Health Square: Keeping Endometriosis at Bay page 3

Tip-offs of Endometriosis

Painful menstrual periods with heavy, irregular flow, so common in a variety of reproductive disorders, are a hallmark of endometriosis. Pain may begin before the period and go on even after it ends, and may be accompanied by pain in the lower back. However, the problem that first sends most women with endometriosis to their doctors is a chronic pain in the pelvis (the area below the navel, above the thighs, and between the hips).

Other signs of possible endometriosis include diarrhea and painful bowel movements during periods, consistently painful intercourse, and long-standing infertility. For some women, however, the only symptom may be tenderness of the abdomen, sometimes in a particular spot. For others there may be no symptoms at all, even when the disease is well advanced.

What It Is

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You can see from this description that endometriosis appears to be related to the menstrual cycle. In fact, it is a benign (not cancerous) condition that, in 95 percent of the cases, affects women only during their child-bearing years. The endometrium, a layer of tissue that lines the uterus, normally thickens with blood, shreds, and is shed through the vagina as the menstrual period arrives. Sometimes however, this tissue is found outside the uterus attached to or imbedded in other body tissues. The name given this condition, endometriosis, comes from the Greek words, endo (within), metra (uterus) and osis (abnormal or diseased condition).

Obviously, that's a misnomer. For in endometriosis, fragments of endometrial tissue appear almost anywhere in the body, except “within” the uterus. Most often affected are the ovaries, the fallopian tubes between the ovaries and uterus, the vagina, and the uterine wall, followed by the abdomen, intestine, bladder, and kidney. In rare cases, endometrial tissue is even found in the lungs, skin, surgical scars, certain nerves, the brain, and the lymphatic system ( a connected group of glands that produce and circulate infection-fighting cells). Only in the spleen (largest organ of the lymphatic system) has the endometrial tissue never been found.

What It Does

The endometrial tissue that develops outside the uterus appears normal and, stimulated by estrogen, continues to perform its normal function—swelling to accept a fertilized egg, disintegrating when conception does not occur, and sloughing off in preparation for the next cycle. During each menstrual period, the tissue bleeds just as the endometrium does. The trouble is that the tissue is no longer in the uterus where it belongs, but elsewhere in the body. The bloody debris formed by the breakdown of this misplaced tissue has no way to escape. Accumulating in the tissues in which it has become lodged, the debris produces irritation, inflammation, and pain that can continue period after period. Unchecked, the bleeding may create scar tissue that can spread through the pelvis, twisting and attaching organs to each other, interfering with their proper function, filling the entire cavity, and eventually producing a tumor-like mass.

RIGHT TISSUE, WRONG PLACE

Not a cancer, endometriosis develops when normal tissue from the uterine lining begins to appear in abnormal places. Favored sites are the vagina, the ovaries, and the fallopian tubes that connect the ovaries to the uterus. Patches of misplaced tissue sometimes even settle in the lungs! The vagrant tissue causes cyclical pain because it swells and sloughs off in concert with the normal lining inside the uterus.

The spread of fragments of endometrial tissue outside the uterus helps explain a number of the symptoms mentioned earlier, such as chronic pelvic pain, painful intercourse, and infertility. Pain can come back with each period wherever dislocated endometrial tissue is attached in the pelvis—to the uterine wall, ovaries, bladder, or intestine, for instance. And it can get worse, remaining constant except for a few days after menstruation. A deep-seated ache from the front to the back of the pelvis is typical. If nodules of endometrial tissue have formed on the ligaments that hold the uterus in place, the result will be pain during intercourse, when the ligaments are stretched. Infertility, long considered almost synonymous with endometriosis, can result from distortion of the reproductive organs or interference with their function by misplaced endometrial tissue.

What Else It Might Be

Menstrual and pelvic pain is not limited to endometriosis. There are several other explanations your doctor must consider.

Pelvic Inflammatory Disease (PID) is a leading possibility because so many of its early symptoms are similar to those of endometriosis. PID is the result of bacterial infection. It can be cleared up with antibiotics; and in fact, a course of antibiotic therapy is one way doctors establish a diagnosis. However, there are other distinguishing clues. Women with PID often also have fever, chills, a pus-containing vaginal discharge, and fallopian tube blockage. The combination of a pelvic examination and medical history is an important way of differentiating the diseases. The doctor may also need to perform a laparo-scopy, a routine diagnostic procedure in which a tiny viewing instrument is inserted through the wall of the abdomen.

Fibroids (benign tumors of the uterus) are another possibility. These growths develop in the uterine wall, occasionally between the muscle and the endometrium. They are very common, ranging in size from a pea to a football. Like endometriosis, they can cause heavy menstrual bleeding, painful periods, and abdominal and lower back pain, though they usually have no symptoms at all. Stimulated, as endometrial tissue is, by estrogen and sometimes seen with endometriosis, fibroids can interfere with fertility.

Cervical polyps (small non-cancerous growths that project from the inside surface of the neck of the uterus, called the cervix) can also bring on bleeding after intercourse and between periods.

Cysts (fluid-filled sacs) can form in the ovaries when, for example, hormonal communication with the brain breaks down and no eggs can be released. Besides infertility, ovarian cysts can cause abdominal pain, irregular periods, and, if a cyst ruptures, internal bleeding. This could create a medical emergency.

Cervical, ovarian, and uterine cancers may also be responsible for some signs similar to those of endometriosis, including mild or acute chronic abdominal tenderness, pain and pressure, uterine bleeding, and development of an abdominal mass. Since these cancers are most responsive to early treatment, it's particularly urgent for you to get an accurate diagnosis.

Structural abnormalities in the reproductive organs, including the uterus, can lead to infertility, just as endometriosis does. They may result from weakened or stretched supporting muscles and tissues or hereditary variations in organ position and shape, as well as from scar tissue formed by endometriosis.

Uterine infections, like endometriosis, can account for painful intercourse, irregular menstrual bleeding, and lower pelvic pain. They can leave scars on the uterine wall that prevent the endometrium from accepting an egg.

next page Factors That Increase  the Odds of Endometriosis

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