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House Call: Often painful, endometriosis affects millions

Tue., March 25, 2014, midnight

A dear friend of mine had horribly painful periods and trouble with infertility for several years. She was eventually diagnosed with endometriosis, a condition that affects more than 5 million women in the United States.

National Endometriosis Month in March brings attention to this condition. Theories abound as to why endometriosis happens, but doctors and scientists are still trying to understand this complex condition more completely.

The endometrium is the lining of the uterus. When the cells making up this lining are found outside of the uterus and attached to other organs, it is called endometriosis. Just like when they are in the uterus, these endometrial cells respond to the hormones of a woman’s menstrual cycle by thickening, breaking down and bleeding with each menstrual cycle. This out of place tissue has no way to exit from the uterus like it normally would, so it becomes trapped and may cause pain, heavier menstrual bleeding and scar tissue that can become very thick.

Endometriosis symptoms may start soon after a girl starts having periods or not until later in life. Symptoms like irregular periods with heavy cramping, chronic pain in the lower back and pelvis, problems with the intestines or bladder, fatigue and infertility can worsen with time.

Some women have endometriosis without much pain and may not realize there is a problem until they have difficulty getting pregnant. Those who do have pain and become pregnant in spite of endometriosis may experience improved symptoms during pregnancy.

If you think you may have endometriosis and see a health care provider, you will be asked about symptoms, family history and health history. Your health care provider may also want do a pelvic exam. Other tests like a Pap test, blood tests and imaging may help to rule out other causes of your symptoms. Sometimes, a surgical procedure called laparoscopy is recommended to allow a physician to look inside your abdomen for endometrial growths on your ovaries, intestines and elsewhere. Sometimes during laparoscopy, biopsy samples may be taken from growths seen in these areas.

Once endometriosis is diagnosed, there are several treatment choices, which often depend on the woman’s age, the location and size of endometrial tissue growths, symptoms and whether the woman wants to have children in the future. There are a variety of medication, hormone and surgery options.

For pain, taking over-the-counter medication like acetaminophen or ibuprofen during menses is a reasonable place for many women to start. If these do not provide effective relief, you may need to discuss prescription pain medication with your health care provider.

Several types of hormone treatments in shots, pills or other forms can be used to suppress your hormone cycle and periods, which can reduce or eliminate your endometriosis symptoms. It is only possible to use these if you do not want to become pregnant during treatment and are willing to prevent pregnancy while on these hormones.

The majority of women do not need surgery to treat their endometriosis, but in some cases, they will. The proceedure to remove endomentrial growths can be done with a few tiny incisions and a fairly rapid recovery. If your uterus and/or ovaries are severely damaged by endometriosis, having them surgically removed may be recommended.

Many successful treatments for endometriosis are available, and can decrease complications such as scarring, infertility and ongoing pain. If you think you may be suffering from endometriosis, see your health care provider and take steps to make it better.

Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section.

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