Endometriosis Awareness Month!
- Rachel Hewitt-Gervig
- Mar 11, 2021
- 6 min read
March is Endometriosis Awareness month!
What is endometriosis?
Endometriosis occurs when tissue similar to the inner lining of the uterus, also known as the endometrium, is found outside its normal location, where the tissue should not be. This may result in inflammation, as the tissue even outside the uterus will respond to the monthly fluctuations of the menstrual cycle.
The disease affects 1 in 10 reproductive-aged individuals (aged 12-52) - an estimated 200 million women worldwide - and many often experience a decade-long delay in diagnosis. Currently, there is no known exact cause of endometriosis, and there is no cure.
Where can endometriosis be found?
Generally, endometriosis is found in the pelvic cavity. It can attach to any of the female reproductive organs including, but not limited to, the outside of the uterus, fallopian tubes, ovaries, uterosacral ligaments, peritoneum, and any of the spaces between the bladder, uterus, and vagina. Endometriosis can also involve other areas including the large and small bowel, appendix, diaphragm, lungs, and rectum.
What are the most common symptoms of endometriosis?
There are many symptoms of endometriosis, but not everyone will experience all, most, or even any of the symptoms. The disease can go undiagnosed for years and only present itself once the symptoms become severe.
Abnormal periods [including Periods with heavy bleeding (menorrhagia) and prolonged periods]: A typical period will last 3 to 5 days. While it is considered normal to have a period lasting as long as 7 days, individuals with endometriosis can have periods longer than 7 days. In addition, periods with heavy bleeding will mean that tampons or pads usually need to be changed as often as every 1-2 hours.
Painful periods [Painful menstrual cramps (dysmenorrhea)]: Pain can last for more than one day and even continue after the period is over. Most commonly, pain can be felt in the lower abdomen, pelvis or lower back. The pain may not be easily relieved with non-steroidal anti-inflammatory drugs (NSAIDs).
Painful sex (dyspareunia) This may be a symptom of endometriosis that involves deeper tissues of the vagina and pelvic walls. While painful sex can also lead to relationship and body issues, patients can also start to become anxious and even fearful of having sex.
Bowel and urinary disorders Disorders can include diarrhea, constipation, painful urination, bowel movements, blood in urine, and frequent urge to urinate. Individuals can also feel nausea, vomiting, bloating, and gassiness.
Neuropathy Endometriosis can often implant in pelvic tissue underlying the nerves that lead to the legs. In these cases, it is common for patients to experience nerve pain in their lower extremities.
Infertility As scar tissue and adhesions build-up, it decreases the chances of fertilization occurring. The longer these lesions or related issues go untreated, the higher the risk of infertility. Studies have shown that endometriosis is linked to 1/3 of infertility cases, can prevent the release of eggs, and decrease the quality and number of eggs.
Fatigue and Personality Changes Due to the chronic pain caused by endometriosis, many individuals find themselves feeling “different.” Patients can feel fatigued not only due to the pain but also due to the
many years of stress searching for the proper diagnosis and treatment.
Definitive Diagnosis
LAPAROSCOPIC SURGERY
Laparoscopic surgery is achieved by first making 2-4 small incisions on the skin of the abdomen. Through those small incisions, ports are created to the abdominal and pelvic cavities inside, which are inflated with sterile CO2 gas. The doctor will then use a tool called the laparoscope, which is a camera, through these ports to examine the tissue and organs in the abdominal and pelvic cavity.
Upon examination of the pelvis, the doctor can search specifically for endometriosis lesions. If suspicious areas are found, samples can be taken for biopsy and confirmation of the disease will be made by a pathologist, who will issue a pathology report.
Thorough biopsy of lesions is a method that can also be used to remove endometriosis lesions.
Diagnostic tools used to assist in definitive diagnosis
While there are diagnostic tools used to raise suspicion of the disease or find congenital abnormalities that may be exacerbating symptoms, they cannot specifically confirm if a patient has endometriosis. Instead, these tools can be used in conjunction with diagnostic laparoscopy and an accompanying pathology report.
CONSULTATIONS
A physician may be able to suspect that you have endometriosis based on the information you provide during your consultation.
It will be beneficial to explain your symptoms and pain with as much detail as possible. Bring in previous medical records, journals, symptom trackers or any materials that can provide essential information.
Be prepared to ask questions. Visit this page to learn more about preparing yourself for an appointment.
PELVIC EXAMS
A focused pelvic exam is typically considered to be a preliminary step in the diagnosis process.
The exam will include examining the pelvis and pelvic organs and will evaluate for specific points of tenderness.
ULTRASOUNDS
An ultrasound may be used to gain additional information, sometimes during the same visit as the initial pelvic exam. This device is used to send sound waves to produce images of the inside of the body. It is a safe method of imaging that does not expose one to any radiation. There are two main types often used by OB/GYNs:
Transvaginal Ultrasound: Rather than using the probe on the outside of the stomach or pelvic region, it is inserted into the vagina. This can be done during any phase of the menstrual cycle.
Sonohysterography: During the ultrasound, sterile saline fluid will be injected through the cervix and into the uterus. The fluid helps produce much greater detail and allows for the doctor to examine the contour of the uterus and endometrial cavity. Thisis typically used to find underlying causes of abnormal bleeding, miscarriage or infertility, and can help to look for growths and scarring. This specific type of sonogram is best performed during the first half of the menstrual cycle.
CTS
Computerized tomography (CT) scans produce images of bones, vessels, and tissues similar to normal X-rays but in greater detail.
This form of imaging is often conducted in emergency rooms to often rule out endometriosis-related emergencies such as ovarian torsion or a cyst rupture.
MRIS
Magnetic resonance imaging (MRIs) produce very detailed and clear images of tissues and organs and can be used to assist in definitive diagnosis.
How can endometriosis be treated?
Conservative Surgery
While there is no definitive cure for endometriosis, there are several options that have proven highly effective and have provided symptom relief for patients. Conservative surgery is an endometriosis surgery technique that is most often performed when endometriosis lesions can be well-recognized and specifically removed, leaving healthy organ tissue intact. Only the affected tissue is removed in this approach. While there are many different techniques of conservative surgery, laparoscopic excision surgery is the gold standard of treatment for endometriosis.
Deep-excision is performed during laparoscopic excision surgery, where the surgeon carefully excises or removes the entire lesion from wherever it is found, including the tissue beneath the surface. Endometriosis acts like an iceberg - despite the disease being identified above the surface of the tissue, the majority is implanted into the tissue below the surface. This is why it is so important to find a surgeon who removes lesions in their entirety. For information about identifying a proper excision surgeon and preparing for your visit to the doctor please visit this page.
Definitive Surgery
Definitive surgery is performed when there is diffuse involvement of endometriosis to a particular site, and involves the removal of organs. The most common form of definitive endometriosis surgery is a hysterectomy (removal of the uterus). This can either include or exclude removal of the ovaries and cervix depending on the form of hysterectomy the patient and physician agree upon. As undergoing a hysterectomy is a serious decision, it is crucial that the patient and physician fully discuss the necessity for this procedure and that the patient is comfortable with their decision.
It is a common myth that having a hysterectomy will cure endometriosis. There is no cure for endometriosis and a hysterectomy is rarely the best treatment. Most endometriosis is located in areas other than the reproductive organs. If you simply remove the uterus and do not excise the remaining lesions, patients will continue to have pain. Decisions regarding a hysterectomy should be made with a doctor experienced in treating endometriosis and should only be performed if agreed upon by the patient. For more information, see Endometriosis and Hysterectomy.
How can symptoms be managed?
There are many ways of obtaining endometriosis relief, but it must be noted that the options below do not treat the endometriosis itself - they rather serve to alleviate some of the symptoms caused by the condition. These include:
Low-Dose Oral Contraceptives
Hormonal intrauterine device (IUD) (Rather than copper)
Other hormonal therapies that provide long-acting progesterone medication (Injection or implant)
Painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs)
Hormone (GnRH) therapy
Acupuncture
Changes in diet
Exercise
endofound.org
References
https://www.nejm.org/doi/full/10.1056/NEJMra0804690?journalCode=nejm&journalCode=nejm&journalCode=nejm&journalCode=nejm&journalCode=nejm&journalCode=nejm&journalCode=nejm&journalCode=nejm&journalCode=nejm&journalCode=nejm
https://pubmed.ncbi.nlm.nih.gov/30790565/
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