Endometriosis

Endometriosis

What is Endometriosis?

Endometriosis is a gynaecological condition where the endometrial tissue (tissue that lines the uterus and builds up and then sheds with every menstrual cycle) begins to grow outside of the uterus. Endometriosis affects approximately 10% of women of reproductive age, including teens.

What Causes Endometriosis?

It is still not fully understood what causes endometriosis. It is believe that factors involved include the immune system, environmental exposures and genetic predisposition.  One theory is retrograde menstruation and another is hormonal-triggered transformation of cells in the abdomen into endometrial cells, which then multiply. If a close relative has endometriosis, a woman is 7 times more likely to also develop endometriosis.

What are Typical Symptoms of Endometriosis?

Common symptoms include pain at time of menstruation, although pain can also occur at other times during the cycle, such as ovulation. Pain may also occur with bowel movements and with vaginal penetration, including intercourse. Other symptoms can include abdominal bloating, heavy periods, and fatigue.

Endometriosis is Always Painful, Right?

Interestingly, not all people with endometriosis experience pain, and their disease may have been found incidentally during a procedure for another problem. In addition, the staging of endometriosis also does not always correspond with pain experience. For example, someone with stage 4 endometriosis may have very little pain, whereas someone with stage 1 endometriosis may have severe pain.

Does Endometriosis Cause Infertility?

A majority of people with endometriosis will maintain fertility. A minority (about 30-40%) may have infertility due to endometriosis affecting the fallopian tubes and ovaries.

How is Endometriosis Diagnosed?

Definitive diagnosis is confirmed through biopsies taken during a laparoscopy.  A preliminary diagnosis can be made based on symptoms, physical exam, and specialized ultrasound exam.

What if Cyclical Pain Over the Years Changes to Daily Pain?

Some people with endometriosis continue with only cyclical symptoms (at menstruation or ovulation), whereas others can start to have non cyclical pain. Research now shows that women with persistent pelvic pain have changes in the nervous system, which can present as widespread pain, bladder and bowel pain, sexual pain, migraines, fatigue, and environmental sensitivities.

How is Endometriosis Treated?

International Clinical Guidelines vary. However, lifestyle changes are generally supported. The SOGC recommends a healthy diet, increasing exercise and relaxation and mindfulness. Hormone based treatments to stop the period and growth of endometriosis are common. These may include combined hormonal contraception, progesterone-like medications, or gonadotropin releasing hormone (GnRH) agonists with ‘add-back’ therapy (low doses of estrogen and progestin). These help to manage endometriosis based symptoms. Some people experience physical and mood side effects that limit their tolerance to these treatments,  others may choose not to take hormonal treatments.

Laparoscopy is often offered as a treatment for extensive endometriosis or if fertility is affected, but repeated laparoscopies are now discouraged without offering other treatment modalities. Laparoscopy techniques include oblation, where the endometriosis is cauterized, or excisional where the endometriosis and surrounding tissue is removed. It is important to acknowledge that although surgeons can skilfully remove endometriosis through laparoscopy, there is no guarantee that this will improve pelvic pain, especially if pain has become persistent and widespread sensitivity is present. The surgeon may decide to refer their patient for multidisciplinary treatment to calm the nervous system first before considering surgery.

Multidisciplinary treatment, including working with a counsellor, physiotherapist, and dietician, is often being offered to people with pelvic pain, with or without endometriosis, to given them the opportunity to address the multiple factors involved. Treatment could include pain education, cognitive behavioral therapy, mindfulness strategies, pelvic physiotherapy, and dietary changes to reduce sensitivity. This sentence needs to be changed to: There is interest in establishing more pelvic pain programs in Canada to help address this need.

The Endometriosis Network of Canada (TENC) is a non for profit organization who is dedicated to promote awareness while providing education, support and resources nationally, for people with endometriosis and those whose lives it touches. 

     https://endometriosisnetwork.com