Endometriosis can be a painful condition where tissue that normally grows inside the uterus, called the endometrium, grows outside the uterus. Common locations are the ovaries, fallopian tubes, and the tissue lining the pelvis.
Endometriosis can create fertility problems, and it can be quite painful. We help our patients from all around the Houston area with endometriosis treatment at River Oaks.
What is endometriosis?
Endometriosis in its simplest description is that tissue similar to the endometrium tissue that lines the uterus grows outside of the uterine cavity. It typically remains with the pelvic region, but it can spread outside of the area. Endometrial tissue growing outside the uterus is called an endometrial implant.
Is endometriosis cancer?
Endometriosis is not cancer. In endometriosis, endometrial cells grow in other places, but the cells are normal.
In endometrial cancer, cells of the endometrium become abnormal looking, grow out of control, and form a tumor. These cells may spread to other parts of the body and become tumors at those distant locations.
What are the symptoms of endometriosis?
The primary symptom of endometriosis is pelvic pain, often during menstrual periods. This is pain far above normal cramping associated with menstrual periods.
These are the common signs and symptoms of endometriosis:
- Painful periods — Pelvic pain and cramping may begin before and extend several days into a menstrual period. The pain may also radiate out to the lower back and abdomen.
- Pain during intercourse — Endometriosis typically makes intercourse painful.
- Pain with bowel movements or urination — This will typically occur during your period.
- Excessive bleeding — Menstrual bleeding can become heavy and there can be bleeding between periods.
- Infertility — Patients seeking help with fertility often first learn of their existing endometriosis.
- Fatigue, diarrhea, constipation, bloating, or nausea — These other symptoms accompany the menstrual periods.
What causes endometriosis?
The exact cause of endometriosis is not certain, but there are several possible theorized causes:
- Retrograde menstruation — When this happens, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These endometrial cells stick to the pelvic walls and surfaces of the pelvic organs. There they grow and continue to thicken and bleed with each menstrual cycle.
- Transformation of peritoneal cells — In this theory, it is thought that hormones or immune factors promote the transformation of peritoneal cells (cells that line the inner side of the abdomen) into endometrial-like cells.
- Endometrial cell transformation — Hormones such as estrogen may transform embryonic cells (cells in the earliest stages of development) into endometrial-like cell implants during puberty.
- Surgical scar implantation — It is thought that after surgery such as a C-section endometrial cells attach to a surgical incision.
- Endometrial cell transportation — Blood vessels or the lymphatic system may transport these cells to other areas of the body.
- Immune system disorder — A problem with the immune system may make the body unable to recognize and destroy endometrial-like tissue that’s growing outside the uterus.
Are there risk factors for developing endometriosis?
Several factors put a woman at a greater risk for developing endometriosis:
- Starting menstrual periods at an early age
- Going through menopause at an older age
- Never giving birth
- Short menstrual cycles
- Heavy menstrual periods that last longer than seven days
- Having higher levels of estrogen in your body
- Low body mass index
- Genetic influences
- Any medical condition that prevents the normal passage of menstrual flow out of the body
- Reproductive tract abnormalities
How is endometriosis diagnosed?
At River Oaks, our team will have you describe your symptoms. You will note exactly where you’re feeling the pain and when it occurs. From there, we will likely conduct one or more of these tests:
- Pelvic exam — We will manually feel areas in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus.
- Ultrasound — These tests use high-frequency sound waves to create images of your vaginal area. We may use standard ultrasound on the outside of your abdomen or transvaginal ultrasound where the transducer is inserted into your vagina.
- Magnetic resonance imaging (MRI) — Here a magnetic field and radio waves create detailed images of your soft tissues. For some patients, we will use an MRI to plan necessary surgery.
- Laparoscopy — Here a laparoscope is inserted through a tiny incision made near your navel. The camera on the laparoscope allows us to see the location, extent, and size of your endometrial implants. It can also be used to take a tissue sample, a biopsy, for lab testing. In some cases, we can treat the endometriosis at the same time we perform the laparoscopy.
What are the four stages of endometriosis?
Being able to see endometriosis implants and scarring is what enables doctors to classify the different stages of the disease. Numbers are used, and a score of 15 or less means that the disease, visually, is either in Stage 1 or Stage 2. A score of 16 to 40 means the disease is Stage 3, and 40 or more puts the disease as severe, Stage 4. These are the categorizations of endometriosis:
Endometriosis is categorized into four different stages:
- Stage 1 (1 to 5 points) — Endometriosis in this stage is considered to be minimal. The implants are small, few in number, and shallow. This doesn’t mean the pain is minimal, and it doesn’t mean there isn’t a significant impact on the woman’s life.
- Stage 2 (6 to 15 points) — This is considered to be mild endometriosis. We may find more implants, and they are deeper than the superficial implants found in stage 1 endometriosis.
- Stage 3 (16 to 40 points) — This is moderate endometriosis. Not only are there many deep endometrial implants, but there may be endometrial cysts on at least one ovary. These cysts form when the tissue attaches to an ovary and begins to shed blood and tissue. The blood collects and turns brown. Because of that, these are sometimes called “chocolate cysts.”
We may also find thin bands of tissue, called filmy adhesions, that bind organs together. These adhesions are the scar tissue that forms when the body tries to heal from the inflammation caused by endometriosis. This can lead to sharp, stabbing pain and nausea.
- Stage 4 (40 or more points) — This is severe endometriosis. In addition to many deep endometriosis implants, there are large cysts on at least one ovary and many dense adhesions throughout the pelvic region.
What are the treatment options for endometriosis?
There isn’t a cure for endometriosis; the goal is to manage the patient’s symptoms and relieve their pain. We first try conservative treatment options, although surgery can be necessary if they are unsuccessful. Treatment options include:
- Pain medication
- Hormone therapy — Supplemental hormone therapy can stop the progression of endometriosis by helping to regulate the monthly hormonal changes.
- Hormonal contraceptives — These prevent the monthly growth and buildup of endometrial tissue.
- Gonadotropin-releasing hormone (GnRH) agonists and antagonists — This therapy works to block the production of estrogen, which creates an artificial menopause.
- Danazol — This medication is used to stop menstruation and reduce symptoms.
- Conservative surgery — The goal is to remove or destroy the endometrial growths without damaging the reproductive organs. These procedures are used for women who want to get pregnant. They are usually performed laparoscopically.
- Hysterectomy — This is a last resort treatment if the patient’s condition doesn’t respond to other treatments. In a hysterectomy, the uterus, cervix, and ovaries are removed.