Abdominal and pelvic cramps are not uncommon and can be very normal for
many women. But what happens when these cramps stop being normal? This
could be a sign of a condition known as endometriosis.
What is Endometriosis?
Endometriosis is a condition in which the cells that should be in the
lining of the uterus (endometrial cells) begin to grow on the outside
of the uterus. This tissue does not belong outside the uterus. As a result,
the tissue--also called an endometrial implant--can break down, bleed
and cause symptoms like abdominal or back cramps, and nausea. The cells
typically stay in the pelvic area, but can migrate to almost any other
area of the body.
What are the Symptoms?
Some women with endometriosis have no symptoms while others have significant
symptoms. The most common symptom of endometriosis is pain in the pelvic
and/or lower back region, either just before or during menstruation. There
may be pain with sexual activity or with bowel movements. Additionally,
some women can develop lesions and scar tissue in the pelvic area or on
Does it Affect Fertility?
Endometriosis can make it harder to become pregnant, depending on the
severity of the condition. Out of all women diagnosed with endometriosis,
only around 25 percent experience problems with fertility. However, women
with moderate to severe endometriosis may develop complications like distorted
pelvic anatomy, altered egg quality, and scarring that prevents an egg
from entering the fallopian tube. These women may need advanced fertility
treatment to improve their chances of pregnancy success.
Are There Treatment Options?
The good news is endometriosis can be treated, and an obstetrician/gynecologist
(OB/GYN) can tailor treatment to each patient. "A treatment plan
for endometriosis typically begins with hormonal therapy," says
Gregory Sacher, MD, a board-certified OB/GYN with
St. Joseph Health Medical Group in Sonoma County. "The hormone estrogen exacerbates the symptoms
of endometriosis, so there are several kinds of estrogen-suppressing medication
that are used to shrink the lining of the uterus and any lesions that
have formed on that lining."
Medications used to treat endometriosis include:
- Nonsteroidal anti-inflammatory medications, such as ibuprofen, for general
- Oral contraceptives or similar methods such as a vaginal ring or birth
control patch, to deliver hormones to the body. For many years the oral
contraceptive pill was the main hormonal drug used to treat endometriosis.
The low doses of estrogen-related hormones delivered in the pill relieve
the pain of endometriosis by tempering the menstrual cycle and slowing
the growth of endometrial implants. Many women tolerate the pill better
than other hormonal drug treatments and can safely take it for many years.
- Progesterone (a female hormone) or progestins (drugs that mimic the behavior
of progesterone). Both progesterone and progestins come in different forms,
including pill, injection, implant and IUD. Like other hormonal treatments,
these drugs relieve symptoms while, at the dosages usually prescribed,
causing menstruation to stop during the course of treatment. After stopping
treatment, menstruation usually resumes within 4-6 weeks, depending on
the dosage and the rate at which the woman's metabolism removes the
drug from the body.
- GnRH (gonadotropin-releasing hormone) agonist. This is typically the most
effective nonsurgical treatment, putting the body into temporary menopause.
A GnRH agonist is a drug that helps control the menstrual cycle by stopping
the production of estrogen. Without estrogen, the endometrial implants
become inactive and start to degenerate. GnRH agonists are given via injection
or nasal spray, and many OB/GYNs use them in combination with other medications
to reduce common side effects such as hot flashes or night sweats. Like
progesterone and progestins, these drugs cause the body to stop menstruating
during treatment. Menstruation usually returns within 6-10 weeks of the
last injection, or 4-6 weeks of the last spray, as the body needs time
to work the drug out of its system.
Some women may, after trying medication, opt for surgery to diagnose, treat
and remove the implants caused by endometriosis. Medications are almost
always tried first because any surgery--even the minimally-invasive procedure
used to diagnosis and treat endometriosis--involves some level of risk
that complications may develop during or after the procedure. On the other
hand, surgery is the only way to determine for sure whether endometriosis
is present; there is no x-ray, ultrasound, or CT scan that can show endometriosis.
And some women may need relief from unpleasant and difficult-to-live-with
side effects that can accompany long-term hormonal therapy, such as bleeding,
bloating, lethargy and nausea.
Surgery begins with an exploratory laparoscopy, considered the most reliable
method for diagnosing endometriosis. It involves placing a tiny camera
into a small incision in the abdomen so that pelvic anatomy can be seen.
The gynecological surgeon looks for endometriosis and, if found, an operative
laparoscopy is performed at the at the same time to remove or burn away
lesions, implants, and scar tissue. Laparoscopy is considered safe and
effective, and most complications, if any (such as difficulty urinating
or vaginal discharge) are minor and go away rapidly. In more serious cases,
a full hysterectomy (removal of uterus and ovaries) may be needed. This
is permanent and will cause a woman to start menopause.
Dr. Sacher says that women seeking treatment for endometriosis should start
by consulting with their doctor to discuss their symptoms, make sure they
understand their options, and provide the doctor the information needed
to come up with a plan that's right for them. "Endometriosis
is a process that, generally speaking, requires a lifelong management
plan that maximizes medical therapy and avoids repeat surgical intervention,"
he says. "The treatment plan is individualized to take into account
the clinical presentation, symptom severity, disease extent and location,
reproductive desires, patient age, medication side effects, surgical complication
rates, and cost.”
If you are experiencing pelvic symptoms that don’t seem normal, speak
with your OB/GYN. If you don't have one
click here to find an experienced OB/GYN affiliated with one of the 16 St. Joseph
Health hospitals located throughout Northern California, Southern California