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Not surprisingly, distortion and obstruction of reproductive
organs because of congenital defects and lifetime
developments predisposes affected women to endometriosis. For
example, if you have chronic pain in the pelvis from a uterus
tipped out of position the risk of endometriosis is
greater.
The chances of disease appearing in a
woman whose mother, aunt, or sister have it are seven to 10
percent greater than in other women—so is the likelihood
that it will appear earlier in life and be more
severe.
The old stereotype of the typical
endometriosis candidate as white, in her late thirties, and
not yet a mother has now been generally discarded. The
disease occurs twice as often in Japanese as in Caucasian
women and it is common in American blacks. More research is
needed to determine disease rates in women of other
races.
Who Gets It?
From 10 to 20 percent of American women
develop endometriosis some time in their lives. Currently,
between 5 million and 12 million are estimated to have the
disease. It has been found in girls and women aged 10 to 70,
though a large majority of cases are in the childbearing
years. In any case, both those who have borne children and
those who have not are targets. The disease is also now
recognized as more common in teenagers that once
thought.
And
Why?
No single cause for endometriosis is
universally accepted. As one authority puts it, “there
is no simple explanation”—probably because it is
often accompanied by diseases with similar symptoms and
effects. It varies in intensity from one person to another
and is sometimes unaffected by or returns after
“definitive” treatment, including hysterectomy
(surgical removal of all or most of the reproductive
organs).
No fewer than 12 theories have been
proposed since 1921 to explain how and why endometriosis
occurs. Of the three best known, the oldest is based on the
fact that blood flow during menstruation can back up into the
fallopian tubes, possibly carrying endometrial tissue
fragments into the ovaries and abdomen. This theory does not,
however, explain why only some of the nine out of 10 women
who experience this backward flow develop endometriosis. Nor
does it tell why some women still have endometriosis even
though they have had their fallopian tubes tied, blocking
access to the abdomen.
Another suggestion is that, since all
tissues in which endometriosis is found originate from the
same part of the embryo, some of these tissues such as the
peritoneum (which covers the organs inside the abdomen), may
gradually change into functioning endometrial tissue in
response to chronic irritation by wandering menstrual blood.
This could also account for the widely separated sites such
as lungs, arms, and legs, where endometriosis has been found.
However, there is no conclusive evidence that tissues with a
common embryonic source can be transformed in this
way.
A third idea, the “immune
defect” theory, is based on the high levels of
antibodies (disease-fighting proteins) found in endometriosis
patients' blood, plus observation of spontaneous development
of endometriosis in monkeys and the fact that women whose
close relatives have the disease are at increased risk. In
some women a hereditary tendency toward endometriosis,
together with an immune reaction against their own tissues,
might bring on the disease. Research into this theory is on
the rise. Among other mysteries it might help clear up is why
endometriosis is so rare in the cervix, despite its regular
exposure to menstrual fluid.
Finally, environmental factors that
possibly contribute to endometriosis may be uncovered by
current studies of levels of the pesticide dioxin and similar
chemicals in the blood of women with the disease. These
studies stem from the unexpected finding of endometriosis in
80 percent of female rhesus monkeys exposed to very small
amounts of these chemicals over four years. More of the
monkeys on the highest doses had moderate to severe disease
than those on the lowest doses. Monkeys not receiving dioxin
did not develop either moderate or severe disease.
How the Disease Plays
Out
While the search for causes continues, a
cure for endometriosis has yet to be found. Though the
disease is seldom life threatening, the damage it can do to
the quality of a woman's life is immense. There is no easy
way to “live with” severe pain that can return
month after month and often progresses to involve major
organs and other areas of the body. Symptoms can interfere
with building a career or even holding a job, bearing
children and caring for them, having sex, or simply enjoying
life. It is not surprising that phone “help” lines
for women with “Endo” (as its sufferers have dubbed
it) are to be found in many communities. The psychological
effects on personal relationships and feelings of self-worth
can be devastating.
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THE “OTHER”
ENDOMETRIOSES
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Though
endometriosis develops when endometrial tissue grows and
functions
outside the uterus, endometrial tissue
inside the uterus can also grow
abnormally—invading the muscular wall of the uterus
on which the endometrium lies.
For many years
both conditions were considered forms of the same disease
and were called endometriosis externa and interna. Now
they are considered two different diseases. Though both
can be found in the same person 20 percent of the time,
adenomyosis, as it is now termed, usually affects
women in their 30s and 40s who've already had several
children. It is thought to result from the trauma and
damage to the uterine wall produced by repeated
pregnancies, deliveries, and subsequent return of the
uterus to normal size. Unlike the isolated tissues of
endometriosis, the islands of endometrial glands formed
by adenomyosis always maintain a connection with the
endometrium, even when buried in the uterine wall. The
disease is associated with a greater chance of developing
fibroids, polyps, and endometrial cancer than is
endometriosis itself.
Finally, there
is
stromal endometriosis, which doesn't look or
behave like endometriosis, but instead like an abnormal
growth in the uterus. Independent growths have never been
found outside the uterus, though extensions of the
intrauterine growth can make their way out of the uterus
and involve other organs. The disease is termed stromal
(supporting tissue) endometriosis because no endometrial
glands are found in the lump of endometriotic tissue it
forms. It is often highly malignant, and is treated as an
endometrial cancer.
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Though many women have a mild form of
endometriosis that passes with vague and minor soreness in
the lower abdomen, the adhesions and scar tissue that build
up in others can eventually “freeze” the
reproductive and other pelvic organs in place and, along with
internal bleeding and other progressive effects, destroy
them. A rating system that ranks severity of a woman's
endometriosis in five stages has been established. In the
first stage, pain is minimal and there is no abnormal
bleeding. In the second, the pain is greater and accompanied
by internal bleeding. In the next stage the disease
progresses, with hemorrhaging and adhesions in which tissues
covering various organs, inflamed by the endometrial growths
bleeding into them, begin to stick together. The adhesions
grow thicker in the next stage and destruction of organs
begins. In the final stage there is total loss of
reproductive function, extensive organ destruction, and a
“frozen pelvis” produced by dense
adhesions.
Probably the most “pain” women
experience next to the severe pain of the disease itself, is
the threat endometriosis presents to fertility. Nearly half
of women with the disease have reported infertility problems.
Severe endometriosis can, of course, block and bend
reproductive organs into abnormality, yet no direct causal
link has been found between endometriosis and infertility.
Though pregnancy often reduces or eliminates symptoms, at
least temporarily, it is not a cure. The disease can progress
while the baby is developing and bring back symptoms after
the child is born. If you have a family history of
endometriosis, your doctor may encourage you to have children
early, before the disease arrives and brings progressive
complications. Of course, this advice can't help the
increasing number of women who develop the disease as
teenagers, especially since research seems to indicate that
women with endometriosis in the family develop serious cases
earlier than others.
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What can you do to help yourself? Pain
relief is a principal concern of anyone with the difficult
and painful menstrual flow that so often is a symptom of
endometriosis. Several medications that attack this pain are
available without a prescription. Aspirin is the original,
but ibuprofen (Advil, Motrin, others) is considered more
effective. However, allergies to these drugs and too frequent
use at too high doses can cause side effects. These
medications reduce the effects of prostaglandins
(hormone-like compounds involved in the production of pain
and inflammation) that increase rapidly as menstruation
approaches. They are therefore often most effective when
taken just before, as well as during, your
period.
Good nutrition helps fight any disease,
but its value against endometriosis is somewhat limited. Most
approaches are designed to reduce the effect of estrogen on
endometrial tissue. B vitamins, especially B
6, promote the liver's ability to change estrogen
to estradiol, a form of the hormone less prone to promote
endometrial growths. Vitamin E has been called an estrogen
antagonist and may break down the hormone when it is present
in excessive amounts. Whole wheat, citrus fruit, and yams are
reported to raise estrogen levels and perhaps should be
avoided. Fish oils are said to reduce prostaglandin
production. Before making any of these dietary adjustments,
it's wise to check with your doctor, and none should be made
too radically. Remember, too, that diet cannot repair damaged
tissues and organs and is probably useful only in early
endometriosis.
One nutritional supplement that you
should definitely keep in mind is extra iron. Excessive
bleeding at menstruation can reduce this essential component
of the blood. Exercise is also advisable, since it tends to
reduce menstrual flow and, therefore, the irritation and
inflammation where foreign endometrial tissue is
growing.
None of these remedies get at the
underlying problems of endometriosis, but they can make the
symptoms more bearable. However, when symptoms begin to
interfere with daily living, it is important to consult your
doctor. Remember that the severity of the disease is not
necessarily reflected by the severity of the
symptoms.
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