Women's Health by Dr. Amber Shamburger

2013-10-30

Endometriosis

Endometriosis is a common cause of pelvic pain in women. This is a condition where small cells from inside your uterus move into your abdomen via various mechanisms.  One theory of how this happens it that the cells move through the tubes and fall into the abdomen during a period instead of being shed though the vagina.  This process is called retrograde menstruation.  These endometrial cells that are now inside the abdomen will still respond to the hormones that the body normally produces during the menstrual cycle, which will cause them to have a small amount of blood in them around the time of a period.  Blood is very irritating to the inside of the abdomen and will cause very painful periods.  It can also cause scar tissue to form inside the abdomen, which can lead to chronic pelvic pain.

Typically, people who have endometriosis experience pelvic pain that begins 2-3 days prior to their period and lasts for the duration of their period. If scar tissue has formed inside of their abdomen, this can lead to chronic pelvic pain that is unrelated to the menstrual cycle. This scar tissue can sometimes make it difficult to become pregnant.

Endometriosis can be diagnosed clinically (meaning without any tests) if the patient’s symptoms match the typical symptoms reported with this disease. If there are any questions to the diagnosis, a simple surgical procedure called a diagnostic laparoscopy can be performed. Endometriosis is not usually seen on an ultrasound or other imaging studies, unless a cyst that contains old blood has formed. These are called endometriomas.

Treatment options include medications that stop the normal cycle of hormones that are produced by the body and surgical procedures. Medical options for treatment are birth control pills, the depo provera shot, the Implanon device, or the depo Lupron shot. The last injection causes a menopausal-type state, so it is usually reserved for when other medications have failed. Other medical options may include a Mirena IUD. Surgical treatments can be performed at the time of laparoscopy if one is being performed to obtain a diagnosis. If endometriosis implants are seen, they can then be destroyed or removed.  A surgical treatment of last resort would be a complete hysterectomy, usually including removal of the ovaries as well.




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