Endometriosis: Overview, Symptoms and Treatment

Ever since your first period, you had painful menstrual cramps. But you didn’t complain much. Your mother had always had bad cramps, and you both assumed they ran in your family.

When you started having sex, you sometimes felt discomfort on intercourse. It wasn’t pleasant, but again, you didn’t get too upset. When you got married, and you and your husband used a commercial lubricant and engaged in extended foreplay, your sex became more comfortable.

But a new problem developed: You couldn’t get pregnant. Your gynecologist advised patience, but after a year, you wanted action. She suggested a laparoscopic examination of your reproductive organs. She gave you a sedative and inserted the laparoscope’s flexible fiber-optic tube into a small incision in your navel, and from there, threaded it down to your pelvic area.

That’s when she discovered your real problem—patches of variously colored cells that could mean only one thing—endometriosis.

What’s Going On?

Endometriosis is a mysterious condition estimated to affect more than 5 million American women, some 10 percent of the reproductive-aged population. White women in their thirties are at hightest risk. It causes severe menstrual cramps, and often persistent pelvic pain, pain on intercourse, and often infertility. Among women with fertility problems, some 30 to 50 percent also have endometriosis.

Other possible symptoms include: low-back pain, breast tenderness, nausea and vomiting, hot and cold flashes, fatigue, headaches, and painful ovulation. But if you have endometriosis, chances are that what you find most distressing are the severe menstrual cramps and day-to-day pelvic pain.

As if endometriosis isn’t enough, it also doubles your risk of vaginal yeast infections.

Endometriosis is a disease of errant cells, the cells of your uterine lining (endometrium) to be exact. They ought to stay put inside your uterus or exit your body during menstruation. Instead, they wind up elsewhere stuck to other organs: your ovaries, fallopian tubes, bladder, or digestive organs—or possibly even your lungs and brain. But errant endometrial cells (“implants”) still act like they were comfortably ensconced in your uterus. They grow and multiply every month in response to your hormonal cycle, notably estrogen, and when you have your period, they bleed. But blood from your runaway uterine cells has no natural outlet, so your body reacts with inflammation, pain, and scarring.

One odd thing about endometriosis is that its symptoms have little to do with the number of implants around your body. You may experience severe symptoms with few implants, or mild symptoms with many. No one knows why.

Endometriosis is not classically hereditary, but it often runs in families. For reasons that remain unclear, if you have allergies, you’re at somewhat higher risk.

Thirty years ago, endometriosis was called “the career woman’s disease,” because it seemed to strike working women without children more frequently than mothers. But that notion has faded. Pegnancy and motherhood help relieve the condition in some women, but not all. And risk has nothing to do with where you work—at home or outside it.

If endometriosis implants develop on your digestive organs, you might suffer bloating, diarrhea, and/or constipation. You—and your doctor—might mistake these symptoms for irritable bowel syndrome. But if your irritable bowel symptoms get noticeably worse every month around the time of your period, that’s a tip-off that you actually have endometriosis.

Doctors have been researching—and arguing about—endometriosis for more than 70 years. The first study was published in 1927. But they still can’t agree on what causes it. Currently there are four contending theories, none of which fully explain things:

• The original “retrograde menstruation” theory holds that during your periods, some blood flows backward into your fallopian tubes, and from there to your ovaries, and into your abdomen, resulting in endometrial implants.
• The “chameleon cell” theory argues that for, reasons that remain a mystery, certain cells in your abdominal cavity spontaneously turn into endometrial cells.
• The “circulation” theory contends that roving endometrial cells enter the bloodstream and lymph circulation, which take them far from the uterus.
• Finally, the “embryo” theory holds that before birth, some cells meant to become part of your uterine lining wound up elsewhere, but still grew into endometrial cells.

Whatever causes endometriosis, researchers generally agree that an immune deficiency appears to play a role in the disease. In animal studies, exposure to radiation or substances that depress immune function increase risk. Experts believe this is why endometriosis sufferers are prone to yeast infections and other ailments.