dose of estrogen or progesterone, in conjunction with the Gn-RH agonists and antagonists can alleviate the side effects of menopause. These include hot flashes, vaginal dryness, and bone loss. Menstrual periods, and the ability to become pregnant returns when you stop taking the medicine.
Progestin therapy. Progestin is a lab-made version of a hormone that plays a role in the menstrual cycle and pregnancy. A variety of progestin treatments can stop the menstrual periods and the growth of endometriosis, the tissue, which may relieve the symptoms. The progestin therapies include a small device that's placed in the uterus that releases levonorgestrel (Mirena, Skyla, other), a contraceptive rod is placed under the skin of the arm (Nexplanon), the birth control injection (Depo-Provera) or progestin-only birth control pill (Camila, Slynd).
Aromatase inhibitors. These are a class of medications that reduce the amount of estrogen in the body. Your health care team may recommend an aromatase inhibitor, together with a progestin or combination of birth control pills for the treatment of endometriosis.

Conservative surgery

Conservative surgery remove endometriosis tissue. It aims to preserve the uterus and the ovaries. If you have endometriosis and you are trying to get pregnant, this type of surgery may increase your chances of success. It can also help if the condition causes a terrible pain — but the endometriosis and the pain may return in the time after the surgery.

The surgeon can perform this procedure with small cuts, also called laparoscopic surgery. Less often, a surgery that involves a larger incision in the abdomen, it is necessary to remove the thick bands of scar tissue. But even in cases of endometriosis, the majority can be treated with the laparoscopic method.

During laparoscopic surgery, the surgeon places a thin viewing instrument called a laparoscope through a small incision near the belly button. The surgical instruments are inserted to remove the endometriosis, the tissue through a small cut. Some surgeons, laparoscopy with the help of robotic devices that they control. After the surgery, your health care team may recommend taking hormone medicine to help improve the pain.

Fertility treatment

Endometriosis can lead to problems getting pregnant. If you have a hard time to conceive, your health care team may recommend a fertility treatment. You may be referred to a doctor who treats infertility, call a physician assisted reproduction. Fertility treatment may include medication that helps the ovaries to produce more eggs. You can also include a series of procedures that mix together the eggs and sperm outside the body, called in vitro fertilization. The right treatment for you depends on your personal situation.

Hysterectomy with removal of ovaries

Hysterectomy is surgery to remove the uterus. Take out the uterus and ovaries was thought to be the most effective treatment for endometriosis. Today, some experts believe that it is a last resort to relieve pain when other treatments have not worked. Other experts, instead of recommending the surgery that focuses on the careful and complete removal of all endometriotic tissue.

Having the ovaries, also called oophorectomy, causes early menopause. The lack of hormones produced by the ovaries can improve the pain of endometriosis for some. But for others, the endometriosis that is left after the surgery continues to be a cause of the symptoms. Early menopause, also carries a risk of heart disease and diseases of the blood vessels, certain metabolic conditions, and early death.

In people who do not want to become pregnant, hysterectomy, at times, can be used for the treatment of symptoms associated with endometriosis. These include heavy menstrual bleeding and painful menstruation due to uterine contractions. Even when the ovaries are left in place, a hysterectomy may still have a long term effect on your health. This is especially true if you have the surgery before the age of 35.

To manage and treat endometriosis, it is key to find a health care professional with whom you feel comfortable. You may want to get a second opinion before starting any treatment. That way, you can be sure you know all the options and the pros and cons of each one.

Lifestyle and home remedies

It may take time to find a treatment that works. Until then, you can try some things at home to ease your pain.

Baths of warm water and a heating pad can help to relax the muscles of the pelvis. This reduces cramping and pain.
Nonsteroidal anti-inflammatory drugs (Nsaids) can help relieve painful menstrual cramps. Nsaids include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).

You can also ask your health care team if physical therapy can help. A therapist can teach you how to relax the muscles that support the uterus, called the pelvic floor. Relax those tight muscles may help pelvic pain associated with endometriosis feel less intense.

Alternative medicine

Alternative medicine consists of treatments that are not part of standard medical care. Some people with endometriosis say that the relief of the pain of alternative therapies, such as:

Acupuncture, in which a trained practitioner places of very thin needles in the skin.
Chiropractic care, in which a licensed professional adjusts the spinal column and other body parts.
Herbs such as cinnamon, trig, or licorice root.
Supplements such as vitamin B1, magnesium and omega-3 fatty acids.

Acupuncture has been shown to be promising to relieve the pain of endometriosis. But in general, there is little research on a great relief to people with the condition of alternative medicine. Always consult with your health care team before you try a new therapeutic alternative to find out if it is safe for you. For example, the supplements and herbs can affect the standard treatments, such as medications. If you are interested in trying acupuncture or chiropractic care, ask your health care team to recommend reputable professionals. Check with your insurance company to see if the cost will be covered.

Coping and support

Think about joining a support group if you have endometriosis or a complication, such as fertility problems. Sometimes it is helpful just to talk to other people who can relate to their feelings and experiences. If you can not find a support group in your community, look for one online.

Preparing for your appointment

Your first appointment will probably be with your primary care doctor or a gynecologist. If you are looking for a treatment for infertility, you may be referred to a doctor called a reproductive endocrinologist.

Appointments can be brief, and can be difficult to remember everything that you want to discuss. So it's a good idea to plan ahead for your appointment.

What you can do

Make a list of the symptoms that you have. Include all the symptoms, even if you don't think that is related to the reason for your appointment.
Make a list of all the medicines, herbs or vitamin supplements you take. Include the frequency with which you take them, and how much to take, called the dose.
Have a family member or close friend to join you, if possible. You can get a lot of information on your visit, and can be difficult to remember everything.
Take a notepad or electronic device with you. Use to take notes of the important information during your visit.
Prepare a list of questions to ask your doctor. The list of your most important questions first, to make sure that you bring up those points.

For endometriosis, some basic questions to ask your doctor include:

How is endometriosis diagnosed?
What medications for the treatment of endometriosis? There is a medication that can relieve my symptoms?
What side effects can I expect from the medicine?
Do you recommend surgery?
Is endometriosis affects my ability to get pregnant?
Can the treatment of endometriosis to improve my fertility?
Can you recommend any alternative treatment that I could try?

Make sure that you understand all that your health care team tells you. It is okay to ask your team to repeat information or to ask questions.

What to expect from your doctor

Some of the questions your doctor may ask include:

How often do you have these symptoms?
How long have you had these symptoms?
How bad are the symptoms?
Do your symptoms seem to be related to your menstrual cycle?
Is there something to improve your symptoms?
Does anything make your symptoms worse?