All About Endo

What is Endometriosis?

Endometriosis is a common disease affecting at least 5.5 million women in North America alone. Endometriosis is not discriminatory, striking any menstruating woman from the time of her first period to menopause. The pain associated with the disease can be so intense that it can affect a woman's quality of life such as her ability to work, her relationships (with her partner, children and friends) and can also affect her ability to reproduce.

Endometriosis is also commonly known as 'endo' and was formed from the word 'endometrium'. Endo means 'inside' and metrium means 'mother'. The endometrium is also known as the 'uterine lining' which are cell tissues that line the inner layer of the uterus. This tissue builds up and is shed monthly in response to the hormonal changes of the woman's menstrual period.

With endometriosis, tissue that looks and acts like the endometrial tissue is found growing outside the uterus, usually on the surfaces of organs in the pelvic and abdominal areas. To be more specific, endometriosis is mostly found in the pelvic cavity, growing on or under the ovaries, on the fallopian tubes, behind the uterus, on the tissues that hold the uterus in place, or even on the bowels or bladder or in the internal area between the vagina and rectum. It is extremely rare but, it can also be found growing in the lungs or other parts of the body such as in the thigh or arm.

When the uterus begins to shed its endometrial lining at the end of each cycle, the tissue growing on the outside of the uterus breaks apart and bleeds, and unlike the 'normal' menstrual flow which is discharged from the body, the blood from this misplaced tissue flows into the woman's pelvis. This is what is also known as a 'retrograde menstrual flow'.

The tissues surrounding the area of endometriosis can become inflamed or swollen producing scar tissue. These endometrial tissue sites can develop into what is known as 'lesions', 'nodules', 'implants', or 'growths'.

Stages of Endometriosis

• Minimal/mild endometriosis - implants that are small and not widespread
  
  
• Moderate endometriosis - larger implants or more extensive scar tissue is present
  
  
• Severe endometriosis - large implants and extensive scar tissue

What causes Endometriosis?

What causes endometriosis is not specifically known at this stage although there are many theories. At present, the National Institute of Child Health and Human Development (NICHD) which is a part of the National Institutes of Health (NIH), are continually conducting and funding vital research into the causes and treatments for endometriosis in the hopes that one day a cure and prevention of this painful disease will be uncovered.

Researchers are exploring every theory of possible causes such as the theory that the cause of endometriosis could involve genes, resulting from hereditary genes or genetic errors making some women more susceptible in developing the condition over others. They are also looking at oestrogen as it appears to promote the growth of endometriosis. If that is the case, endometriosis could be a disease of the endocrine system which is the body's network of glands, hormones and other secretions into the blood and lymph's.

Other theories include that the woman's immune system may not remove the menstrual fluid in her pelvic cavity properly; that the chemicals created by the endometrial areas may irritate or promote growth of more areas or whether environmental agents are related to the cause of endometriosis.

FACT:Surgically removing the uterus and/or ovaries does not guarantee that the endometriosis and/or associated symptoms will not return.

How do I find out if I have Endometriosis?

There are a number of tests used by doctors to diagnose endometriosis.When visiting your doctor, provide them with a family history, write down all your symptoms and anything you consider relevant as the more information you provide can assist in diagnosing whether or not you have the condition. Full diagnosis will involve imaging tests and perhaps even surgery.

Imaging allows the specialists to locate larger endometriosis areas such as cysts or nodules. Two ways of doing this are by ultrasound and MRI.

• Ultrasound - a machine using sound waves to make a picture of the inside of your body
  
  
• Magnetic Resonance Imaging - also known as an MRI, the machine uses magnets and radio waves to make a picture of the inside of your body

Sometimes the only way to accurately diagnose endometriosis is by surgery. The most commonly used procedure is known as a Laparoscopy.

What are the symptoms?

Symptoms of endometriosis commonly start years after menstruation begins. The symptoms tend to gradually increase as the endometriosis areas increase in size. Generally after menopause, the abnormal implants shrink away and the symptoms begin to ease.

Symptoms of endometriosis can include:

• Severe pain in the lower back, pelvic areas although most commonly in the abdomen
  
  
• Extremely painful (or disabling) menstrual cramps - the pain may also get worse over time - also known as dysmenorrhea
  
  
• Painful bowel movements
  
  
• Painful urination during menstrual periods
  
  
• Heavy menstruation
  
  
• Premenstrual spotting or bleeding between periods
  
  
• Intestinal pain
  
  
• Gastrointestinal symptoms resembling a bowel disorder
  
  
• Fatigue
  
  
• Pain during or after sex - also known as dyspareunia
  
  
• Infertility

FACT:Some women with endometriosis can have severe pain while others who share the condition will have no symptoms.

Can Endometriosis be treated?

There are various treatments used for both pain and infertility in regards to endometriosis. Common treatments include:

• Pain medication - works well if the symptoms are mild.
  
  
• Hormone therapy -is most effective if the endometriosis areas are small and/or if there is minimal pain. Hormones can be administered by injection, nasal spray or in the form of a tablet. The most common hormones used to treat endometriosis pain are Gonadatropin-Releasing Hormone (GnRH), Progesterone, Danazol, and the Contraceptive Pill.
  
  
• Surgery - such as a laparoscopy or laparotomy. This option is used if the endometriosis is extensive or if there is severe pain. Surgical procedures range from minor to major surgery.

Hormones can be effective in treating the symptoms associated with endometriosis as hormones actually cause the endometriosis to go through a similar pattern as the menstrual cycle. Doctors may go over a women's diagnosis again to be sure she actually has endometriosis if her symptoms do not respond to the hormone therapy.

Hormone treatment for Endometriosis

Contraceptives

Contraceptives regulate the growth of the tissue lining the uterus and can often decrease the amount of menstrual flow. This therapy contains two hormones known as 'Oestrogen' and 'Progestin' although some of them will only contain one or the other and can be taken in pill form or by injection.

This treatment will often work, so long as you are using them. Once treatment has stopped, not only does the ability to conceive returns, your symptoms of endometriosis may return also. Every woman's symptoms, pain levels and reaction to treatment vary which is why some women may not have pain for several years after stopping the treatment.

Possible mild side effects:

• Weight gain
  
  
• Bleeding between periods
  
  
• Bloating
  
  
• Depression

Danazol

Danazol works by stopping the release of hormones involved in the menstrual cycle. While using this drug, women may either get their period every now and then or not at all.

Taking steps to prevent pregnancy is vital during the use of Danazol as it can be harmful to the unborn child. Health Care Professionals recommend the use of condoms, a diaphragm or other pregnancy prevention methods that do not involve the use of taking other hormones such as contraceptives as they are to be avoided.

Common side effects include:

• Weight gain
  
  
• Tiredness
  
  
• Tender breasts
  
  
• Smaller breasts
  
  
• Muscle cramps
  
  
• Weakness
  
  
• Hot flashes
  
  
• Headaches
  
  
• Dizziness
  
  
• Slight voice deepening (while on treatment)

Gonadatropin-Releasing Hormone (GnRH) Agonists

GnRH Agonists prevents menstruation by blocking the production of pituitary gland hormones. This allows or stops the growth of endometriosis by sending the woman's body into a "menopausal" state. Once treatment is stopped, the body will come out of this "menopausal" state allowing her to begin her period.

This treatment can be administered daily through a nasal spray or from once a month to every three months by injection. Most doctors recommend that this treatment be used for at least six months. Once treatment is stopped, the menopausal state will cease allowing the periods to begin again and making it possible to fall pregnant. Approximately 50 percent of women using this treatment have some return of their symptoms once they have ceased their treatment.

Side effects include:

• Fatigue
  
  
• Hot flashes
  
  
• Headaches
  
  
• Sleeping problems
  
  
• Depression
  
  
• Loss of bone minerals
  
  
• Vaginal dryness

For more information regarding research on the use of other hormones for the treatment of endometriosis, it is best to consult with your specialist.

Did you know?

Endometriosis can also persist after menopause. The hormones taken for the symptoms of menopause may cause the continuation of the endometriosis symptoms.

Surgical treatments for Endometriosis

Laparoscopy

This procedure involves inflating the abdomen slightly with a harmless gas. They then make a small incision in the abdomen and using a laparoscope (a small viewing instrument with a light), view the intestines, reproductive organs and other surfaces to see if they can locate any evidence of endometriosis. Diagnosis is based on the characteristic appearance of endometriosis and can be confirmed by performing a biopsy. Any endometriosis found can be treated through the following procedures...

• Excising - removing the endometriosis areas
  
  
• Cauterizing - using intense heat to destroy and seal the blood vessels without using stitches
  
  
• Vaporizing

It is common for some doctors to remove scar tissue in case it is a contributing factor in the woman's endometriosis pain, although it is still not known for certain. Laparoscopy procedures are usually done through outpatients as there generally isn't a need to stay overnight in hospital. Recovery times are much faster with laparoscopies compared to major surgery such as a laparotomy.

During a laparotomy procedure, doctors may either perform a hysterectomy or remove the endometriosis. If the ovaries are severely damaged or have endometriosis in them they may also be removed during a hysterectomy. Every Health Care Professional should advise you that this is a Last Resort. Not only is there no guarantee the endometriosis and associated symptoms will not return but, if you have not yet had children you may someday regret the decision.

Can Endometriosis affect fertility?

Approximately 30 to 40% of women with endometriosis are infertile. Sadly, some women don't even find out that they have endometriosis until they are having problems conceiving. Infertility in endometriosis is an ongoing area of research with some studies suggesting that the condition may alter the uterus so as not to accept an embryo. Studies include whether the condition alters the egg or if it gets in the way of transporting the egg to the uterus. Extensive scarring and organ damage associated with severe endometriosis may also affect fertility.

The treatment of infertility in endometriosis is often successfully achieved through the use of hormones and surgery. Women who are seeking to fall pregnant are usually advised by their doctor to have unprotected sex for about 6 months to a year. This is especially the case for women who suffer from minimal endometriosis. If conception has not occurred with that time, then further treatment may be needed.

FACT:Endometriosis is considered to be one of the three major causes of female infertility.

Resources:

Endometriosis Association (Victoria) Inc

National Institutes of Health

National Institute of Child Health and Human Development

You can buy Danazol here

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