Sat | Jan 19, 2019

Dealing with Endometriosis

Published:Saturday | December 27, 2014 | 12:00 AM

It is often said that 'women were made to feel pain' , and there are a number of painful conditions that either affect women more frequently or even exclusively. Endometriosis is one of those conditions which affect women exclusively and can cause severe pain.

The lining of the cavity of the womb changes in response to the hormonal changes that take place throughout the menstrual cycle as it prepares to accept a fertilised egg which leads to pregnancy. If no pregnancy occurs, then the lining sheds and flows out through the cervix and then through the vagina along with blood (the period). In endometriosis, bits of this lining are outside of the womb but behave just like the one in the womb, yet there is nowhere for the shed lining and the blood to go. These bits of lining may be in the ovaries, Fallopian tubes, the covering of pelvic and abdominal structures, cervix, vagina, bladder, intestines, abdominal wall (especially inside of surgical scars) and even the kidney, liver and stomach.

Endometriosis affects women during their reproductive years, especially ages 25-35. It is less common in blacks than whites. It's more common in slender persons and those who delay having children. It also seems to run in families.

Endometriosis usually causes painful periods, which get worse over time and can be incapacitating. There may also be pelvic pain outside of periods, as well. It may also cause pain during exercise, intercourse, urination and/or defecation. Abnormal uterine bleeding may occur such as heavy periods, bleeding between periods and after intercourse. Also about 20-40 per cent of infertility cases are caused by endometriosis, even when there is no other symptom, and about 30-40 per cent of women with endometriosis are subfertile. In addition, blood-filled cysts (endometriomas) may form on the ovaries and there is an increased risk of ovarian cancer.

Examination and ultrasound are not usually adequate for diagnosis. A laparoscopy (looking into the pelvis through a small cut though the tummy with a special device) is usually required.

Treatment is based on the severity. For mild cases, the pain can be relieved by NSAIDs, like ibuprofen. Hormonal treatment may be required - ranging from oral contraceptive pills to more specialised treatments. Surgery may also be required, and this can range from removing cysts from the ovaries and other resulting tumours found to removal of all the internal female reproductive organs (womb, cervix, ovaries and Fallopian tubes).