WHAT IS ENDOMETRIOSIS?
Endometriosis is a benign (non-cancerous) condition where tissue normally found inside the uterus implants within the abdominal cavity on the ovaries and other abdominal structures. These cells cycle and bleed in implanted areas and may cause pain and fertility problems for affected women. Bleeding and inflammation may also cause scarring leading to further pain. Endometriosis occurs in 1 of 10 women and is most often first diagnosed in women in their 30s and 40s.
WHAT ARE THE SYMPTOMS OF ENDOMETRIOSIS?
The most common symptom of endometriosis is long-term pelvic pain, especially just before and during the menstrual period. Pain also may occur during sex. If endometriosis is present on the bowel, pain during bowel movements can occur. If it affects the bladder, pain may be felt during urination. Heavy menstrual bleeding is another symptom of endometriosis. Many women with endometriosis have no symptoms.
HOW IS A DIAGNOSIS OF ENDOMETRIOSIS MADE?
The only way to diagnose endometriosis accurately is by visualization of the implants. This requires a surgery called diagnostic laparoscopy where the doctor can check for these implants. The implants have a variety of different visual appearances including specific color changes. A biopsy at the time of surgery is the most accurate way to make the diagnosis, although clinical symptoms and physical exam will often suggest the diagnosis without surgery.
WHAT ARE THE TREATMENT OPTIONS FOR ENDOMETRIOSIS?
Treatment for endometriosis depends on the extent of the disease, symptoms, and future desire for fertility. Endometriosis may be treated with medication, surgery, or both. When pain is the primary problem, medication usually is tried first.
Medications that are used to treat endometriosis include pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), and hormonal medications including birth control pills, progestin-only medications, and gonadotropin-releasing hormone agonists. Hormonal medications help slow the growth of the endometrial tissue and may keep new adhesions from forming. These drugs can help relieve symptoms, but do not get rid of the endometriosis tissue (implants).
If medical treatments are not successful in treating pain symptoms, or if fertility has been affected, surgery can be considered. During surgery, endometriosis implants can be removed. After surgery, most women have relief from pain. However, about 40–80% of women may have pain again within 2 years of surgery, and therefore surgery is not considered a permanent solution to pain. The more severe the disease, the more likely it is to return. Taking birth control pills or other medications after having surgery may help extend the pain-free period.
If pain is severe and does not go away after treatment, a hysterectomy may be a "last resort" option depending on desire for future children. Endometriosis is less likely to come back if your ovaries also are removed. If you keep your ovaries, endometriosis is less likely to come back if endometriosis implants are removed at the same time you have the hysterectomy. There is a small chance that pain will come back even if your uterus and ovaries are removed. This may be due to endometriosis that was not visible or could not be removed at the time of surgery.
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| © 2014-2018 copyright Taraneh Shirazian, MD