What is endometriosis?
Endometriosis is a condition where tissue, similar to the tissue that normally grows inside the uterus, also grows outside of the uterus. The tissue inside the uterus is called “endometrium” and the tissue outside of the uterus is called “endometriosis”.
The most common places where endometriosis occurs are the ovaries, the fallopian tubes, the bowel, and the areas in front, in back, and to the sides of the uterus.
What are the signs and symptoms I should be looking out for?
- Painful periods
- Pain during sex in lower belly or lower back
- Pain in between your periods on non bleeding days in your cycle
- Pain during urinating or passing stool in rare cases
- Difficulty in conceiving
- Irregular Periods!
How do I know if I have it ?
Endometriosis is called a diagnosis of exclusion. The healthcare provider can suspect it if you have the characteristic symptoms, but the only way to be certain is to have surgery so a doctor can actually see and biopsy the abnormal tissue. Endometriosis cannot be diagnosed by ultrasound, x-ray, or other noninvasive methods.
Depending on how many lesions or sites endometriosis is found in, your doctor can tell you if your condition is mild, moderate or severe.
What are the common treatments for endometriosis ?
- Painkillers / NSAIDs :
- Started as the first line of treatment, NSAIDs (Nonsteroidal anti-inflammatory drugs) such as Ibuprofen help to reduce the symptoms around your period.
- They generally help persons with milder symptoms and are safe for most. Not so helpful by themselves, they work best when combined with other therapies.
- Most common side effects include heartburn, worsening of blood pressure or kidney disease.
- Hormonal Birth Control:
- Hormonal Birth control needs to be taken continuously and works best for patients who don’t have severe symptoms. It helps patients by reducing heavy bleeding. Pills and rings both work equally well.
- For persons who can’t have combined hormonal birth control, progestin-only contraceptives can be used.
- Most common side effects include nausea, bloating and breast tenderness.
- Gonadotropin-releasing hormone analogues:
- Gonadotropin-releasing hormone (GnRH) analogues (agonists and antagonists) are medicines that work by causing a temporary menopause.
- The treatment causes the ovaries to stop producing estrogen, which causes the endometriosis implants to shrink.
- Examples of agonists and antagonists include: GnRH agonists (such as Nafarelin, Leuprolide and Goserelin), and GnRH antagonists (such as Elagolix)
- Aromatase inhibitors —
- These drugs block the enzyme (aromatase) that increases estrogen levels in tissue. There is increasing evidence that endometriosis tissue makes its own aromatase.
- Examples of aromatase inhibitors include letrozole and anastrozole. Both medications are pills that are taken once a day.
- Combining these drugs with hormonal birth control, progestins, or GnRH agonists may be more effective than any of them alone.
Surgery is an option to be considered if you have trouble getting pregnant despite medical treatment or have severe symptoms that are resistant to medication. The treatment involves a laparoscopic technique wherein the doctor enters your belly through a small port and visualizes the inside with a mini camera. They then go ahead and ablate the endometriosis lesions.