Young Women Can Find Help for Chronic Pelvic Pain

By Marjan Attaran, M.D.

Endometriosis

Endometriosis is a common and often overlooked problem in young women. A study funded by the World Endometriosis Research Foundation included more than 1,400 women from 10 countries who reported that they experienced painful symptoms for an average of seven years before they were diagnosed with the condition. Two thirds of the women had symptoms before they turned 30.

Endometriosis is a disorder in which the endometrium, the tissue that lines the uterus, grows outside of the uterus on the ovaries, fallopian tubes, and the pelvic and abdominal areas — places that it is not supposed to grow. This misplaced tissue sheds during menstruation, causing local inflammation and scarring in the pelvis.

Some women don’t have symptoms from endometriosis. But in those who do, the most common symptoms are:

• Very painful cramps or periods
• Heavy menstrual bleeding
• Chronic pelvic pain including lower back pain
• Intestinal pain
• Pain during and after sex
• Infertility

The pain can be so intense that it affects a woman’s quality of life, from her relationships to her day-to-day activities. In fact, the recent study found that lost hours of productivity as a result of endometriosis pain averaged 11 hours per woman per week.

Women who don’t experience pain from endometriosis may not find out that they have the condition until they have trouble getting pregnant. About 30 percent to 40 percent of women with endometriosis are infertile, making it one of the top three causes of female infertility.

WHAT CAUSES ENDOMETRIOSIS?

The cause of endometriosis is unclear, although several theories currently are being explored. It’s possible that menstrual blood containing endometrial cells flows back through the fallopian tubes and grows outside of the uterus. Or it may be that endometrial cells are carried through the bloodstream to other sites in the body. There also seems to be a genetic component, since endometriosis tends to run in families. Further study is necessary to uncover the cause.

HOW IS ENDOMETRIOSIS DIAGNOSED?

If you have pelvic pain or are struggling to get pregnant, it’s important to visit your gynecologist. He or she will ask you to describe your symptoms and will perform a pelvic exam. During the exam, the doctor will manually feel areas in your pelvis for abnormalities. It usually is not possible to feel small areas of endometrial growth, but your doctor may be able to detect other growths, such as cysts, during the exam.

Your doctor may conclude that you have endometriosis based on symptoms and signs alone. But the only way to confirm the diagnosis is through surgery. The most common type of surgery is called laparoscopy. In this procedure, which is done under anesthesia, the surgeon:

1. Inflates the abdomen with CO2.
2. After making a small incision in the abdomen, the surgeon uses a tiny viewing instrument with a light, called a laparoscope, to look at the reproductive organs, intestines and other surfaces to see if there is any endometriosis. He or she can make a diagnosis based on the characteristic appearance of endometriosis.
3. The diagnosis can then be confirmed by doing a biopsy, which involves taking a small tissue sample and studying it under a microscope. These findings will help the physician develop an appropriate treatment plan to help control the symptoms of endometriosis.

HOW IS ENDOMETRIOSIS TREATED?

While there is no cure for endometriosis, there are a number of treatments for both pain and infertility related to the disorder, including:

• Pain medication, which works well if your pain or other symptoms are mild. These medications range from over-the-counter remedies to strong prescription drugs.
• Hormone therapy, which is effective if your areas are small and/or you have minimal pain. Hormones can come in pill form, by shot or injection, or in a nasal spray. Common hormones used to treat endometriosis pain are progesterone, birth control pills, danocrine, and gonadotropin-releasing hormone (GnRH).
• Surgical treatment is usually the best choice if your endometriosis is extensive, if you have more severe pain, or if you are experiencing infertility. Conservative surgery includes removing endometrial growths, scar tissue and adhesions without removing your reproductive organs. Today, most endometriosis surgery is being done through the laparoscope. But a full abdominal incision, called a laparotomy, may still be required in rare cases when there is extensive disease.

WHEN SHOULD YOU SEE A DOCTOR?

Annual pelvic exams should be part of routine healthcare throughout a woman’s life. But any time you have signs and symptoms that may indicate endometriosis, see your gynecologist for help. It may take some time to pinpoint the cause, but uncovering the problem early will help you avoid unnecessary complications and pain.

Dr. Attaran is a board-certified reproductive endocrinologist who heads the Section of Pediatric and Adolescent Gynecology in Cleveland Clinic’s Ob/Gyn & Women’s Health Institute. She sees patients at main campus and at the Strongsville Family Health and Surgery Center.