More than 11% of women develop endometriosis in their reproductive years, but it can take a long time to receive an official diagnosis. In fact, it can take six to ten years to learn you have this condition, especially if the symptoms mimic bad menstrual cramps. Sometimes, this condition does not cause any physical symptoms and is discovered during an unrelated physical exam, abdominal surgery, or procedure. Either way, it can impact fertility and derail your plans for the future.
Thankfully, you do not have to simply live with endometriosis and its effects, as medical advancements have brought many potential treatments to the table. To help you better understand this condition, here’s an in-depth look at what it is, how it is diagnosed, and the treatments available today.
What is Endometriosis?
Endometriosis occurs as the tissue inside the uterus grows outside of its confines. This often happens as the uterine lining sheds during your cycle and travels through the fallopian tubes. At that point, it starts to grow around the ovaries, bladder, and other nearby structures.
Often called endometriosis growths or lesions, these pockets of tissue then follow the same pattern as your menstrual cycle. They swell up and bleed as they would inside your uterus, but the tissue it sheds cannot evacuate your body.
As this occurs, many complications can arise, including scar tissue and adhesions that cause your organs to stick together. Blockages along the fallopian tubes are common as well, which can lead to painful ovarian cysts and torsion.
Once it develops, endometriosis never really goes away on its own, but there are preventative measures you can take.
Menopause can help minimize the effects of this condition as the decrease in estrogen circulating through your body shrinks the growths. You do not need to wait until menopause to find relief, however, since doctors may have treatment options that will work for you.
Endometriosis symptoms can vary wildly in type, duration, and severity. Sometimes, there are no symptoms at all. When they do arise, pelvic pain is the most common complaint and it can be absolutely debilitating. Even in mild cases, pain levels can skyrocket, leaving you in misery during your period and well after. The pain can even occur during and after sexual intercourse, which can impact not only your wellbeing but also your relationship.
Other physical symptoms caused by this condition include:
- Heavy menstrual bleeding
- Bleeding between periods
- Cramps that last longer than normal
- Lower back pain
- Uncomfortable bowel movements
- Constipation and/or diarrhea
- Painful urination
- Blood in your urine
With high pain levels and other physical symptoms affecting your life, it is not uncommon to feel anxious and depressed. Anxiety can occur as you dread the pain to come and struggle to fulfill your daily obligations. Depression is also common as the symptoms impact your normal activities, especially without hope for a lasting solution.
The mental health impacts can worsen if you are struggling with infertility, which is quite common. Endometriosis is closely linked to infertility, as it is found in 20% to 50% of women who are having trouble getting pregnant. Even when it is not the sole cause, it complicates matters by blocking eggs from freely traveling out of the ovaries and down the fallopian tubes.
Since endometrial lesions do not show up well on x-rays, ultrasound scans, or other imaging tests, the only way to get an official diagnosis is with laparoscopic surgery. Your physician needs to take a direct look inside the abdominal cavity to check for growths along the outside of your uterus and along your nearby organs. To do this, they have you come in for day surgery and put you under using general anesthesia.
With you resting comfortably, they make a small incision in your pelvic area, then look inside using a laparoscope. This device is a long wand with a camera on the end that sends real-time video to a viewing screen. With that, your surgeon can gently look around your abdominal cavity to diagnose or rule out endometriosis.
If you do not want to go through surgery, your physician can prescribe medications to treat the condition. If your symptoms improve while taking those medications, they can tentatively diagnose endometriosis, though it is not official without visual confirmation.
Endometriosis is often diagnosed during abdominal surgery for other reasons, especially in those without symptoms. Surgeons might spot endometrial tissue outside the uterus while removing the appendix, for example. After the procedure, they can let the patient know about the condition, helping them best manage their health.
Available Treatments for Endometriosis
Even after making an official diagnosis, doctors cannot cure endometriosis. They can help decrease your symptoms to minimize their impact on your daily life and overall sense of wellbeing. The most common treatment option is hormonal birth control, though you can only take it when not actively trying to get pregnant. You can also try medications that block estrogen production or undergo surgery to remove the endometrial growths or your uterus.
Hormonal Birth Control
With hormonal birth control, you can decrease or eliminate your monthly cycle to stop heavy bleeding and severe menstrual cramps. You can choose between many different types, including pills, vaginal rings, and implants. If one does not provide the intended results, your doctor can help you switch to another option to see how it goes.
Since estrogen supports the growth of endometrial tissue, doctors might have you try hormones that block its production. With their oversight, you may take gonadotropin-releasing hormone or androgen, like Danazol. As these medications decrease the estrogen pumping through your system, the endometrial growths should shrink, resulting in a decrease in symptoms.
If you are not a good candidate for medications, want to get pregnant soon, or need a lasting solution, then surgical interventions might suit your needs. You must weigh the pros and cons with your doctor to see if this option is right for you.
If you are looking to add to your family soon, your doctor can potentially resolve your infertility caused by endometriosis with the removal of the lesions. They may also perform this procedure to reduce or eliminate symptoms, though the effects are often temporary since the lesions can grow back.
Surgeons complete the lesion removal procedure using laparoscopic tools as a day surgery in most cases. They may destroy the growths using a laser to eliminate their impact on your reproductive health without harming your organs.
For those who are not planning to get pregnant in the future or are done having children, doctors may consider performing a hysterectomy. This procedure is often the last resort for those with serious symptoms that are not controllable through other methods, as it only resolves severe pain in 50% to 95% of patients.
During a hysterectomy, the surgeon removes the entire uterus, cervix, and ovaries. They also remove as many lesions as possible. If any remain, they may soon shrink since your ovaries are not there to produce estrogen. There is no guarantee of that happening, however.
Getting Care for Endometriosis
If you have painful periods or are having trouble getting pregnant, it might be time to speak to your doctor about endometriosis. They can help you track down the cause of your discomfort or infertility using your health history, exam results, and diagnostic tests. You can then work with your doctor to find the treatments that work and give you back control of your life.