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Women’s Health

March 19th, 2004

By Louis Wittig :eCureMe Staff Writer
March 18th, 2004 : Physician Approved

It’s one of the most common gynecological diseases - estimated to affect 10% to 15% of women in their child-bearing years - and it can lead to infertility and in extreme cases, radical surgery: endometriosis. Though serious, endometriosis can often occur without symptoms - making it all the more important for women who are considering having children to keep the term in mind at their next gynecologist’s appointment.


Pelvic Pain

Also known in medical shorthand as "endo", endometriosis afflicts at least 5.5 million women in North America. Any woman who’s ovulating - from her first period to menopause - is at risk. The disorder is directly linked to women’s monthly cycles - specifically changes in the lining of the uterus.

A specialized tissue - called the endometrium - covers the inner surface of the uterus. Every thirty or so days, a cycle of hormones signals the endometriosis to thicken, anticipating the possibility of pregnancy. When no pregnancy occurs and hormone levels drop, the thickened lining that’s built up on the endometriosis breaks down and exits the body through the vagina.

Occasionally, however, bits of the endometrium tissue that’s designed to work in the uterus are found in other parts of a woman’s reproductive system, pelvis or abdominal structures. These patches are known as implants, lesions or nodules. Scientists don’t yet know exactly how or why they develop outside the uterus (most often the it occurs on the ovaries, fallopian tubes, tissues surrounding the uterus, bowels and bladders - in extreme cases, endo patches can grow on distant parts of the body - such as lungs). Some theories hold that the origins are genetic, while others focus on the immune system or estrogen in causing the disorder.

[ Go to ’Endometriosis’ Page]

The problem these growths cause is that, even outside the uterus, they continue to thicken and breakdown each month as they receive hormonal signals. Since the natural exit isn’t available for the menstrual material generated by the nodules, it builds up and can come to irritate the tissue around it. This build up can, in turn, cause cysts and scarring, as well as adhesions - anomalous tissues that connect two normally unconnected organs. In the short term, the most common symptom of endometriosis is pelvic or abdominal pain. The pain can be chronic, or can be pronounced around specific events - such as menstruation, urination, bowel movements or sex. Other symptoms include intestinal pain, heavy periods and spotting between periods. In some cases women with endometriosis don’t experience any pain. Scarring on the ovaries or fallopian tubes can lead to infertility; 30% to 40% of women who have the disease are unable to conceive. Recent research has also found that women who suffer from endometriosis are at increased risk for a host of other diseases: rheumatoid arthritis, multiple sclerosis, chronic fatigue syndrome, fibromylagia (recurring muscular pain), allergies and asthma.

Diagnosis & Treatment

If there is any upside to endometriosis, it’s that aside from the potential for infertility, researchers haven’t attributed any serious long-term effects to it. No cure is available, but a number of treatment options are and diagnosis isn’t difficult.

The only way for doctors to be sure that endo is at the root of a woman’s symptoms is to literally see it. Commonly, patients who are suspected of having endometriosis undergo ultrasound and magnetic resonance imaging (MRI) procedures that produce images of the pelvic organs and allow physicians to spot large areas of the misplaced tissue. Confirmation can be obtained through a more invasive procedure - laparoscopy. Laparoscopy involves a surgeon inserting small tube that holds a light and a camera (a laparoscope) into the body through a small incision in the abdomen. The laparoscope allows the surgeon to see any endo growths on internal organs.

Depending on the severity of the pain, one of three (or a combination of several) treatment options is possible. The use of medication - from relatively weak over-the-counter pills to strong prescription medications - can be effective in controlling mild pain. Hormone therapy is also possible. As the progress of the disease is related to the hormonal signals the endometrium receives, altering those signals - by taking drugs that regulate or block the flow of certain hormones throughout the body - can decrease or stop completely a woman’s menstrual cycle. As long as the cycle is held in check, so are the symptoms.

When the disease is widespread, and / or the pain is severe - surgery may be necessary. The first surgical option is an extension of the diagnostic process. After using the laparoscope to see the growths, surgeons may use a second tube mounted with lasers or small surgical tools to either remove the unhealthy tissue or use intense heat to seal off the surrounding blood vessels which keep it alive. The alternative, laparotomy, is only used in extreme cases. Performing a laparotomy involves removing the entire uterus - and if the damage is extensive enough - the ovaries and fallopian tubes as well.

While such major consequences are rare, the fact that they occur at all speaks to the pain and complication that endometriosis can cause. Keeping aware of the disease is the first step in keeping ahead of it.

Contact Louis Wittig at

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