Endometrial tissue lines the uterus and is essential for pregnancy, providing a place for the fertilized egg to implant and grow. The hormones released by the ovaries causes this tissue to break down every month during one’s period and grows back naturally. When endometrial tissue gets displaced, however, it can be painful and dangerous. The endometrial tissue sometimes grows outside of the uterus and continues to act as it would inside the uterus, breaking down and bleeding every month. This can be painful during one’s period, and can lead to adhesions and scarring, sometimes irritating surrounding tissue and binding organs together. Endometriosis can affect your ovaries, bowel, and tissues lining the pelvis.
The cause of endometriosis is believed to be retrograde menstruation. In some cases, menstrual blood carrying endometrial cells will flow back into the pelvis and fallopian tubes instead of leaving the body. These cells will attach to the pelvic walls and organs, continuing to thicken and bleed with one’s menstrual cycle. Since this abnormal tissue growth sometimes obstructs the fallopian tubes, roughly one third of the women with endometriosis have issues with fertility.
Diagnosis for endometriosis can be tricky, as the level of pain experienced during menstruation is not a reliable indicator of the disorder. Some women with endometriosis will feel extreme pain while others experience little to none. Endometriosis is often confused with pelvic inflammatory disease or irritable bowel syndrome. Symptoms include painful periods, pain during or after intercourse, pain with bowel movements or urination, heavy periods, infertility, fatigue, diarrhea, bloating, nausea, or constipation. Women with the following risk factors have a higher chance of having endometriosis: never giving birth, having family members with endometriosis, experiencing short menstrual cycles with bleeding longer than eight days, and having had pelvic infections.
Dr. Ayalon can determine if you have endometriosis through a pelvic exam, an ultrasound, or laparoscopy. During the pelvic exam Dr. Ayalon will manually check for cysts on the pelvic walls that form as a result of endometriosis. If an ultrasound is needed, the scanner will be inserted into the vagina, emitting sound waves to produce images of the pelvic walls. The most accurate test for endometriosis involves a laparoscopy. A laparoscopy is a minor surgical procedure where an incision is made into the abdomen and a small instrument is inserted to find visual evidence of endometrial tissue in the pelvis but outside of the uterus.
If endometrial tissue is found and your symptoms are severe you may choose to have it removed through minor surgery or go through hormone therapy to reduce pain. If you are trying to get pregnant, surgery to remove any obstructing endometrial growth is the option with most successful results. Hormone therapy is another treatment option, but is not a permanent solution. Medications taken will only be successful at alleviating symptoms, and after treatment is over, symptoms may return over time. In very severe cases a hysterectomy may be needed to remove the uterus, cervix, and ovaries. Typically we only suggest surgery as a last resort, especially for women who are in their reproductive years.
If you experience the symptoms of endometriosis and have one or more risk factors, you should schedule a check up before symptoms worsen. Contact Dr. Ayalon or call us at (818) 654-9312 to screen for diagnosis and to talk about options for treatment.