What is endometriosis?

When tissue implants are found outside of the uterus that look like pieces of your uterine lining, or endometrium, we call this condition endometriosis. Implants of endometriosis are most commonly found in the pelvic area and on the ovaries, fallopian tubes, rectum and bladder dome. There are uncommon reports of endometriosis outside the pelvis such as in the lung, colon, inside the bladder, and even as far away as the brain.

What are the stages of endometriosis?

There are four stages of endometriosis. Stage I is referred to as minimal endometriosis because there are not a lot of implants in the pelvis. Stage II is called mild endometriosis and there is more disease. Stage III, or moderate endometriosis, is characterized by even more pain and pelvic organs being affected. Severe endometriosis means stage IV disease and is the most difficult to treat.

What causes endometriosis?

Scientists have not identified the cause of endometriosis so different theories exist. Shedding from the endometrium is a natural part of your period. But not all cells flow out the cervix. During this process, endometrial cells also flow through your fallopian tubes and settle in the pelvic area. Normally the immune system should clean these out. Because of a possible failure of immune system function, the endometrial cells may attach to the tissues in the pelvis. Cyclic bleeding in endometriosis then causes worsening cramps due to inflammation of the surrounding tissue.

Endometriosis tends to run in families, which supports a potential genetic link.

Endometriosis is stimulated by cyclic ovarian estrogen and progesterone production, so symptoms generally subside after menopause. HRT (estrogen with progesterone) for menopause may result in pain.

How many women get endometriosis?

The generally quoted occurrence of endometriosis is 10-15% of women. Endometriosis is more common in caucasian women than other ethnic groups. The majority of women with endometriosis, about 90%, have stage I or II disease. Stage III and IV are less common but usually associated with more pain and faster recurrence.

​Is endometriosis cancerous?

Endometriosis itself is not cancer. The incidence of endometrial cancer in women, who have had endometriosis, even if taking estrogen only after a hysterectomy, does not appear very high. There are reports of endometrial cancer arising in endometriosis, so it is possible, but this does not appear to be a contraindication to estrogen for moderate to severe menopausal symptom relief.

What are the signs and symptoms of endometriosis?

The most common symptoms of endometriosis we see at the Advanced Women’s Institute include:

• Worsening menstrual cramps
• Increased days of cramping in the cycle
• New painful intercourse
• Cyclic bowel and/or urinary pain
• Nonspecific bowel and/or urinary pain
• Lower back pain
• Pelvic pressure

What is the best treatment option for endometriosis?

There are two main choices for managing endometriosis, medical or surgical, and both have their merits. Options for medical management include:

• Oral contraceptives (OCs): Generally the first recommendation, especially for younger women. OCs reduce menstrual cramps and flow. Side effects, complications, failure to control pain or return of symptoms may occur. It is possible to give EPC’s continuously to extend the interval between periods, thus decreasing periods to 4 or less each year. It doesn’t work for every woman, but is worth a try.
• Pain medication: Non-Steroidal Anti Inflammatory drugs such as ibuprofen can help cramps. This is also a first line treatment and is frequently combined with OCs. Narcotic pain medication can also be used but there is concern about the risk of opioid addiction. 
• Provera/Depoprovera: Provera binds inside the ovary to reduce estrogen production and prevent ovulation. There is an oral and injectable(Depo) formula. Side effects include depression symptoms and abnormal bleeding. Provera is relatively inexpensive.
• Danazol: Danazol is an androgenic compound that works similar to but more effectively than Provera. The androgen side effects include weight gain, oily complexion and acne. It is seldom used today.
• GNRHa (gonadotropin releasing hormone agonist): A class of compounds that selectively stop the pituitary gland from stimulating the ovaries. They are highly effective. The estrogen levels can get so low some women develop hot flashes and night sweats common to menopause. They are also costly.
• GNRH antagonists: They lower estrogen like the agonist, only faster. The side effect profile and patient tolerance is similar to the GNRHa.

There are a variety of medicines available, each with their own side effects. Dr. Moore and the team will discuss each option with you in detail. It should be kept in mind that drug treatment does not cure endometriosis, but continuous use of your medication can help you manage your symptoms effectively. For more permanent solutions, you may opt for a surgical solution, such as:

• Laparoscopy: This requires small incisions in the abdomen so a scope can be inserted through the belly button to diagnose and treat endometriosis. If endometriosis is identified at the time of diagnostic laparoscopy, an operative laparoscopy can then be performed to remove the endometrial tissue implants. This requires additional small incisions for the placement of graspers, scissors, and other instruments to remove the implants. The procedure is done as an outpatient and return to work is expected in approximately 2 weeks or less.

  
• Open Abdominal Surgery for Endometriosis: This procedure is accomplished using a 4-6 inch open abdominal incision to perform the operation. However, laparoscopy represents a less invasive, less painful approach to endometriosis.

​What about a natural remedy or diet?

While it may be possible to manage some symptoms with various alternative methods, Advanced Women's Health Institute is unaware of any controlled studies.

If you choose to use some alternative methods, it should be noted that all therapies and diets should be discussed with your physician to make sure that there is no contraindication with any prescriptions or other therapies or treatments being performed or contemplated. Always keep communication open between you and your practitioners.