Women's Health

Endometriosis is a condition that can affect many women at different life stages. Let me give you three scenarios.

First — A young woman who has had miserable periods for several years. She gets terrible cramps during her period (and even cramping at other times of her menstrual cycle), as well as constipation and frequency of urination around the time of her period. She lives with chronic pain.

Next – An adult woman who has never had children and has been trying to conceive for over six months without any results. Her husband has been tested for fertility and is fine. She had a sonogram of her pelvis, and her doctor told her she has an ovarian mass.

Finally –  An adult woman who has very bad cramps before and during her period, pain during sex, intermittent bleeding during her menstrual cycle, back pain and lower abdominal pain.

All three of these women have endometriosis, a benign, common, chronic estrogen- dominant disease. Endometriosis affects 12  to 32 percent of menstruating women. Pain is the most common presentation — chronic pelvic pain, pain during the menstrual period or pain upon deep penetration during intercourse.

Endometriosis can also be the reason for infertility in 50 percent of women who undergo a laparoscopy, a surgery where a scope is inserted into the abdomen to visualize the pelvic organs. And 50 percent of teenage girls with chronic pain will be diagnosed with endometriosis.

So what is endometriosis?  It is when the lining of the uterus (that is shed every month during menstruation) surfaces in other places where it should not be, such as in all the reproductive organs as well as other places in the body. It can bleed just like the uterine lining and cause severe inflammation of the tissues. There seems to be a genetic component, as well. If a woman has endometriosis, a first-degree relative has a seven percent chance of developing the disease.

After a complete history and physical has been performed by the gynecologist and other conditions have been ruled out, a doctor should perform a sonogram of the pelvis. If the diagnosis seems to point to endometriosis, treatment with anti-inflammatory medication should be tried first, either alone or along with birth control pills (or other hormonal treatments).  If the patient does not respond to these treatments after three months, a laparoscopy should be performed. This procedure is the most definitive way to diagnose endometriosis because there is direct visualization of the pelvis: endometriosis looks like cigarette burns on various pelvic organs. There can be burns on the bowel and the bladder, causing these organs to develop symptoms. Also, cysts — called chocolate cysts — can present as masses in the ovaries.

Once the diagnosis is confirmed at surgery, the surgeon should try to remove all the endometriosis he or she sees. It can be lasered, cauterized and resected. The more of the endometriosis that  is removed, the more likely it is that the patient’s fertility will improve and her pain will subside.

A diet free in hormones — going organic, watching out for any hormones that are fed to animals or hormones that could be in dairy products — may help a woman who has been diagnosed with endometriosis. This is a disorder that is fed by estrogen, so any soy or phytoestrogens must be avoided. After menopause, when a woman’s hormones have declined substantially, this disease is much less of an issue.

If a woman with endometriosis is trying to conceive, she may need to consult an infertility specialist. After she is diagnosed with endometriosis and has had surgery to remove all the endometriosis, she may then, depending on the stage, try to conceive on her own for six months. If she does not conceive, she may need help from a specialist who will treat her with fertility medications or in vitro fertilization (IVF).

Last, and unfortunately, in order to control the chronic pain of this disease, a woman may need to be treated with birth control pills or other hormonal treatments until she reaches menopause. It is an ongoing problem that does not seem to leave one’s body until after menopause ceases. Sometimes, a patient can only be free of pain after undergoing a complete hysterectomy.