Letter to the Editor: Endometriosis

Did you know that endometriosis affects about 200 million women worldwide? Here in the United States, more than 11% of women aged 15–44 have this chronic condition.

Endometriosis can cause significant pain. Endometrial tissue normally lines the uterus and is shed each month during menstruation. However, with endometriosis there is tissue growing outside of the uterus: on the ovaries, the Fallopian tubes, the surface of the uterus, the bowel, or on the lining of the pelvic cavity. (Quite rarely, it’s even found outside of the pelvis: in the liver, brain, lung, or on old surgical scars.)

Still, most women who have endometriosis have no symptoms at all. When there are symptoms, the most common are: pain before menstruation, painful sexual intercourse, cramping during bowel movements or urination, and infertility. Symptoms can vary from month to month. Although pain is the clue that most often leads to the discovery and diagnosis of endometriosis, sometimes nodules can be felt during a vaginal exam. An ultrasound or laparoscopy with tissue biopsy will usually be done in order to confirm the diagnosis.

While the cause is unclear, there are several factors that place a woman at greater risk for endometriosis. These include: never having given birth, starting menstruation at an early age, going through menopause at an older age, short menstrual cycles (fewer than 27 days), heavy menstruation that lasts longer than seven days, higher levels of estrogen, low body mass index, having one or more relatives with endometriosis, having any medical condition that prevents normal passage of menstrual flow, and reproductive tract abnormalities.

Endometriosis treatments usually involve medication and/or surgery. The goals are to relieve symptoms and (if pertinent) treat infertility. Anti-inflammatory medications may help to relieve pain. Other medications can be used to suppress or stop menstrual cycles, which trigger pain, or to reduce the size of the endometrial tissue.

Surgery (usually laparoscopic) may be considered when the symptoms are severe, medications are not effective, or if scarring and inflammation interfere with the pelvic organs, bowels or urinary tract. Unfortunately, endometriosis often returns, so medication is usually continued as well.

If you suffer from chronic pelvic pain, I urge you to seek medical care. Treatment can make an enormous difference. And of course, the cause of the pain may not be endometriosis - other possibilities include interstitial cystitis, irritable bowel disease, pelvic floor dysfunction, or neuropathy.