Women’s Month and endometriosis

THIS month is Women’s Month. We celebrate the social, political, economic and other achievements of women. In remembering Women’s Month, I was reminded of a little known condition affecting women called endometriosis. This is an often painful disorder in which tissue similar to the tissue that normally lines the inside of the uterus — the endometrium — grows outside the uterus.

Endometriosis most commonly involves the ovaries, fallopian tubes and the tissue lining the pelvis. Rarely, endometrial tissue may spread beyond pelvic organs.

Endometriosis can cause pain — sometimes severe — especially during menstrual periods. Fertility problems may also develop. Fortunately, effective treatments are available. It is estimated that 1 in 10 women of child bearing age suffer from this dreadful condition.

The primary symptom of endometriosis is pelvic pain, often associated with menstrual periods. Although many experience cramping during their menstrual periods, those with endometriosis typically describe menstrual pain that’s far worse than usual. Pain also may increase over time.

Common signs and symptoms of endometriosis include:

◆ Painful periods. Pelvic pain and cramping may begin before and extend several days into a menstrual period. You may also have lower back and abdominal pain.

◆ Pain with intercourse. Pain during or after

sex is common with endometriosis.

◆ Pain with bowel movements or urination. You’re most likely to experience these symptoms during a menstrual period.

◆ Excessive bleeding. You may experience occasional heavy menstrual periods or bleeding between periods (intermenstrual bleeding).

◆ Infertility. Sometimes, endometriosis is first diagnosed in those seeking treatment for infertility.

◆ Other signs and symptoms. You may experience fatigue, diarrhoea, constipation, bloating or nausea, especially during menstrual periods.

The severity of your pain isn’t necessarily a reliable indicator of the extent of the condition. You could have mild endometriosis with severe pain, or you could have advanced endometriosis with little or no pain.

The exact cause of endometriosis is not certain and there are various theories to explain this painful phenomenon.

Several factors place you at greater risk of developing endometriosis, such as:

◆ Never giving birth

◆ Starting your period at an early age

◆ Going through menopause at an older age ◆ Short menstrual cycles — for instance, less

than 27 days ◆ Heavy menstrual periods that last longer

than seven days

◆ Having higher levels of oestrogen in your body or a greater lifetime exposure to oestrogen your body produces

◆ Low body mass index

◆ One or more relatives (mother, aunt or sister)

with endometriosis

◆ Any medical condition that prevents the normal passage of menstrual flow out of the body ◆ Reproductive tract abnormalities Endometriosis usually develops several years after the onset of menstruation. Signs and symptoms of endometriosis may temporarily improve with pregnancy and may go away completely with menopause, unless you’re taking oestrogen.

The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant.Even so, many with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise those with endometriosis not to delay having children because the condition may worsen with time.

Endometriosis is also known to increase the risk of ovarian cancer and other rare gynaecological cancers.

Treatment for endometriosis usually involves medication or surgery. The approach you and your doctor choose will depend on how severe your signs and symptoms are and whether you hope to become pregnant. Doctors typically recommend trying conservative treatment approaches first, opting for surgery if initial treatment fails.

Over the counter pain medications like brufen may help improve endometriosis associated period pain. Hormone therapy in combination with the pain relievers is also a useful option if you are not trying to get pregnant.

Supplemental hormones are sometimes effective in reducing or eliminating the pain of endometriosis. The rise and fall of hormones during the menstrual cycle causes endometrial implants to thicken, break down and bleed. Hormone medication may slow endometrial tissue growth and prevent new implants of endometrial tissue.

Hormone therapy isn’t a permanent fix for endometriosis. You could experience a return of your symptoms after stopping treatment.

If you have endometriosis and are trying to become pregnant, surgery to remove the endometriosis implants while preserving your uterus and ovaries (conservative surgery) may increase your chances of success. If you have severe pain from endometriosis, you may also benefit from surgery — however, endometriosis and pain may return.

Surgery to remove the uterus (hysterectomy) and ovaries (oophorectomy) was once considered the most effective treatment for endometriosis. But endometriosis experts are moving away from this approach, instead focusing on the careful and thorough removal of all endometriosis tissue.

If you are worried about endometriosis, please visit your doctor.