Regarding endometriosis.

"Dear KnowYourV, 

 I've been reading your weekly blogs and have learned so much, but I was wondering if you could help me? I am 23 years old and have been diagnosed with endometriosis and told this could make me unable to have children. I also suffer from severe pain during my cycles that often keeps me home from school and work.

I need to know if there is any hope for me? Is there a cure for it, or do I have it the rest of my life? What is the best treatment for me now that can give me some relief?"

Endometriosis is, unfortunately, a lifelong chronic disease that begins in adolescence. Endometriosis is estrogen driven, therefore it will subside during menopause. It is the quality of life between those years and the desire for children that can be challenging and heartbreaking for both patient and physician.

Firstly, find out how bad it is. Most Ob/GYNs are trained in laparoscopic surgery and should be able to evaluate the progression of your endometriosis, and fallopian tubes for patency and obtain a biopsy for diagnosis. From this,your doctor will initiate best treatment to help alleviate your symptoms and arrest progression of the disease which will definitely make it easier to get pregnant later on.

Although endometriosis can cause extensive scaring and a sort of matting together of the uterus, ovaries and fallopian tubes by adhesions (which in turn can also attach to the colon, large intestine, and pelvic and abdominal walls), pregnancy is possible. It is well known that the number of adhesions does not at all correlate with amount of pain. It is not unusual to see no visible disease in women that have the worst pain. It is also not unusual to find women with a large amount of scaring that experience very little pain.

So what is the cause of endometriosis? I can only give you some theories that have been speculated and tested. Endometriosis is defined as the presence of, and growth of, uterine glands and stroma outside the uterine cavity. Speculation on how this happens is that during a normal cycle, as we release the endometrial tissue as our menstrual period, some of the lining flows out through the fallopian tubes and into the pelvic cavity. This is called retro-grade flow. In some women their immune systems activate and simply clear the blood and debris to break it down so the body can recycle it. For the women plagued with endometriosis, their immune system reacts differently and when the endometrial tissue is approached it is walled off and remains. Now, with each cycle, the ectopic endometrial tissue will react the same as the endometrial tissue within the uterus. So if it sits on an ovary or fallopian tube, it will give you cramps and bleed and this is what eventually causes the inflammation, scaring and infertility.

So far we have only touched on diagnosis (laparoscopic surgery). Your doctor will schedule you for the day in a surgical center. During surgery you get a tiny 1 centimeter incision in your navel and one or two more a little lower down. One is for the placement of a camera and the other two are for the laparoscopic instruments that are needed to take a biopsy or remove scar tissue. Usually pictures are taken so the doctor can show the patient what was done and discuss what should be done in the future. Often a diagnosis can also be made from a patient’s history and a physical exam. Most women with endometriosis have very painful periods (dysmenorrhea), pelvic pain (that can be cyclic with periods or other times just constant pelvic pain), irregular menses and deep dysparunea (pain during sex caused by deep penetration).

Treatment is limited and usually focuses on pain control and resting of the female reproductive system. Anti-prostaglandins like ibuprofen, naproxen, and naprosyn can help. Birth control helps as it stops ovulation and rests the female reproductive system. Sometimes Lupron injections are given which are a powerful GnRH agonist. Lupron completely shuts down the female system as if you are in menopause, giving the body a chance to recover and heal. Some women experience a few years of relief after a course of Lupron injections.

While the above only briefly touches the surface of this subject, I hope it helps in some way so that you have better understanding about your body.