Common Co-Morbidities With Endometriosis

Endometriosis is as common as 1 in 10, however diagnosis is incredibly hard to acheive due to many factors. One issue is that Endometriosis has very similar symptoms to other pelvic conditions, and can occur at the same time as them as well. Often it takes getting one diagnosis to lead to the others.

• Adenomyosis

• Uterine Fibroids

• Painful bladder syndrome (interstitial cystitis)

• Polycystic ovary syndrome (PCOS)

• Pelvic inflammatory disease (PID)

• Irritable bowel syndrome (IBS)

Endometriosis

Endometriosis is a chronic disease in which tissue similar to the inner lining of the uterus, also known as the endometrium, is found outside its normal location, where the tissue should not be. This results in inflammation, as the tissue even outside the uterus will respond to the monthly fluctuations of the menstrual cycle.

The disease affects 1 in 10 reproductive-aged individuals (aged 12-52) - an estimated 200 million women worldwide - and many often experience a decade-long delay in diagnosis. Currently, there is no known exact cause of endometriosis, and there is no cure. Diagnosis currently can take 4-11 years on average.

Symptoms

Common Symptoms

• Severe pain during menstruation

• Pelvic or abdominal pain not associated with menses

• Low back and/or leg pain

• Pain with sex

• Painful bowel movements

• Stomach problems including nausea, bloating, diarrhea and/or constipation

• Fatigue

• Infertility

Less Common Symptoms

• Pain with breathing and/or shoulder pain particularly during menstruation may indicate diaphragm or lung endometriosis

• Coughing up blood or collapse of lung during period may indicate lung endometriosis

• Feeling sick or faint, or vomiting during your period

• Difficulty participating in day-to-day activities because of excessive pain, exhaustion, or weakness

 Adenomyosis

Adenomyosis is a condition where tissue like the lining of the uterus invades the muscle of the uterus. It can be either diffuse or focal, meaning it can spread out over the uterus or can be grouped together. This condition has many similar symptoms with endometriosis, which makes it very difficult to tell the two apart.

Symptoms

• Heavy menstrual bleeding

• Painful periods and menstrual cramps (medical term: dysmenorrhea)

• Abnormal uterine bleeding

• Bloating

• Pain with sex (before, during, and/or after) (medical term: dyspareunia)

• Pelvic pain

• Infertility

• Miscarriage

Diagnosis and Treatment

Diagnosis Process

Pelvic exam:

After talking about your symptoms with your gynecologist, he or she could give you a pelvic exam to feel for any endometriosis lesions, such as cysts or scars

Ultrasound:

Sometimes, ovarian cysts from endometriosis can be seen on an ultrasound—a type of imaging that uses sound waves to produce pictures of the inside of the body

Laparoscopy:

Your doctor may suggest a surgical procedure called a laparoscopy to actually look inside of your pelvis to see lesions. Surgery can help confirm the diagnosis of endometriosis. During the laparoscopy, your gynecologist may remove a small piece of tissue to study.

Treatment Options

Monitoring and Painkillers

Both prescription and over-the-counter painkillers can decrease inflammation and may help with endometriosis-associated pain.

Hormonal Birth Control

Hormonal birth control can prevent estrogen fluctuation, which may reduce endometriosis-associated pain during the period. Hormonal birth control can be used in several ways. Some include:

• Birth control pills (includes estrogen/progestin pills and progestin-only pills)

• Hormonal IUDs (intrauterine devices)

• Progestin injection

• Implants

Many people with endometriosis take a very high dose of birth control, which you need a special prescription for.

Laparoscopy

The gold standard treatment for Endometriosis would be a successful excision surgery. Excision surgery is done by a surgeon during a laparoscopy, where they go in and cut out all of the endometriosis lesions from the root. This form of surgery will give the best results, as opposed to an ablation, which is when a surgeon will burn off the top of the lesions, leaving the root intact. Many surgeons are unfortunately not well informed on most up tp date treatments of endometriosis, so when choosing a surgeon make sure this is discussed.

Hysterectomy

A hysterectomy is not a cure for endometriosis, however is for adenomyosis. In a hysterectomy the surgeon will completely remove your uterus, and possibly ovaries. This can drastically improve pain levels in those with adenomyosis, but endometriosis lesions which were not on the uterus will still impact you.