Understanding the Ins and Outs of Endometriosis
By Dr. Crystal Moore
I will never forget how endometriosis was taught during my medical school training. The professor had it in his syllabus and announced in front of the lecture hall that, “Endometriosis is a disease of high-strung, nulliparous (never gave birth), overachievers.” As half of the class would have fit his “patient profile,” we were justifiably offended at the characterization. Fortunately, this type of archaic thinking is no longer taught and the approximately five million American women afflicted with the condition are no longer blamed for their illness and told to “relax” as a form of treatment.
The endometrium is the nutrient-rich, lush lining of the uterus that prepares monthly for the potential implantation of a fertilized egg. If a pregnancy does not occur, the endometrial lining is shed during menstruation (a woman’s period). The condition of endometriosis occurs when some of this lining becomes implanted in other areas of the body. These sites are most commonly the ovaries, fallopian tubes, and the lining of the pelvis. However, the endometrium can also implant more remotely. I have seen biopsies of endometriosis from the skin at the belly button and even from the elbow. The reason for the tissue displacement is not well understood. However, the result of the process is well-characterized.
Endometriosis is often a painful disorder. The pain can be quite severe, especially during menstruation. The same hormones that are preparing a woman’s body for a potential pregnancy in the uterus, are active on the displaced endometrium as well. This displaced tissue continues to cycle as it would within the uterus. However, since it cannot slough off in the form of a period, the displaced endometrium irritates the tissue within which it has implanted and causes the pain that is all too familiar to many women with the condition.
Who is at risk for endometriosis?
Although any woman can develop endometriosis, it is more commonly seen in women in their 30s and 40s who have never given birth, experience periods that last more than seven days, began their period at an early age, go through menopause at a late age, have short menstrual cycles (<27 days), some form of uterine abnormalities, and/or a family history (mother, aunt, or sister) of endometriosis.
What are the symptoms of endometriosis?
The symptoms are varied depending on the location of the displaced tissue. Pain is a relatively universal symptom of affected women. However, the severity of the pain may not be proportional to the amount of disease. The pain is often a chronic pain felt in the lower back and pelvis. It may be felt more intensely during menstruation. There can be pain during or after sexual intercourse and pain during bowel movements or urination. Bleeding or spotting between menstrual periods and digestive problems are also common complaints. And finally, since endometriosis often affects the ovaries and fallopian tubes, infertility (the inability to become pregnant) can be a presenting symptom.
How is endometriosis diagnosed?
Your health care provider will talk with you concerning your symptoms and assess what types of diagnostic tests could help determine if your symptoms are caused by endometriosis or some other type of condition, such as pelvic inflammatory disease (PIDS) which has many overlapping symptoms. She will likely do a pelvic exam and order imaging tests, such as an ultrasound to assess your uterus, fallopian tubes, and ovaries. If the diagnosis is still unclear, an exploratory surgery (laparoscopy) can be performed to visualize potential endometrial implants that can be biopsied, excised, and analyzed by the pathologist for definitive diagnosis.
How is endometriosis treated?
There is currently no cure for endometriosis. But the good news is that treatment can help better manage your symptoms. For mild conditions, over the counter NSAIDS such as acetaminophen, ibuprofen, or naproxen are very effective. More severe cases can be managed with hormonal treatments such as birth control pills, shots, and nasal sprays to decrease symptoms. The most severe cases may require conservative surgical treatment to provide relief, particularly if fertility problems have arisen and you are trying to get pregnant. The most severe cases may require a total hysterectomy (removal of uterus and ovaries) to alleviate symptoms.
Finding a medical professional with whom you are comfortable discussing and managing your symptoms is essential for your comfort, protected fertility, and possibly even to preserve your life. There is a rare type of ovarian cancer of which endometriosis is a known precursor. My own sister, a woman in her late-30s who never gave birth and suffered terribly with endometriosis, developed and later died of this type of cancer. Though her story is a very uncommon one, early detection and management of endometriosis is certain to improve your overall quality of life.
Dr. Moore is a native of the Hampton Roads area of Virginia, where she resides with her two teenage sons.
Dr. Moore professed, even as a young child, that she wanted to be a physician. For her, medicine is not just a profession, but also a calling. Following that calling led her to pursue a dual doctorate, physician-scientist, MD/PhD degree at the Medical College of Virginia. Her Ph.D. was awarded in the Department of Biochemistry and Molecular Biophysics. She completed her residency training in Anatomic and Clinical Pathology at Duke University and is a board-certified Fellow of the College of American Pathologists.
As a sought after speaker, Dr. Moore delivers complex information in a highly understandable and remarkably humorous manner. She speaks to the total person and her message heals the body, mind, soul, and spirit. Dr. Moore believes and conveys that health is wealth-not to be taken for granted, but to be actively pursued. Accordingly, she guides individuals and audiences on a journey to wellness and abundant life.
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