Endometriosis: The Invisible Illness

It’s been called the “invisible illness”. Which is surprising, given the fact that anywhere between six and ten percent of women between the ages of 25 and 401 may have endometriosis. The condition can be painful and is linked to difficulties with getting pregnant. In fact, 30 to 50 percent of women who have been diagnosed with infertility have also been diagnosed with the condition2. Making all this more complicated is the fact that endometriosis can be difficult to diagnose, because a number of it symptoms – like pain and infertility – can mimic other conditions.

What is it?

The name of the disease comes from the word "endometrium,” which is the tissue that lines the inside of the uterus. In endometriosis, that same tissue is found outside the uterus, usually in the pelvis or fallopian tubes. Once there, it acts exactly as it would inside the uterus. In other words, it breaks down and bleeds through each menstrual cycle. However because the blood has nowhere to go, the areas surrounding the misplaced endometrial tissue becomes swollen and inflamed, eventually leading to scar tissue.

Common locations for these endometrial patches include:

  • On or under the ovaries
  • On the fallopian tubes, which carry egg cells from the ovaries to the uterus
  • Behind the uterus
  • On the tissues that hold the uterus in place
  • On the bowels or bladder

Diagnosis and Treatment

The most common way to confirm endometriosis is through a laparoscopy. A small incision is made in the abdomen and the surgeon uses a small viewing instrument called a laparoscope to look at the internal organs for endometriosis. While there are treatments for endometriosis itself, there are a number of ways to treat pain and problems related to infertility.  Keep in mind, different treatments work for different women, depending on age, severity and other factors.

For pain treatment, both over-the-counter and prescription medications are often used. Hormone therapy is also sometimes recommended. In some cases, surgery is recommended for treating pain but according to the American Radiological Society7, 40% to 80% of women have recurrent pain within two years of surgery.

Cause Unknown

While the exact cause of endometriosis isn’t known, researchers believe there are combination of factors that lead to the condition including:

  1. Endometriosis runs in families,which means that genes are probably involved in some way
  1. A condition called “retrograde menstruation” in which menstrual blood backs up into the fallopian tubes and pelvis

In addition, there are some increased risk factors associated with the condition, such as:

  • Mother or sister had endometriosis (which raises the risk about sixfold)3
  • Periods started at an early age (before age 11)4
  • Monthly cycles are short (less than 27 days)5
  • Menstrual cycles are heavy and last more than 7 days6

The most significant symptom of endometriosis is pain – either during intercourse or through the menstrual period, especially when it’s located in the abdomen or lower back. The level of pain, however, is not indicative of how severe the disease is.

The relationship between infertility and endometriosis is not always clear. In women with mild endometriosis, doctors will typically recommend laparoscopy to remove the growths in order to improve fertility. When formulating a treatment plan, you and your doctor will take into consideration such factors as age, level of pain and duration of fertility. . If you think you have endometriosis, the first thing you should do is talk with your doctor. Don’t assume that heavy periods and gastrointestinal or abdominal pain are normal.

1. https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/Pages/at-risk.aspx. Accessed 3/17/2017
2. Endometriosis – A Guide for Patients. American Society of Reproductive Medicine booklet. Patient Information Series. Page 4. 2012
3-7. Ibid, Endometriosis – A Guide for Patients. American Society of Reproductive Medicine booklet. Patient Information Series.

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