Pain. This is the most common symptom. Endometriosis pain can come in many different forms. These include: - very painful menstrual cramps. The pain may get worse over time. - chronic (long-term) pain in the lower back and pelvis - pain during or after sex. This is usually described as a "deep" pain and is different from pain felt at the entrance to the vagina when penetration begins. - intestinal pain - painful bowel movements or pain when urinating during menstrual periods. In rare cases, you may also find blood in your stool or urine.
Bleeding or spotting between menstrual periods. This can be caused by something other than endometriosis. If it happens often, you should see your doctor.
Infertility or not being able to get pregnant. The various mechanisms of how endometriosis causes infertility have been discussed in a previous blog.
Stomach (digestive) problems. These include diarrhea, constipation, bloating, or nausea, especially during menstrual periods.
What causes endometriosis pain and health problems?
Endometriosis growths bleed in the same way the lining inside of your uterus does every month — during your menstrual period. This can cause swelling and pain because the tissue grows and bleeds in an area where it cannot easily get out of your body.
The growths may also continue to expand and cause problems, such as:
Blocking your fallopian tubes when growths cover or grow into your ovaries. Trapped blood in the ovaries can form cysts.
Forming scar tissue and adhesions (type of tissue that can bind your organs together). This scar tissue may cause pelvic pain and make it hard for you to get pregnant.
Problems in your intestines and bladder
How is endometriosis diagnosed?
If you have symptoms of endometriosis, talk with your doctor. The doctor will talk to you about your symptoms and do or prescribe one or more of the following to find out if you have endometriosis:
Pelvic exam. During a pelvic exam, your doctor will feel for large cysts or scars behind your uterus. Smaller areas of endometriosis are harder to feel.
Imaging test. Your doctor may do an ultrasound to check for ovarian cysts from endometriosis. The doctor or technician may insert a wand-shaped scanner into your vagina or move a scanner across your abdomen. Both kinds of ultrasound tests use sound waves to make pictures of your reproductive organs. Magnetic resonance imaging (MRI) is another common imaging test that can make a picture of the inside of your body.
If your doctor does not find signs of an ovarian cyst during an ultrasound, he or she may prescribe medicine:
Hormonal birth control can help lessen pelvic pain during your period.
Gonadotropinreleasing hormone (GnRH) agonists block the menstrual cycle and lower the amount of estrogen your body makes. GnRH agonists also may help pelvic pain.
If your pain gets better with hormonal medicine, you probably have endometriosis. But, these medicines work only as long as you take them. Once you stop taking them, your pain may come back.
Laparoscopy. Laparoscopy is a type of surgery that doctors can use to look inside your pelvic area to see endometriosis tissue. Surgery is the only way to be sure you have endometriosis. Sometimes doctors can diagnose endometriosis just by seeing the growths. Other times, they need to take a small sample of tissue and study it under a microscope to confirm this.
How is endometriosis treated?
There is no cure for endometriosis, but treatments are available for the symptoms and problems it causes. Talk to your doctor about your treatment options.
If you are not trying to get pregnant, hormonal birth control is generally the first step in treatment. This may include:
Extended-cycle (you have only a few periods a year) or continuous cycle (you have no periods) birth control. These types of hormonal birth control are available in the pill or the shot and help stop bleeding and reduce or eliminate pain.
Intrauterine device (IUD) to help reduce pain and bleeding. The hormonal IUD protects against pregnancy for up to 7 years. But the hormonal IUD may not help your pain and bleeding due to endometriosis for that long.
Hormonal treatment works only as long as it is taken and is best for women who do not have severe pain or symptoms.
If you are trying to get pregnant, your doctor may prescribe a gonadotropin-releasing hormone (GnRH) agonist (e.g. Depo Lupron 3.75 mg intramuscularly every month or 11.25 mg every 3 months). This medicine stops the body from making the hormones responsible for ovulation, the menstrual cycle, and the growth of endometriosis. It causes a temporary menopause and also helps control the growth of endometriosis. Once you stop taking the medicine, your menstrual cycle returns, but you may have a better chance of getting pregnant.
Long-term use of GnRH agonists is problematic as they are associated with bone loss. Adults lose 5 – 8 % of bone in the spine after only 3 – 6 months of GnRH agonist treatment. The bone loss can persist after stopping the treatment. We will therefore often prescribe medications that prevent bone loss along with the GnRH-agonist (add-back therapy). Aygestin (northindrone acetate) 5 mg daily prevents this bone loss.
Surgery is usually chosen for severe symptoms, when hormones are not providing relief or if you are having fertility problems. During the operation, the surgeon can locate any areas of endometriosis and may remove the endometriosis patches. After surgery, hormone treatment is often restarted unless you are trying to get pregnant.
Other treatments you can try, alone or with any of the treatments listed above, include:
Pain medicine. For mild symptoms, your doctor may suggest taking over-the-counter medicines for pain. These include ibuprofen (Advil and Motrin) or naproxen (Aleve).
Complementary and alternative medicine (CAM) therapies. Some women report relief from pain with therapies such as acupuncture, chiropractic care, herbs like cinnamon twig or licorice root, or supplements, such as thiamine (vitamin B1), magnesium, or omega-3 fatty acids.
Dr. Karande is Board Certified in the specialty of Obstetrics and Gynecology as well as the subspecialty of Reproductive Endocrinology and Infertility. He is a Fellow of the American College of Obstetricians and Gynecologists and Member of the American Society for Reproductive Medicine.