All women expect to experience some level of cramping while on their period. However, women who have endometriosis endure physical pain that is much worse than a woman with a “normal” menstrual period. Women may also experience emotional pain as they try, but fail, to conceive. What is endometriosis—and how can it affect a woman’s life?
What is Endometriosis?
The Mayo Clinic explains, “Endometriosis…is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond pelvic organs.”
The displaced tissue acts normally by thickening, breaking down, and bleeding with every menstrual cycle. However, the displaced endometrial tissue is unable to exit the body and becomes trapped. The tissue around the trapped endometrial tissue may develop a fibrous sticky material, called adhesions. These adhesions can make organs, as well as other tissues, stick together.
Women with endometriosis often experience severe pain—especially while having their period. Women may also experience fertility problems due to endometriosis.
Another possible issue with endometriosis is the formation of cysts called endometriomas. Endometriomas might form if the ovaries become involved. These cysts are sometimes referred to as chocolate cysts, as they are filled with old brown blood. If a cyst becomes too large, surgery may be required.
Signs and Symptoms of Endometriosis
Signs and symptoms of Endometriosis may include the following.
- Severe pelvic pain, extreme cramping, lower back pain, abdominal pain, pain during or after intercourse, pain while urinating, and pain while having bowel movements. The pain is most likely to happen during your period, but may also happen a few days before or after. Some women feel pain all of the time, some women with endometriosis do not experience abnormal pain at all.
- Heavy periods. Every period may be heavy, or you may only have heavy periods occasionally. You may also experience clotting while on your period (a clotted blood flow). Some women have spotting or bleeding between periods, or another form of abnormal bleeding.
- Some women don’t know they have endometriosis until they try to get pregnant and can’t. Endometriosis is often diagnosed by women seeking treatment for their infertility. According to WebMD “Between 20% and 40% of women who are infertile have endometriosis.”
- Various symptoms. These may include fatigue, nausea, bloating, diarrhea, or constipation. These symptoms are more likely to occur during your period.
Treatments Offer Hope
There is not a cure for endometriosis, but there are treatments that can allow for better quality of life. Pain usually plays a large role in women suffering from endometriosis. There are 3 main ways pain is treated. The first treatment tried is pain medications.
Pain medications will usually only work if the pain is mild. Some over-the-counter pain medication, or prescription medication, may be tried. Because the pain and symptoms experienced are often severe, pain medications of any kind will not help relieve the severe pain. The sufferer usually needs to move on to the next step, to try and find pain relief.
“Hormone treatments stop the ovaries from producing hormones, including estrogen, and usually prevent ovulation. This may help slow the growth and local activity of both the endometrium and the endometrial lesions. Treatment also prevents the growth of new areas and scars (adhesions), but it will not make existing adhesions go away,” reports the US Department of Health and Human Services National Institutes of Health (NIH). Some of the possible hormone treatments may include:
- Birth control pills: These make a woman’s period lighter and more regular. Sometimes the pills are taken continuously (skipping the 7, or sometimes 3, sugar pills per pack). Doing so will often help with the pain of endometriosis.
- Progesterone and progestin: May be given by injection, taken as a pill, or by the use of an intrauterine device (IUD).
- Gonadotropin-releasing hormone agonists: Also known as GnRH agonists, these stop certain hormones from producing. They prevent ovulation, menstruation, and the growth of endometriosis. When this treatment is used, it will place a woman’s body into a kind of menopausal state.
In addition to these options, other treatments are being researched to help with endometriosis and the pain associated with it. All of the listed treatments have possible side effects—some more severe than others. A woman and her doctor need to weigh the options and see what hormone treatment, if any, may work best for her.
Surgery is only used for severe cases of pain. During surgery, the doctor locates and removes the endometrial adhesions, which helps to relieve some of the patient’s pain. The two main surgeries that are sometimes used to ease the pain of endometriosis are:
- Laparoscopy: The surgeon fills the patient’s abdomen with gas and makes a small cut in the abdomen to insert a light/viewing instrument to view inside. Once the surgeon locates the adhesions, she or he makes two or more (small) cuts in the abdomen to insert either a laser or another instrument to remove the adhesions and scar tissue.
- Laparotomy: This is a major surgical procedure of the abdomen. Because a large cut is made, the surgeon is able to see more of the endometriosis adhesions and remove them. Sometimes these adhesions are attached to other organs, when this happens, the surgeon carefully removes the adhesions from the organ without damaging it. There may also be endometriomas (chocolate cysts) that need to be removed. If necessary, the surgeon will remove the patient’s uterus (hysterectomy). If the patient’s ovaries have endometriosis adhesions on them, or there is too much damage, the surgeon may need to remove not only the uterus but the fallopian tubes and the ovaries. If possible, the surgeon will leave the ovaries because they play an important role in a woman’s health. This surgery is only recommended as the last resort for the treatment of endometriosis. Unfortunately, endometriosis adhesions can still come back after surgery.
What About Fertility?
Some women with endometriosis do have fertility problems. As mentioned earlier, some women don’t even find out they have endometriosis until they have problems conceiving. Women may need to consult a fertility specialist to find out what options they have in becoming pregnant. One of the more conservative treatments for endometriosis, often a laparoscopy, may need to be used to allow for a greater chance of getting pregnant. If the woman has had a laparoscopy and is still having trouble getting pregnant, in vitro fertilization (IVF) may be recommended to improve her fertility.
Living with Endometriosis
Endometriosis is very painful and hard to live with, for many women. It can also be painful dealing with the fertility problems that often come with endometriosis. Luckily, with the conservative, and not so conservative, treatments, there are ways a woman can live a healthy, happy life while living with endometriosis.