Imagine a young woman about 14 years old waking up in the middle of the night with a horrible pain in her abdomen. So painful all she can do is roll up in a little ball in the corner of the room and cry. When she tries to stand to go to the restroom it feels as if all of the blood in her body rushes out of her and she passes out. When she comes too she runs to the restroom to throw up, then to use the restroom, she realizes that she is losing a tremendous amount of blood and has clots the size of quarters.
She knows this is no regular menstrual cycle and yells for her mom. After telling her mother what happened they went up to the emergency room. After thorough inspection the physician diagnoses the girl with dysmenorrhea and prescribes some pain medication to help. After a year of going through the same pain and many visits to the hospital and doctors they finally figured out what the problem was… endometriosis. You may ask, what is endometriosis?
Endometriosis is a condition when the endometrial tissue, which is the inside lining of the uterus, is located outside of the uterus. Endometriosis broken down into its prefix, root, and suffix is: (prefix) endo- within, (root) metri/o uterus, (suffix) –osis abnormal condition. So it is an abnormal condition within the uterus. Some of the areas that the endometrial tissue can grow are usually around the pelvic area including the ovaries, bowels, bladder and rectum, but can spread farther in some cases.
About 5-10% of women has or has been diagnosed with this condition and all of them during their reproductive years. As a matter of fact it is often found in women that are infertile. The only way to diagnose endometriosis is by laparoscopy or other surgeries with lesion biopsy. Although in rare cases endometrial cysts, large areas of endometriosis, or fluid in the cul-de-sac can be spotted by ultrasound or MRI (magnetic resonance imaging), but most of the time the endometriosis isn’t severe enough and doesn’t get noticed.
Once diagnosed there is a staging system that the doctors go by that is based on the physical state of the disease; Stage 1: Minimal findings located on superficial lesions and possibly a few filmy adhesions, Stage 2: Mild, All of what is included in stage 1 but additional deep lesions present in the cul-de-sac, Stage 3: superficial lesions, a few filmy adhesions, deep lesions in cul-de-sac, present on ovaries and more adhesions, and Stage 4: all of the above including large endometriomas and extensive adhesions. The cause of endometriosis is unknown although there are many theories.
One of these theories suggests that endometriosis is reliant on estrogen and is aimed at lowering estrogen levels to control the disease. Another theory that I find interesting was originally proposed by John A. Sampson. He suggested that during menstrual flow some of the endometrial debris exits the uterus through the fallopian tubes and attaches to the lining of the abdominal cavity, where it invades the tissue as endometriosis. Although there are many theories scientists have recognized that it is hereditary in most cases.
The number one symptom of endometriosis is pelvic pain, although there are many more symptoms including dysmenorrhea (painful menses), dysuria (painful urination/ frequent) and dyspareunia (painful intercourse). Some common more universal symptoms include constipation, chronic fatigue, back pain, premenstrual spotting, hypoglycemia, depression, headache, extreme pain in legs and thighs, and many more. The amount of pain and symptoms isn’t related to the extent of the endometriosis. It is possible to have stage 4 endometriosis and have no pain or symptoms whatsoever, or have a stage 1 and have extreme pain and many symptoms.
Although the most pain is associated with menses making women with endometriosis dread their period, pain is still possible at other times during the month such as the time of ovulation, pain because of inflammation, pain with bowel movements, and pain with over exertion (during exercise or intercourse). Though there is no cure for endometriosis in many instances it diminishes after menopause. Although if your merely a 14 year old girl menopause would seem like a century to deal with the agonizing pain of endometriosis. It sure is a good thing that it can be at least managed.
The goals to manage endometriosis is to provide the patient with pain relief, to restore or preserve fertility where and if needed, and to restrict progression of the process. If you are a young woman most often multiple surgeries are attempted to remove endometrial tissue and preserve the ovaries without damaging normal tissue, if you are older and are infertile then a hysterectomy would be the best bet, although it isn’t guaranteed that symptoms won’t come back , plus you would have the menopausal symptoms due to the procedure. For women that do not want to become pregnant there is another treatment option, hormonal medication.
There are many hormonal medications that could help lower the spread of endometriosis and lower the amount of menstrual cycles lowering the monthly pain. The patient’s symptoms and fertility plays a major role in treatment of endometriosis as you can see, although not all therapy or treatment option works for all patients. Proper counseling requires adequate knowledge of the disease. It is very important to properly diagnose the patient with the right stage of endometriosis to see what the best treatment option would be and to treat it with the proper therapy.
The 14 year old girl mentioned above was diagnosed with stage 2 endometriosis after undergoing a laparoscopy where they carefully removed as much adhesion as possible without harming normal tissue, the best treatment option for her was to do routine ultrasounds followed by minimally invasive surgeries if necessary, NSAID’s (non-steroidal anti-inflammatory drugs), an opiod medication (painkiller) oxytocin, and an oral contraceptive (birth control medication) Seasonique until ready to have children.