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Most women expect some level of discomfort or pain during their menstrual cycles. But for about 10 percent of women, this pain can be severe and a symptom of a deeper problem known as endometriosis.
“We don’t know exactly why it happens, but it’s a condition where the tissue that normally lines the inside of the uterus, called the endometrial tissue, is located outside of the uterine cavity,” said IU Health Southern Indiana Physicians Women’s Health provider Kathleen Jones, MD.
These abnormal implants of endometrial tissue are typically found outside of the uterus in the pelvic area and abdominal cavity. These tissue implants grow and create inflammation with the influence of the menstrual cycle hormones. This inflammation leads to pain and scar tissue.
Typical symptoms of endometriosis include severe pelvic and low back pain, especially during periods, as well as pain with intercourse and bowel movements.
“People can start having symptoms of endometriosis at any point during their reproductive age years.” said Dr. Jones. “When a patient complains of pelvic pain and tells you ‘I always have pain, but especially during my period. I can’t go to work or do my normal activities during my period.’ you really think about endometriosis.”
The spectrum of the effects of endometriosis are broad. While some people may be diagnosed incidentally and have little to no pain or scarring, others may have severe pain, severe scar tissue and infertility.
It is important to manage the health issue with hormonal therapy in order to prevent worsening of the inflammation, scar tissue and pain that occurs with the hormonal influence of the menstrual cycle. Since the endometriosis implants and the subsequent inflammation are impacted by hormones, the pain associated can improve during pregnancy and menopause.
“If someone is having very painful periods or chronic pelvic pain, I would encourage them to make an appointment with a gynecologist to talk about it,” said Dr. Jones. “We would be able to obtain more of their history, find out what other symptoms they’re having, and perform a more thorough evaluation for potential causes such as pelvic infections, cysts, fibroids, endometriosis, etcetera.”
One potential side effect of endometriosis are cysts on the ovaries called endometriomas. They are filled with old blood and, unlike a typical cyst, will not resolve on their own. Treatment may slow their growth, but they may eventually need to be removed surgically.
Treatments for endometriosis depend on a variety of factors including the severity of the pain, the extent of the disease and whether or not the person is trying to become pregnant. One of the first things a woman may try for period-related pain are over-the-counter antiinflammatories such as ibuprofen, which may reduce pain and potential scarring.
“If anti-inflammatory medications during periods do not improve the pain of endometriosis, the next step is hormonal therapy in the form of uninterrupted birth control pills, a progesterone IUD, or Depo-Provera injections to name a few options. The goal of hormonal therapy is to prevent the cyclical inflammation and pain that occurs with the menstrual cycle,” said Dr. Jones.
Dr. Jones said a medication called Lupron may be used to more dramatically decrease the amount of estrogen in the body which decreases the growth of the endometriosis. Additional medications can be used to counteract the effects of the low estrogen.
“In severe cases, you can have surgery to remove or burn the endometriosis growth,” said Dr. Jones. “And that can be helpful for patients with severe pain. It can also help patients who have infertility as a result of the endometriosis.”
Endometriosis is a chronic condition. There is no cure, but there are many effective treatments available that can help women live their lives with less pain. Speak freely about your symptoms with your primary care provider or your gynecologist.
Featured IU Health Southern Indiana Physicians provider seeing patients for Women’s Health:
Kathleen Jones, MD