What is endometriosis?
Why is it so painful and how does it affect a woman's ability to have a child? These answers are not simple ones, but to women who suffer from endometriosis and its complications these answers are needed so desperately, it pains the heart as well.
According to Dr. David Michael, faculty specialist in Obstetrics and Gynecology at Mt. Sinai Hospital in Chicago, Ill., endometriosis is "the presence of functioning endometrial glands (the glands that normally line the uterus which produce tissue that prepares the uterus for conception) that occurs outside the uterine cavity. These glands can be located anywhere inside the abdominal cavity or attached to the organs within."
The areas inside the abdominal cavity that can be affected by endometriosis include the abdominal wall, kidneys, ovaries, bladder, fallopian tubes, the outside of the uterus itself or even the areas in between these organs, which are referred to as "cul-de-sacs."
"Since endometriosis spreads by local means, it will end up in the most dependent parts of the woman's abdomen wherever gravity is going to pull to the lowest point," says Dr. Michael.
As mentioned, endometriosis causes great discomfort to those women it affects. The pain can prohibit everyday activities as well as a woman's ability to work outside the home. "Due to my endometriosis I was bed ridden for at least two days every month," says Sharon Hector, a Web designer from Silver Spring, Md. "I would be literally crawling to the bathroom to vomit with hot bags on my lower abdominal area. I lived on painkillers just to make it through."
Hundreds of women can relate to Hector's tale, as their stories contain similar situations when dealing with the pain of endometriosis. But what causes the pain and why is it so extreme?
According to Dr. Michael, the cycles of discomfort and pain felt with endometriosis are directly related to a woman's menses. "The pain of endometriosis is called cheamenil meaning monthly or correlating with the monthly menses," says Dr. Michael. "It can come a few days before the menses begins and can last a few days or a week or two into the cycle.
Just like the uterus is going to bleed monthly to rid the body of the tissue used in the event of conception, the endometrial tissue outside the uterus is going to bleed monthly as well, causing pressure and pain in the abdomen or where the tissue is located. A woman with endometriosis basically has two menses cycles one within the uterus and one outside."
The Symptoms
Unlike other conditions or illnesses, the signs and symptoms of endometriosis are not black and white. As many of the signs and symptoms of endometriosis also could be indications for other ailments, the time or occurrence of the events becomes important.
"The signs and symptoms of endometriosis are not easily determined," says Dr. Michael. "However, the presence of painful intercourse, painful menses, chronic pelvic pain, back pain, painful bowel movements and, if advanced enough, kidney or bladder pain where there was not before, offers a good indication for endometriosis. It is most suggestive if it begins after years of someone having no pain in these areas or [corresponding with these] events. The pain can be cyclical or constant, but if evidence shows it to be more intense in cycles and occurs after years of 'normal' activity, then endometriosis should be suspected."
"I didn't begin experiencing painful menses or [painful] sexual intercourse until about a year after my third child was born," says Kristina Powers, a student and mother of three from Petersburg, VA. "I began having very bad pain with intercourse, my period, and had back pain almost all the time. It was hard to figure out what was wrong, but as the pain got worse, my doctor suggested endometriosis."
The Diagnosis
There are many women who suffer from, but are not aware of, endometriosis. Diagnosis is extensive, invasive and costly. Doctors and patients may choose to treat the signs and symptoms of endometriosis rather then partake in an actual diagnosis. "It is suspected that approximately 10 percent of women of reproductive age have endometriosis," says Dr. Michael. "But it is hard to say exactly how many women actually have endometriosis because it is a condition where diagnosis requires laparoscopy or some type of invasive surgery. Most woman will just be treated by their symptoms so we won't necessarily diagnose them. There are certain things a doctor can feel on pelvic exam that may also indicate the evidence or suspicion of endometriosis, but more than likely actual diagnosis requires a more invasive procedure such as a laparoscopy."
"My doctor has told me that he feels that my condition is endometriosis but doesn't suggest that I have the procedure done for diagnosis," says Powers. "I'm not arguing with that because I trust his judgment and the treatments for the condition are working so far. Besides, the last thing I want to do is have to have surgery, and without insurance, it would be too expensive."
The Treatment
According to Dr. Michael, it is important to understand how endometriosis works in order to offer a treatment that is effective and sufficient. "Endometriosis is fed by estrogen," says Dr. Michael. "Estrogen is the hormone that a woman's body has a surge of each month that causes the uterine lining to thicken. Then, the estrogen level goes down and they have their period. If you take away the estrogen, the endometrial glands starve; they atrophy. That's where the treatment comes from starving the endometrial glands of estrogen."
The degree of the endometriosis, as well as the area affected, will determine what type of treatment will be offered. "One of the most common therapies for the treatment of endometriosis, especially if the woman's condition is a mild to moderate one, is oral hormone suppressant medication," says Dr. Michael. "When taken, these medications will suppress the level of estrogen in a woman's body and decrease the amount of tissue that is affected with each monthly cycle. With these hormone suppressant medications, a woman can find a good amount of relief from the pain and discomfort of the endometriosis. However, these medications do not cure the condition, and oftentimes a woman will still require additional treatments if and when the condition worsens. Right now, all we have are suppressive therapies we don't have a cure."
In relation to the effects of endometriosis on the ability to conceive, Dr. Michael states that the lines of clarity often cross with lines of uncertainty. "There are some things that are obvious to us and there are others that are a mystery," says Dr. Michael. "In the absence of abnormalities, the contributions of endometrial tissue become unclear. There could be adhesions that block the tubes, which does not allow the egg to travel to the uterus. There could be adhesions to the ovary, which inhibits the 'pick up' of the egg by the tube or inhibits the motility of the egg down to the tube to the uterus. In addition, there could also be problems with intercourse; it could be painful, which prevents reproduction from happening. Each woman is different and each time it's a matter of doing what we know while learning along the way."
Whether related to the inability to conceive, painful intercourse or cycles of monthly pain, the condition of endometriosis affects the way a woman lives as well as the quality of her life. However, with proper treatment and medical intervention, women who are affected by endometriosis can find relief and build on the foundation of their family. "These days most women especially those who develop endometriosis and are still relatively young should be able to conceive a child or find relief from pain and discomfort one way or another," says Dr. Michael. "Try to be hopeful. A majority of women who would normally be good candidates to become pregnant will with time and effort become pregnant. And those who have lived their lives in pain, will find comfort."
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