Endometriosis affects between 10 and 15 percent of women in reproductive age, causing problems from pain to infertility.
Dr. Brooke Ritter, an OB/GYN doctor with Contemporary Women’s Care in Clearwater and Seminole, said that endometriosis mainly affects women ages 25 to 35, is most common in thin Caucasian women, and can cause between 50 to 60 percent of infertility.
“Endometriosis is a medical condition when the cells that typically line the uterus are found outside the uterus,” Ritter said. “Usually on the ovaries or the (fallopian) tubes. They can be on the bladder, the bowels. It can lead to pain – pain during periods, pain during intercourse, sometimes pain during a bowel movement or with urination, and it’s also one of the leading causes of infertility.”
Endometriosis can lead to lost time at work or school because of extremely painful periods or can affect relationships because of painful intercourse, Ritter said. And of course, infertility can cause a slew of problems for a couple.
“The cause of endometriosis is not completely known,” Ritter said. “There are different theories of why endometriosis happens. One theory is that during a period, the menstrual blood cannot escape through the vagina and it backs up through the tubes and into the pelvic cavity. That’s called retrograde menstruation. So we do see more endometriosis in women who have blockage – in the cervix, for instance, or women who can’t have periods have a higher incidence of endometriosis. However there are many women who have retrograde menstruation who do not have endometriosis, so that’s not the definitive cause.”
Another theory is that if the immune system is not functioning properly that endometriosis is more likely, Ritter said. For instance, women with hypothyroidism, lupus and other immune disorders are more likely to have endometriosis. If the immune problems are treated and taken care of, there is a better chance of the endometriosis going away.
There also may be a genetic component, because women who have sisters, mothers or aunts with it are also more likely to have endometriosis, Ritter said.
Doctors can treat the symptoms of endometriosis, Ritter said. So if a woman is experiencing pain, she can take anti-inflammatory medicines such as ibuprofen.
“If women are not attempting conception, using birth control pills can be very effective because it suppresses the hormones that cause endometriosis to swell and cause pain,” Ritter said. “There are injection medicines that are called gonadotropin releasing hormone agonists. Lupron would be an example of that medication. And that’s an injection that simulates menopause, so it shuts down estrogen and causes relief of symptoms of endometriosis.”
This is a temporary solution, but many women will experience several years of relief from their symptoms, Ritter said. However, the medicines that put the body into a menopause-like state also carry with it the side effects of actual menopause, such as hot flashes, night sweats, vaginal dryness and bone loss, she said. Therefore, the woman can use add-back therapy, where some of the estrogen is replaced in order to control those symptoms.
“For women who desire fertility or who are trying to conceive pregnancy, surgery is an option,” Ritter said. “Usually laparoscopic surgery, which involves making small incisions in the abdomen as outpatient surgery. And then if any endometriosis is visualized, it’s biopsied and then destroyed, either with heat or a laser, and that can improve fertility as well as decrease pain. And if the woman has scarring in her pelvis from endometriosis, that can sometimes block the tubes and lead to infertility, and that scarring can be removed with laparoscopic surgery as well.”
Relief from surgery lasts for an average of two to four years, she said, and women who have the best response have both the surgery and then take birth control pills or Lupron to suppress it. Women should also try to decrease the amount of estrogen in the body by avoiding alcohol, staying a healthy body weight, exercising regularly, and avoiding excess caffeine.
“For severe cases of endometriosis, if they do not respond to medication and laparoscopic surgery, sometimes it requires a bigger surgery where we need to remove either the uterus and the cervix or else a complete hysterectomy by removing the cervix and both ovaries,” Ritter said. “And that would be the definitive treatment of endometriosis.”
Obviously, this decision would have to be for someone who no longer wants to bear children. If a woman is certain she does not want biological children and she still is young, in her 20s or so, then doctors would try to preserve her ovaries so she does not go through menopause and have all of those complications, Ritter said. The ovaries control menopause, so she would still go through menopause at the regular age, but she would no longer have her menstrual cycle and would not have pain from endometriosis.
Ritter added that if any woman is having severely painful periods or have pain with intercourse, those are not normal things, so they should talk to their doctor to find out what is wrong.