Endometriosis
I promised someone quite a while back I would write a post about endometriosis. I haven’t forgotten. I’ve read up on it over and over to refresh my memory and was wondering to myself why it was taking so long to write about it. I figured it out last night.
Endometriosis is frustrating. Even to read about. So I can’t even imagine how frustrating it is to have. It is another one of those problems that has no definitive cause or cure.
The endometrium is the lining of the uterus. Every month hormones pump out in the natural order of things and the endometrium thickens, preparing for egg implantation and pregnancy. If no egg implants, the lining is shed, known in common parlance as your period, your lady time, your aunt flo, etc. The entire cycle from beginning to end is a menstrual cycle.
In some women, endometrial cells are found outside the uterus. This is not the norm. But no matter where these cells are located, they are still endometrial cells, so they still react to the hormones of the menstrual cycle and thicken and shed. Usually the errant patches of endometrial tissue are in the abdomen, in various areas near the uterus but outside of it instead of inside.
The abdominal cavity is not meant to have these endometrial patches outside the uterus. So they cause pain, sometimes severe. They can cause infertility, because they can attach to the fallopian tubes and interfere with the egg’s trip to the uterus. They can cause adhesions.
Adhesions are scar tissue in the abdominal cavity. The endometrial patches act kind of like when you scrape your knee. You get that scrape and sometimes it keeps oozing a little serous drainage, and if you stick a band-aid on it the band-aid can stick. Then if you try to move that band-aid, it pulls because it is stuck to the scab and that hurts. The endometrial tissue is sort of sticky, and if it is between organs, like between the uterus and bladder, it can make them stick together. That is an adhesion. Then when you move around or your bladder is full or your uterus is swollen it pulls on that attached spot. That is painful.
Endometriosis is sometimes diagnosed by exclusion. If you have all the symptoms, your doctor considers and tests for other things that could be causing them, and if it’s nothing else, it’s endometriosis. The only way to definitively diagnose it is laparoscopy or laparotomy. This means surgery. A little scope is inserted into your abdomen, and the surgeon looks around for endometrial tissue and adhesions in the abdominal cavity in laparoscopy. Laparotomy is the same idea but requires an open incision instead of using a scope. This might be necessary if there is a lot of errant tissue or if the surgeon just can’t see everything with the scope.
When surgery is done for diagnosis, often the surgeon removes any adhesions and endometrial tissue and sends the tissue for biopsy as a precautionary measure. Removing the tissue can relieve symptoms, but it may not be permanent. Just like the example with the scab, when you cut scar tissue, you can create another scar. It isn’t always a great solution, but organs that should not be stuck together can cause complications, so it is important to try and separate them if it is feasible.
There are several theories about how endometrial tissue migrates to the abdomen. These include moving through the lymph system, backwards migration up the fallopian tubes, and congenitally misplaced cells. Some theories call it an autoimmune disorder. No one really knows the answer with any certainty.
Treatment other than surgical intervention is medical. Hormones can be prescribed, including birth control pills. This regulates the menstrual cycle, or sometimes eliminates a period altogether. The treatment depends on whether you want to have children or have already had them. Endometriosis is more common in women who have never had children, and is implicated in 30-50 percent of infertility problems.
There are quite a few websites dedicated to endometriosis education and support. I recommend starting with American Congress of Obstetricians and Gynecologists or ACOG. They have a good page on this topic.
