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Endometriosis: Symptoms, cost and Treatment

What is endometriosis?

Endometriosis is a painful gynecological disorder, which occurs in women when the tissue that makes up the uterus lining develops elsewhere in the body.Women with endometriosis often suffer from infertility, lower abdominal pain, pain during menstruation, or pain during sexual intercourse. Some women with endometriosis, however, may not have any symptoms at all.

How does endometriosis occur?

Every month hormonal changes in women cause the lining of the womb to thicken, to prepare itself for pregnancy. When the pregnancy does not occur, the cells break down and bleed out of the body naturally, which is the monthly menstruation cycle.

In endometriosis, the womb cells or the tissue that makes up the uterus lining grows in other parts of the body, such as the ovaries, fallopian tubes, the exterior of the uterus, the bowel, or other internal parts. Now, these cells too go through the same monthly cycle and break down during menstruation. But unlike the cells lining the womb, these cells have no outlet to leave the body once they break down. This can cause inflammation and scar tissue to form.

There are different types of endometriosis:

Peritoneal endometriosis: which occurs when cells which form the uterus lining stray into different parts of the body and accumulate till they become scar tissue.

Endometriosis of ovary: these start as coloured spots and form deposits which can go deeper into the ovary, where they eventually create cysts.

Adenomyosis: which occurs when the endometrial tissue grows into the muscle layer of the uterus damaging the uterine wall. It usually affects women over 30 who have had several births.

Rectovaginal septum endometriosis: affects ligaments between the uterus and pelvic bones causing adhesions.

Other signs and symptoms. You may experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.

Who is prone to endometriosis?

Some women are more prone to endometriosis than others. They include women who:

  • have a family history of endometriosis
  • are pregnant for the first time at an older age
  • suffer from heavy bleeding during periods
  • have periods which last longer than five days
  • have their first period before 11 years of age
  • regularly have less than 27 days between periods, or having shorter regular cycles
  • have experienced sudden changes in the immune cells
  • are underweight
  • overindulging in alcohol
  • have retrograde menstruation. Retrograde menstruation occurs in almost all menstruating women (up to 90 %) and therefore is considered a natural process. Retrograde menstruation occurs when, during menstruation, the blood flows out of the vagina, but also backwards along the fallopian tubes into the pelvis. In majority of the women the blood, which contains endometrial cells is absorbed or broken down and causes no symptoms. However, problems arise when larger volumes of menstrual fluid reach the pelvic cavity. This is when endometriosis occurs.

What are the causes of endometriosis?

The causes endometriosis are not known, however, there can be many risk factors which can vary from person to person such as:

  • a family history of endometriosis
  • being pregnant for the first time at an older age
  • suffering from heavy bleeding during periods
  • having periods which last longer than five days
  • having their first period before 11 years of age
  • having less than 27 days between periods
  • sudden changes in the immune cells
  • being underweight
  • overindulging in alcohol
  • retrograde menstruation

What are the symptoms of endometriosis?

Endometriosis symptoms include:

  • pelvic pain and discomfort
  • painful, heavy and/ or irregular periods
  • pain during or after sex
  • painful bowel movements
  • stomach bloating
  • back pain
  • leg pain
  • depression
  • constipation
  • fatigue
  • fertility issues
  • pain during urination
  • diarrhea

Since some of the symptoms of endometriosis are similar to Irritable Bowel Syndrome (IBS), acute appendicitis, interstitial cystitis, or celiac disease, there are possibilities of misdiagnosis. In fact what is commonly known as bladder and bowel endometriosis can get misdiagnosed easily to be irritable bowel syndrome or appendicitis.

What is bladder endometriosis? What are the symptoms of bladder endometriosis?

Bladder endometriosis occurs when endometrial-like cells grow on or through the walls of the bladder. Symptoms include:

  • frequent urination
  • pain on urination
  • urinary urgency
  • urinary retention
  • bloody urine

Here are some key points about endometriosis.

  • Endometriosis affects between 6 and 10 percent of women of reproductive age worldwide.
  • The condition appears to be present in a developing fetus, but estrogen levels during puberty are thought to trigger the symptoms.
  • Symptoms are generally present during the reproductive years.
  • Most women go undiagnosed, and in the U.S. it can take around 10 years to receive a diagnosis.
  • Allergies, asthma, chemical sensitivities, autoimmune diseases, chronic fatigue syndrome, fibromyalgia, breast cancer, and ovarian cancer are linked to women and families with endometriosis.

What is bowel endometriosis? What are the symptoms of bowel endometriosis?

Bowel endometriosis occurs when endometriosis affects the ileum, (which is part of the small intestine). The symptoms are:

  • pain on the right side of the abdomen that mimics acute appendicitis
  • bowel obstructions
  • constipation which can last for weeks
  • rectal pain and bleeding

How is endometriosis diagnosed?

Endometriosis can be treated by a gynecologist. The doctor will first ask you for your medical history and then ask you to describe your symptoms. He/ she will perform a pelvic exam manually for abnormalities such as cysts. The doctor will ask you to undergo tests such as :

  • Ultrasound
  • Laparoscopy
  • For bladder endometriosis, the doctor may suggest a biopsy, where a portion of the endometrial implant is sampled from inside the bladder. This will rule out other causes of bladder symptoms, such as interstitial cystitis or rarely, bladder cancer.
  • For bowel endometriosis, the doctor may suggest laparoscopy and proctoscopy (a procedure in which a camera is placed in the rectum) or a CT scan of your abdomen. If you suffer from rectal bleeding your consulting gynecologist may also suggest you be evaluated by a gastrointestinal specialist to rule out the possibility of colon cancer.

What are the complications of endometriosis?

The complications of endometriosis if treatment is delayed, include:

  • fertility issues
  • adhesions ? 'sticky' areas of endometriosis tissue that can join organs together
  • ovarian cysts that can sometimes become very large and painful
  • bowel obstructions
  • constipation which can last for weeks
  • rectal pain and bleeding
  • frequent urination
  • pain on urination
  • urinary urgency
  • urinary retention

Complementary and alternative treatments may include acupuncture How does acupuncture work?, chiropractic, and herbal medicine, but there is little evidence to show that these are effective.

Avoiding caffeine may help to reduce pain, as caffeine can worsen symptoms.

What is the treatment for endometriosis?

Medical Treatment for Endometriosis

Currently, there is no cure for endometriosis. The aim of the treatment for endometriosis is to reduce the severity of the symptoms and the hormones that contribute to the issue.

Based on the severity of your condition the doctor may prescribe medicines which include painkillers, anti-depressants, contraceptive pills. For more severe cases the doctor may suggest laparoscopy, bowel surgery, hysterectomy, or oophorectomy.

Other options includes:

Pain medications: Either over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others) or prescription drugs for the treatment of painful menses.

Hormones: Treatment may be with hormonal therapies such as hormonal birth control, Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists, Medroxyprogesterone (Depo-Provera) or Danazol. Placement of an intrauterine device (IUD) may also be recommended.

Surgery: Initial surgery will seek to remove the areas of endometriosis, but a hysterectomy with removal of both ovaries may be necessary.

Fertility treatment: Pregnancy may be recommended via in-vitro fertilization (IVF).

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