What is Endometriosis?

Endometriosis is a painful, chronic disease that affects 5 1/2 million women and girls in the USA and Canada, and millions more worldwide. It occurs when tissue like that which lines the uterus (tissue called the endometrium) is found outside the uterus -- usually in the abdomen on the ovaries, fallopian tubes, and ligaments that support the uterus; the area between the vagina and rectum; the outer surface of the uterus; and the lining of the pelvic cavity. Other sites for these endometrial growths may include the bladder, bowel, vagina, cervix, vulva, and in abdominal surgical scars. Less commonly they are found in the lung, arm, thigh, and other locations.

This misplaced tissue develops into growths or lesions which respond to the menstrual cycle in the same way that the tissue of the uterine lining does: each month the tissue builds up, breaks down, and sheds. Menstrual blood flows from the uterus and out of the body through the vagina, but the blood and tissue shed from endometrial growths has no way of leaving the body. This results in internal bleeding, breakdown of the blood and tissue from the lesions, and inflammation -- and can cause pain, infertility, scar tissue formation, adhesions, and bowel problems.

What are the Symptoms of Endometriosis?
 

• Pain before and during periods
• Pain with sex
• Infertility
• Fatigue
• Painful urination during periods
• Painful bowel movements during periods

Other Gastrointestinal upsets such as diarrhea, constipation, nausea.

In addition, many women with endometriosis suffer from:

• Allergies
• Chemical sensitivities
• Frequent yeast infections

Diagnosis is considered uncertain until proven by laparoscopy, a minor surgical procedure done under anesthesia. A laparoscopy usually shows the location, size, and extent of the growths. This helps the doctor and patient make better treatment choices.

What Causes Endometriosis?
 

The cause of endometriosis is unknown. The retrograde menstruation theory (transtubal migration theory) suggests that during menstruation some of the menstrual tissue backs up through the fallopian tubes, implants in the abdomen, and grows. Some experts believe that all women experience some menstrual tissue backup and that an immune system problem or a hormonal problem allows this tissue to grow in the women who develop endometriosis.

Another theory suggests that endometrial tissue is distributed from the uterus to other parts of the body through the lymph system or through the blood system. A genetic theory suggests that it may be carried in the genes in certain families or that some families may have predisposing factors to endometriosis.

Surgical transplantation has also been cited in many cases where endometriosis is found in abdominal scars, although it has also been found in such scars when accidental implantation seems unlikely.

Another theory suggests that remnants of tissue from when the woman was an embryo may later develop into endometriosis, or that some adult tissues retain the ability they had in the embryo stage to transform reproductive tissue in certain circumstances.

Research by the Endometriosis Association revealed a startling link between dioxin (TCCD) exposure and the development of endometriosis. Dioxin is a toxic chemical byproduct of pesticide manufacturing, bleached pulp and paper products, and medical and municipal waste incineration. The EA discovered a colony of rhesus monkeys that had developed endometriosis after exposure to dioxin. 79% of the monkeys exposed to dioxin developed endometriosis, and, in addition, the more dioxin exposure, the more severe the endo.

Treatment Options

Although there is no cure for endometriosis, a variety of treatment options exist. Goals may include: relieving/reducing pain symptoms, shrinking or slowing endometrial growths, preserving or restoring fertility, and preventing/delaying recurrence of the disease.

PAIN MEDICATION: Over-the-counter pain relievers may include aspirin and acetaminophen, as well prostaglandin inhibitors such as ibuprofen, naproxen sodium, indomethecin, and tolfenamic acid. In some cases, prescription drugs may be required.

HORMONAL THERAPY: Hormonal treatment aims to stop ovulation for as long as possible and may include: oral contraceptives, progesterone drugs, a testosterone derivative (danazol), and GnRH agonists (gonadotropin releasing hormone drugs). Side effects may be a problem for some women.

SURGERY: Conservative surgery seeks to remove or destroy the growths, relieves pain, and may allow pregnancy to occur in some cases. Conservative surgery can involve laparoscopy (outpatient surgery in which the surgeon can view the inside of the abdomen through a tiny lighted tube that is inserted through one or more tiny abdominal incisions. Also referred to as "belly-button" surgery.) or laparotomy (more extensive procedure, full incision, longer recovery period). Hormonal therapy may be prescribed along with conservative surgery. Radical surgery, which may be necessary in severe cases, involves hysterectomy, removal of all growths, and removal of ovaries.

ALTERNATIVE TREATMENT: Complementary treatment options may include traditional Chinese medicine, nutritional approaches, homeopathy, allergy management, and immune therapy. To learn more about alternative therapies, see: The Endometriosis Sourcebook, Overcoming Endometriosis, and EA newsletters Vol. 17, nos. 2, 3, 5-6.

 

Information courtesy of the Endometriosis Association.

 

Endometriosis and Infertility

Why does endometriosis cause infertility?

According to medical statistics it is estimated that infertility can affect around 40% of women with Endometriosis

 

Infertility can be one of the consequences of Endometriosis. Women are not only dealing with a debilitating disease but they are also in fear of not being able to have children.

But let’s not paint a gloomy picture here. It is fortunate that not all women who have endometriosis are infertile. (If all women who had endometriosis were infertile then birth rates would drop considerably and a rush to find successful treatment for this disease would, hopefully, be implemented.)

Interestingly, it has been found that between 30 to 40 percent of women undergoing laparoscopy as part of an infertility evaluation are found to have Endometriosis. This is when women are finally diagnosed with the disease by default.

There appears to be a number of mechanisms by which Endometriosis impacts on fertility. Scarring or adhesions in the pelvis, for example, may cause infertility. The fallopian tubes and ovaries may adhere to the lining of the pelvis or to each other, restricting their movement. The scarring and adhesions that takes place with Endometrisois may mean that the ovaries and fallopian tubes are not in the right position, so the transfer of the egg to the fallopian tubes cannot take place. Similarly, Endometriosis can cause damage and/or blockage to the inside of the fallopian tube, impeding the journey of the egg down the fallopian tube to the uterus.

Another factor which could cause infertility for women with Endometriosis, may be the over-production of prostaglandins. These are hormones which play and important role in the fertilization and implantation of the embryo. An excess of prostaglandins may interfere with these processes.

Because Endometriosis often causes painful intercourse, couples may fail to have intercourse during the woman’s most fertile time, which will obviously impede the possibility of conception.

A closer look at some of the possible causes of Infertility as speculated by the medical profession:

Abdominal Adhesions and Infertility

As the Endometriosis implants grow and develop in the abdomen, the body tries to surround them with fibrous connective tissue (scar tissue). The body does this in an attempt to isolate the implants and prevent them from doing harm. Adhesions can also be formed during surgery when abdominal tissue is traumatized.

These fibrous growths also have the effect of making the implants stick to adjacent tissue, and in some case organs can be ‘glued’ together. Also the blood from internal bleeding from the implants can forms adhesions, so that an implant may be stuck to several different tissues. For example, an Endometriosis implant on the top of the uterus may cause the ovary and small intestine to become attached at the site of the implant.

If the adhesions caused by Endometriosis pinch off the fallopian tube or if they cause blockage to the opening of the fallopian tube, they could obstruct the merger of egg and sperm and prevent fertilization and conception. Also ectopic pregnancy is more common with Endometriosis, if the embryo can't travel to the womb. This type of obstruction can be easily diagnosed and surgically corrected.

However, this does not explain how patients with just a few Endometrial implants and no adhesions can become infertile. Adhesions can also cause pain, as internal organs which normally slip and slide are firmly glued together. For example, if the bowel is stuck to a tender, painful ovary, flatulence could cause pain.

Secretions from Implants

The normal Endometrium which lines the womb is a very active and vital tissue that secretes a wide variety of nutrients and hormones required for normal conception. The endometrial implants also secrete these same substances, but instead of depositing them into the lumen (center) of the womb as normal, the endometrial implants release their chemical secretions into the abdominal cavity. Some of these substances are potent hormones which could interfere with fertility.

Prostaglandins

One major group of hormones secreted by the normal endometrium is that of the prostaglandins. Prostaglandins are oil-based hormones found in nearly all the tissues of the body and are required for many bodily processes, including several stages of the menstrual cycle and pregnancy.

Prostaglandins are required for ovulation, regression of the corpus luteum (i.e., ending the monthly menstrual cycle), sperm motility, immune interaction, contraction of the uterus at birth and menstrual cramps. Endometriosis implants and the endometrium of the uterus are the richest source of prostaglandin production in the body.
However, the problem with Endometriosis implants includes:
 

• Prostaglandins are released into the abdomen instead of inside the womb.
• Prostaglandins release by the implants seem to be out of phase with their release by the uterus. Prostaglandins are produced at the wrong time sending the wrong message.

For instance, there is a normal surge in prostaglandin F production at the end of the menstrual cycle, causing the effect of the copus luteum of the ovary to die down and signaling the start of a new menstrual cycle. The implants of Endometriosis produce their own prostaglandin surge several days after that of the womb lining. This may be one of the main causes of very early miscarriage.

If a women is a few days pregnant then the Endometriosis implants producing prostaglandin F would incorrectly signal the ovary to start a new menstrual cycle, causing the womb lining with the implanted egg to be expelled - and the consequence is an early miscarriage.

Prostaglandins also play an important role in the contractions of womb and fallopian tubes. During the normal menstrual cycle, the gentle contraction of the womb and fallopian tube aids the movement of egg and sperm to the outer third of the fallopian tube where fertilization occurs. High concentrations of endometriosis implants may prevent fertilization. An excess of PGF2 and PGE2 could cause contractions that are too strong and expel the egg too quickly.

Early Miscarriage

The most common time for a miscarriage to occur is during the first three months of pregnancy. During this time, the embryo is developing into a fetus and is undergoing dramatic changes, including the formation of most of its internal organs. This is a critical period of development that requires an appropriate nutrient-rich environment, a healthy placenta and a very delicate balance between the various hormones involved in pregnancy.

However, the real problem of a an early miscarriage, is that if it occurs during the first six weeks of pregnancy there is a good chance that women may not even be aware that they were pregnant. They may think their period was late.

Regardless of whether or not there is a high miscarriage rate in Endometriosis patients, it is imperative to eat the right sort of nutrient-rich food to try to ensure the maintenance of a pregnancy. Nutrition in both parents, even before pregnancy has a profound effect on the state of the egg and sperm, as well as on the nature of the secretions within the peritoneal cavity. Choice of foods, particularly fats and oils, may be a crucial factor as these affect the production of prostaglandins, cell membranes, steroid hormones, and neurotransmitters etc.

Fertility and the Alert Immune System

In order to achieve pregnancy, sperm has to enter the body. This sperm can be judged as 'alien' by a women's immune cells, because it is 'non-self'. If pregnancy is achieved, the women's immune system has to adapt to the presence of 'alien' tissue growing inside her for nine months.

However, there will be some mechanism in nature, which tells the female immune system that this alien tissue is not a danger, in order to avoid damage to the embryo. Perhaps when the immune system is malfunctioning in Endometriosis, this mechanism fails and causes an immune attack on the embryo and sperm, thought to lead to infertility. Correcting or strengthening the immune system may help to achieve fertility for women with Endometriosis.

 

Tests for Infertility

 

For a woman to be fertile, the ovaries must release healthy eggs regularly, and her reproductive tract must allow the eggs and sperm to pass into her fallopian tubes for a possible union.

After your doctor asks questions regarding your health history, menstrual cycle and sexual habits, a general physical examination is done. This includes a regular gynecological examination. Specific fertility tests may include:

• Confirmation of ovulation. A blood test is sometimes performed to determine the levels of hormones involved in successful ovulation.
• Hysterosalpingography. This test evaluates the condition of your uterus and fallopian tubes. Fluid is injected into your uterus, and an X-ray is taken to determine whether the fluid progresses out of the uterus and into your fallopian tubes and general peritoneal cavity. Blockage or problems often can be located and may be corrected with medication or surgery.
• Laparoscopy. Performed under general anesthesia, this procedure involves inserting a thin viewing device into your abdomen and pelvis to examine your fallopian tubes, ovaries and uterus. A small incision (8 to 10 millimeters) is made beneath your navel, and a needle is inserted into your abdominal cavity. A small amount of gas (usually carbon dioxide) is inserted into the abdomen to create space for entry of the laparoscope — an illuminated, fiber-optic telescope.
  
  The most common problems identified by laparoscopy are endometriosis and scarring. Your doctor can also detect blockages or irregularities of the fallopian tubes and uterus. Often a blue dye is injected into the cervical canal and through the uterus and fallopian tubes to determine whether they are open. At the end of the procedure, the gas and laparoscope are drawn out and the incision is closed. Laparoscopy generally is done on an outpatient basis.
  
   
• Basal body temperature. Although this test was once a standard, basal body temperature charting is used less often today. Charting a woman's body temperature doesn't give as precise time of ovulation as earlier believed.
• Urinary luteinizing hormone (LH) detector kits. A number of at-home kits are available to test your LH level. Although these kits may be helpful, they also can be inaccurate and misleading. Consult your doctor before using one.

Success with Pregnancy

 

Many doctors feel that for a woman who has Endometriosis, the best chances of pregnancy occur during the six to nine months period following treatment with a laparoscopy procedure.

There are many women with Endometriosis who do succeed in having children. For some of these women these pregnancies may have taken place without treatment for Endometriosis; their pregnancies would have happened anyway. There is no way of knowing. For other women, they have successfully conceived after some form of medical treatment.

Other women are achieving pregnancy without any conventional medical intervention for Endometriosis, and are simply taking care of their own health though alternative treatments. This may include changes in diet or getting treatment from an Alternative Health practitioner. Success with pregnancy has been achieved by using Homeopathy, Acupuncture, Traditional Chinese Medicine, Herbalism, to name a few , as well as following self-help programs including vitamins and supplements and diet changes.

For some women, their pregnancy success has come about by combining conventional treatment for Endometriosis along with Complimentary therapies.
To address the problems with infertility and Endometriosis and achieve successful pregnancy may require a combination of treatments. This means correcting hormone imbalances that have been directly caused by Endometriosis; then to repair the structure of the reproductive organs.
 

This is probably best achieved by:

• natural therapies to rebalance hormones, boost the immune system and diminish active Endometriosis
• changing the diet to achieve optimum health
• possibly followed with surgery to correct damage to the structure of the reproductive organs
  Natural and Alternative therapies can work wonders to restore health and bring the body back into balance, but surgery may be required to repair damaged tissue and organs caused by Endometriosis, to restore them close to their original function.
   

IVF and Endometriosis

 

In vitro fertilization (IVF) procedures are effective in improving fertility for some women with endometriosis. IVF makes it possible to combine sperm and eggs in a laboratory and then place the resulting embryos into the woman’s uterus. IVF is one type of assisted reproductive technology that may be an option for women and families affected by infertility related to endometriosis.

In the early stages of IVF, a woman takes hormones to cause "superovulation," which triggers her body to produce many eggs at one time. Once mature, the eggs are collected from the woman, using a probe inserted into the vagina and guided by ultrasound. The collected eggs are placed in a dish for fertilization with a man’s sperm. The fertilized cells are then placed in an incubator, a machine that keeps them warm and allows them to develop into embryos. After three-to-five days, the embryos are transferred to the woman’s uterus. It takes about two weeks to know if the process is successful.

Even though the use of hormones in IVF is successful in treating infertility related to endometriosis, other forms of hormone therapy are not as successful. For instance, hormone therapy that prevents a woman from getting her period, or from ovulating each month, does not seem to improve infertility related to endometriosis.

Courtesy of the Endometriosis Association.

 

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Lynn Repaty's periods were so painful and heavy, she couldn't drive, she couldn't go to work, and she was afraid to even leave the house. Sometimes they were so bad that she had a hard time making it to the bathroom to change her tampon. So she'd camp out, literally, on the bathroom floor.

"I couldn't stand. I couldn't walk. For many years--a good 10 to 15 years--I was debilitated three to four days a month," says the director of membership/support services for the Endometriosis Association in Milwaukee.

She remembers exactly when the pain first started--with her first period at the age of 12. She suffered incredibly heavy bleeding and severe menstrual cramps from that day on. At 17 her doctor put her on birth control pills to control the pain, but it wasn't until much later--during an infertility test at the age of 26--that she found out the cause of her discomfort all those years.

 

Courtesy of MotherNature.com

 

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Endometriosis is a mystery - an enigma! We do not know the origin of the disease. We do not know why it causes such extreme symptoms in some women, and not in others. The treatment options can be - let's be honest: a bit "hit and miss". And, unfortunately, because endometriosis is associated with menstruation, sex, infertility, and pain (all taboo subjects in most societies) it is a disease that is not well known, understood, or accepted in the general public.

This is frustrating for those who suffer from endometriosis, and for those who care for someone with the disease. It is also frustrating for those, who try to treat women with endometriosis: the physicians who cannot guarantee a cure or complete symptom relief is also left with a feeling of "defeat": of not being able to provide his/her patient with a pain free life, or a promise of a much-longed for baby.

Doctors want to cure, but in endometriosis, there isn't a cure - yet.

Because physicians see patients for short amounts of time, and these visits often are about specific aspects of the disease, the true chronic aspect and full scope of endometriosis may not always be apparent. What we have to realize is that a chronic condition needs ongoing medical care and emotional support; including regular follow-up, information, and a good relationship with your doctor and your therapist.

What many women with endometriosis may end up having to accept is that we may need to learn how to live with and manage chronic pain, deal with infertility, and how to increase coping skills and regain control of our lives if we have not been fortunate enough to find a treatment, which adequately takes care of our symptoms.

There is no single prescription or blue print for coping – people use a number of different ways to cope, different methods work for different individuals. In counseling, you will learn many different coping skills such as relaxation and/or journaling. If you find that you need more support, please feel free to come see me. You can tell me how it is to live with a chronic disease. Talking about it; saying it out loud may be the first step toward healthier coping with this awful disease.
Here is the link

Courtesty of Endometriosis.org