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Endometriosis

By Dr Sharon Thompson on March 3, 2016 in Gynecology
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What is endometriosis?

Endometriosis is a by product of what I like to call a female super power–the ability to create and grow a new human being.  During each monthly cycle,  the ovary creates several follicles or cysts.  One of them will release the egg that can go on to create an embryo.  At the same time the lining of the uterus is thickening and creating a ‘nest’ for the early embryo.  If a pregnancy does not occur, that ‘nest’ is destroyed and discarded.  We see that process on the outside of the body as the menstrual flow.  In a woman who has endometriosis, the cells that create the lining inside the uterus, find a way to grow in other locations. The most common place for endometriosis to grow is on the organs near the uterus–the ovaries, bladder, large and small intestines.

Where does endometriosis come from and how does a woman get it?

While we don’t know what causes endometriosis, we do know some facts about it and have some theories about how it develops. Endometriosis runs in families but scientists are not sure what makes one relative get it and not another.  One theory is that endometriosis grows from cells left over from when the woman was an embryo herself.  At that stage cells can become any kind of body tissue so they can form endometrial tissue anywhere.  In fact endometriosis has been found in the skin, lung and brain. Another theory is that some cells in the immune system are not functioning properly. As a result they do not destroy the endometrial cells that are in the wrong place and endometriosis develops.  More research is needed to get definite answers.

What are the symptoms of endometriosis?

Many women with endometriosis will have no symptoms at all.  The most common symptom is pain.  Women may have severe pain with periods that gets worse over time and that starts to occur outside of the days of menstrual bleeding. They may experience other symptoms like nausea, pain in the thighs and some may have problems with urination or bowel function depending on the location and severity of the disease. Twenty to thirty percent of women with endometriosis will have trouble getting pregnant.

How is endometriosis diagnosed?

Endometriosis is diagnosed most commonly by listening to a patient’s history, family history and doing a physical exam.  Ultrasound and surgery are also sometimes needed to make the correct diagnosis. Once the diagnosis is made there are a variety of treatment options.

Are there effective treatments for endometriosis?

Most women are likely to find a solution that treats her symptoms.  Some women get relief using over the counter pain medicines alone but most treatments for endometriosis ‘turn down’ the production of estrogen and progesterone.  Most of the methods developed for birth control–the pill, depo Provera, Nexplanon and the levonorgestrel IUD, can be used to effectively treat endometriosis.  Another medical treatment leuprolide Acetate (Lupron) is very effective and also works by decreasing hormone production.  Surgery can be used for treatment to cut out the areas of endometriosis or to remove the uterus and ovaries.  Forty to 60% of women will have symptoms return after removal of the endometriosis alone so most women will use one of the medicines above after surgery to prevent symptoms from returning.

 

What should I do if I think I have endometriosis?

Keep a journal of your symptoms; when they occur, things that make you feel better and things that make you worse. Take this journal with you to your appointment with your doctor or health care provider.

Dr Sharon Thompson

About the Author

Dr Sharon ThompsonView all posts by Dr Sharon Thompson
Dr. Thompson received her undergraduate degree in Biology from Vassar College and a Masters in Public Health from the University of California at Berkeley. She went on to medical training at Mount Sinai School of Medicine in New York City and completed her postgraduate training in Obstetrics and Gynecology at the Harvard affiliated integrated Brigham and Women's and Massachusetts General Hospital residency program.

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