Endometriosis, the Hidden Women's Disease

By Anne Brown, MD, FACOG

Capital Women's Care

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Endometriosis, the Hidden Women's Disease

Many women suffer for years and years without understanding that the pain they are experiencing with their periods is much worse than it is for other women. One of the main reasons that women can suffer extreme period pain is called endometriosis. This is due to the abnormal growth of tissue that's supposed to grow only inside the uterus in places where it doesn't belong.

Normally endometrial glands lining the uterus grow during the first half of the menstrual cycle (from the end of menstruation to ovulation) and then gradually break down and shed at the end of the cycle. When these glands are growing inappropriately in the pelvis around the ovaries, tubes and bowel, they have nowhere to shed and cause an inflammatory response.

The body's healing process then can lead to scar tissue formation over the months and years, which can further exacerbate pain by allowing organs that normally slide around one another to stick together and move less freely. Women who have family members with this disorder are at a 25% risk of suffering from it, and need to be closely monitored for symptoms.

Treatment of endometriosis can sometimes require surgery, but almost always requires long-term hormonal manipulation to control symptoms. Pregnancy can also put the disease into remission, sometimes for long periods of time. Unless there is a contraindication, significant pain during periods is usually treated with hormonal contraceptives such as birth control pills, patches, rings or shots, which suppress growth of the glands and decrease pain and inflammation.

If there is extensive involvement of the ovaries, causing endometrial or “chocolate” cysts to form, then sometimes draining or removing the cysts or ovary is needed. Surgery can also be valuable in definitively diagnosing and defining the extent of the disorder, treating scar tissue and destroying the larger implants of disease. Simply removing the uterus to get rid of cramps does not cure the disease, which will continue to grow.

Menopause generally will lead to the cessation of pain from endometriosis if the scar tissue is not extensive. Sometimes patients are given injections of drugs that induce a temporary fake menopause called gonadotropin releasing hormone (GnRH) agonists, such as Lupron, to put the disease into remission when other treatments have failed.

If you feel your period pain is out of proportion to what it should be, contact a qualified gynecologist to help you. Even adolescent patients can suffer with this disorder and go undiagnosed for years. Seek help sooner than later.