Q: You published an article about endometriosis a few years back – maybe in 2005 or 2006. I am trying to find it. I searched, but it does not go back that far on your website. Can you either reprint it or cover the topic once again?
A: As with just about every medical condition, research brings about new information, new treatments and better methods of management so perhaps it’s okay you need to begin fresh.
The endometrium is the mucous membrane lining of the uterus that consists of three layers and changes in thickness during each menstrual cycle. Two of the layers are shed and the third provides a surface for placenta to attach to during pregnancy. Because the tissue has no means of exiting the body, it becomes trapped. Surrounding tissue may become irritated and cysts may form. Thus, the medical term of endometriosis is a gynecological condition that occurs when tissue that normally lines the inside of the uterus grows outside of it but within the pelvic region. It is estimated that up to 10% of all women suffer to some degree from this occurrence. The condition generally involves the ovaries, the tissue lining the pelvis, or bowel. It is rare for it to grow beyond the pelvic area.
Common signs and symptoms of endometriosis include excessive bleeding during menstruation, dysmenorrhea (pain linked to menstruation), pain on urination, when having a bowel movement or with intercourse, fatigue, constipation, diarrhea, and bloating – all primarily during a menstrual cycle. The condition commonly develops several years following the onset of menstruation. Those at increased risk for endometriosis are women who have a history of pelvic infection, have never had a child, have issues with uterine abnormalities, began menstruating at a young age, and those with a family history of the disorder. There are a number of other medical conditions that can mimic endometriosis such as irritable bowel syndrome, pelvic inflammatory disease or ovarian cysts to name a few that may need to be ruled out in order to make a diagnosis.
Testing will generally begin with a pelvic examination by a health care provider, followed by ultrasound that will not be definitive but can provide a view of a woman’s reproductive organs and identify any cysts that might be present. Following this, the patient may be referred to a gynecologist for a procedure known as laparoscopy in which a very small incision is made in the area of the navel which will allow the physician to determine if there is evidence of any endometrial tissue outside the uterus.
Depending on the severity of the condition, treatment generally begins very conservatively with pain medication such as over-the-counter nonsteroidal anti-inflammatory drugs. Supplemental hormones may be effective, however they are not a permanent answer for endometriosis. Other options for control of pain may include acupuncture and regular exercise. If a woman hopes to become pregnant and bear a child, conservative surgery may be in line. Further, in an attempt to stop the condition from getting progressively worse, a physician may prescribe birth control pills for up to nine months that will halt menstruation and create a state similar to pregnancy. Other hormonal treatments may include progesterone pills or injections; however, they carry unwanted side effects such as weight gain and depression.
I don’t know if I have sufficiently covered any questions you might have and can only suggest that you contact your gynecologist who may be able to help further.
Readers who are interested in learning more can order Dr. Gott’s Health Report “Managing Chronic Pain” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
