Your monthly menstrual cycle may include symptoms like breast tenderness, bloating, mood swings and mild cramps. But severe menstrual cramps that leave you lying in bed wrapped around a heating pad could be an indication of a different physical condition.
Endometriosis is a leading cause of female pelvic pain and affects more than 5 million women in the North America alone. However, there’s more to endometriosis than just “killer cramps.”
What is endometriosis?
Endometriosis occurs when tissue which normally lines the uterus (endometrium) grows outside the uterus. In women with endometriosis, this tissue – also referred to as lesions, nodules or implants – can be found on the walls of the pelvic cavity, on the ovaries in the form of cysts, on the fallopian tubes, behind the uterus, the recto-vaginal septum or cul-de-sac. Less commonly, lesions are found on the bowel, bladder, intestines or appendix. And, rarely, it’s found on the lungs or brain.
During a woman’s menstrual cycle, the lining of the uterus thickens in preparation for pregnancy. If pregnancy doesn’t occur, this added tissue breaks down, sloughs off and exits the body during her “period.”
With endometriosis, the lesions act the same way. Because this displaced blood and tissue can’t exit the body, the surrounding tissues become inflamed and cause pain. Over time, scar tissue and adhesions develop. Eventually, the scar tissue can cause organs to stick together, which might cause further pain and even infertility.
Endometriosis is more than killer cramps
The hallmark symptom of endometriosis is pelvic pain. However, women with the disease can feel pain anytime during the month as the misplaced endometrial tissue changes. Other symptoms include:
- Painful periods. Severe menstrual cramps, including abdominal and lower back pain, can start a few days before and last the duration of your period.
- Heavy bleeding. Your periods may be heavier than normal or you could have bleeding between periods.
- Pain during or after intercourse. Many women with endometriosis have pelvic pain during or immediately after sex due to the misplaced tissue or adhesions.
- Pain with urination or bowel movements. These symptoms are usually worse during your period.
- Loose stools during your period.
- Infertility. 30-40 percent of women with endometriosis have trouble conceiving, making endometriosis one of the leading causes of infertility.
Are treatments available for endometriosis?
There’s no cure for endometriosis, but treatments are available. Despite the common myth, the severity of the disease doesn’t correlate to the severity of pain associated with it. In other words, some women have many endometrial lesions and excessive scar tissue, but feel little pain. Whereas, other women have fewer lesions and little-to-no scarring, but suffer severe pain. In either case, treatment is available.
- Pain medication – some women with endometriosis can manage their pain with over-the-counter pain medications like ibuprofen or acetaminophen.
- Hormone therapy – sometimes, oral contraceptives are effective by reducing the frequency or duration of your periods. Other hormonal treatments include drugs that block the production of ovarian-stimulating hormones, in essence stopping ovulation and preventing the endometrial tissue from going through the normal monthly changes. These hormones can also shrink existing endometrial lesions, making them easier to remove surgically.
- Surgery – if pain medication and hormone therapy don’t ease your symptoms, excision surgery can help. Excision surgery removes the endometriosis (lesions) and may preserve the integrity of the uterus, fallopian tubes and ovaries.
- Hysterectomy – usually a last resort, a hysterectomy can treat severe endometriosis by removing the uterus, cervix and ovaries. However, hormone replacement therapy, specifically estrogen, can still stimulate endometriosis left behind and cause pain to continue. So, many women with endometriosis have to opt out of hormone replacement therapy and are therefore thrust into immediate, full-blown menopause.
Endometriosis can be difficult to diagnose. If you suffer from chronic pelvic pain, log your symptoms – including the severity of your pain (on a scale of 1-10) and what methods you use to alleviate it. Talk to your Providence primary care provider or gynecologist – and share your log. Work together to create a treatment plan that’s right for you.
For more information about endometriosis, visit the Endometriosis Association website.