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Endometriosis


Anne
had never had problems with her periods the way some of her friends
did. But over time her periods started getting so painful that she
dreaded their arrival. Every month for a few days she would curl up on
the couch with a heating pad and take a pain reliever. The cramps
eventually became so bad that she was missing school a couple of days a
month, and the pain even started happening between periods.

Her doctor thought Anne might have endometriosis.
What Is Endometriosis?

When
a woman has endometriosis, tissue that looks and acts like the lining
of the uterus starts growing in places other than the inside of the
uterus. The most common locations for these growths — called endometrial
implants — are the outside surface of the uterus, the ovaries, the
fallopian tubes, the ligaments that support the uterus, the intestines,
the bladder, the internal area between the vagina and rectum, and the
lining of the pelvic cavity.

It is not known exactly how many
women have endometriosis, but it is believed that more than 5 million
American women, including teen girls, are affected. It's not always
diagnosed right away in teens because at first they or their doctors
assume that their painful periods are a normal part of menstruating, or
that their abdominal pain is due to another problem. But continuing,
excessive pain that limits activity isn't normal and should always be
taken seriously. Because severe endometriosis can make it harder for a
girl to have children in the future, it's a good idea to get medical
help for endometriosis and not wait too long.

To understand why
endometriosis causes problems, it helps to have a basic understanding of
how the monthly menstrual cycle works: During the course of each cycle,
the lining of a woman's uterus builds up with blood vessels and tissue.
This happens because the uterus is getting ready to receive the egg
that will be released from one of the ovaries. If the egg isn't
fertilized by sperm, the uterus sheds the tissue and blood; this is the
menstrual period. This entire process is controlled by the female sex
hormones and usually takes about 28 to 30 days.

Because the
abnormal growths associated with endometriosis are made up of the same
kind of tissue and blood vessels found in the uterine lining, any
endometrial implants will act just like the endometrium in the uterus.
That means they respond in the same way to the hormonal changes of the
menstrual cycle.

However, in the uterus, if the egg isn't
fertilized, the extra tissue and blood leave a girl's body in the form
of menstrual fluid. With endometriosis, though, there's nowhere for the
accumulating blood and tissue to go once the implants start to break
down. This causes irritation of the surrounding body parts, which can
cause pain. With continued build up and irritation, the symptoms of
endometriosis tend to become more painful over time.

What Causes Endometriosis?





Doctors
aren't sure what causes endometriosis. They do know that it is slightly
more common in teens and women who have a family member who has been
diagnosed with endometriosis.

There are several theories about
how the endometrial tissue actually gets outside the uterus in the first
place. One theory suggests that the menstrual blood flow somehow "backs
up" into the fallopian tubes, carrying some tissue from the uterine
lining with it. In effect, the tissue gets transplanted and starts
growing outside the uterus.

Another theory is that endometrial
tissue cells travel out of the uterus through blood or lymph vessels,
and then start growing in the new locations where they're deposited. Yet
another theory suggests that some girls are born with "misplaced" cells
that can turn into endometrial implants later in life. Scientists
continue to research the condition to help doctors fully understand and
treat it.
What Are the Signs and Symptoms?

The
most common sign of endometriosis is severe pelvic (lower abdominal)
pain. It may occur occasionally or constantly, and it may be associated
with a girl's period. Although slight cramps for a couple of days before
or during a menstrual period are normal, lasting or intense pain that
disrupts a girl's day is not. With endometriosis, the pain is usually so
bad that it causes a girl to miss school, sports, and social
activities.

Other possible symptoms include:

* pelvic pain that gets worse after sex or after a pelvic exam
* a very heavy period
* lower back pain
* constipation, diarrhea, or feeling pain or seeing blood when going
to the bathroom (endometrial implants can press on some of the organs
involved in getting waste out of the body, such as the bladder,
intestines, and rectum)

If a girl notices these symptoms, it
doesn't necessarily mean that she has endometriosis. Lots of other
things — like an infection — may cause similar symptoms. But it's
important to see a doctor right away if you notice these symptoms. If
you haven't been examined by a gynecologist for the first time yet, this
is a good time.
BackContinue
Listen
How Is It Diagnosed?





Diagnosing
endometriosis isn't always easy. Lots of things can cause pelvic pain,
so even if a girl's symptoms point to endometriosis, a doctor may want
to rule out other possibilities.

In addition to doing a physical
exam, the doctor will take your medical history by asking you about any
concerns and symptoms you have, your past health, your family's health,
any medications you're taking, any allergies you may have, and other
issues. The doctor may ask about your periods and whether you have had
sex. It's important to answer all of these questions honestly so your
doctor can figure out what's going on.

Depending on your
symptoms, the doctor might ask you to keep a pain diary, which may
involve recording this information every time you experience pain:

* type of pain (is it sharp? dull? aching? crampy?)
* location (where is it?)
* duration (how long does it last?)
* timing (is the pain related to your period? going to the bathroom?)
* intensity (on a scale of 1 to 10, how bad is the pain?)
* treatment (did you try anything to make the pain go away? did it help? did anything make the pain worse?)

The
severity of the pain isn't always an indication of how severe the
endometriosis might be. A girl may have many growths and just a little
pain or a few growths and a great deal of pain. Every girl's situation
is a little bit different.

The only way to know for certain
whether a girl has endometriosis is to perform a minor surgical
procedure called laparoscopy (pronounced: la-puh-ras-kuh-pee). This
allows the doctor to know for certain whether a girl has endometrial
implants and, if so, how extensive they are.

While a girl is
under anesthesia, the doctor makes a small cut near her belly button and
inserts a thin, lighted tube (known as a laparoscope) that acts as a
tiny video camera so that the doctor can view the pelvic organs. During
the procedure, the abdomen is filled with a gas to help the doctor see
the organs better. The doctor may also do a biopsy, which means removing
small pieces of the growths for examination under a microscope. If
endometrial implants are seen, the doctor might be able to remove them.

Even
if symptoms point to endometriosis, the doctor might not want to
perform a laparoscopy right away, and instead may order scanning tests
that can create images of the pelvic region, such as ultrasound or
magnetic resonance imaging (MRI). This helps to rule out other possible
causes of the symptoms. Doctors also may start by telling a girl to take
ibuprofen. Oftentimes, doctors will prescribe birth control pills, not
as a method of contraception but because they reduce painful periods,
especially those associated with endometriosis.

If these approaches don't work for a girl with endometriosis, then the doctor will probably order the laparoscopy.
BackContinue
Listen
What Do Doctors Do?

Endometriosis can't be cured, but its symptoms usually can be controlled.

Doctors
often prescribe birth control pills because they use hormones to
prevent ovulation (the monthly release of an egg from an ovary). If a
girl doesn't ovulate, then the endometrial implants won't build up as
much, and this can make endometriosis less painful.

Other
medications used to treat endometriosis work in a similar way as birth
control pills to modify the hormone-driven buildup and breakdown of
endometrial tissue. Doctors often don't recommend these treatments for
teens until well after puberty is completed, though.

Surgery is
often helpful if medications don't work. A doctor can remove endometrial
growths with the help of a laparoscope. After this treatment, many
girls find relief from their symptoms, but some may experience pain
again if the growths return over time. Laparoscopy is the usual surgical
treatment for endometriosis, although in rare cases more extensive
surgery may be needed.

Doctors often suggest lifestyle changes
for teens who have endometriosis, too. A healthy diet, moderate
exercise, and relaxation techniques such as yoga and meditation can
sometimes help.
What's It Like to Have Endometriosis?

Apart
from the pain, other things can make living with endometriosis a
challenge. Some girls find it difficult explaining to friends and
teachers why they miss school, sports, or other activities, for example.
If you feel embarrassed, ask your doctor to write a note you can give
to teachers and coaches so you don't have to explain yourself. You can
then work with them to be sure you don't miss out on key assignments —
or fun.

You don't have to go into detail about your condition to
friends or classmates unless you want to. If you think someone won't
understand, just tell that person you're not feeling well. You have no
obligation to provide them with a detailed explanation.

These
days, doctors are more likely to recognize endometriosis. Once they're
diagnosed, many girls find that medication limits the extent of their
endometriosis. It also controls pain so they can take part in the
activities they enjoy.

Reviewed by: Larissa Hirsch, MD
Date reviewed: August 2010
Back

How Is It Diagnosed?





Diagnosing
endometriosis isn't always easy. Lots of things can cause pelvic pain,
so even if a girl's symptoms point to endometriosis, a doctor may want
to rule out other possibilities.

In addition to doing a physical
exam, the doctor will take your medical history by asking you about any
concerns and symptoms you have, your past health, your family's health,
any medications you're taking, any allergies you may have, and other
issues. The doctor may ask about your periods and whether you have had
sex. It's important to answer all of these questions honestly so your
doctor can figure out what's going on.

Depending on your
symptoms, the doctor might ask you to keep a pain diary, which may
involve recording this information every time you experience pain:

* type of pain (is it sharp? dull? aching? crampy?)
* location (where is it?)
* duration (how long does it last?)
* timing (is the pain related to your period? going to the bathroom?)
* intensity (on a scale of 1 to 10, how bad is the pain?)
* treatment (did you try anything to make the pain go away? did it help? did anything make the pain worse?)

The
severity of the pain isn't always an indication of how severe the
endometriosis might be. A girl may have many growths and just a little
pain or a few growths and a great deal of pain. Every girl's situation
is a little bit different.

The only way to know for certain
whether a girl has endometriosis is to perform a minor surgical
procedure called laparoscopy (pronounced: la-puh-ras-kuh-pee). This
allows the doctor to know for certain whether a girl has endometrial
implants and, if so, how extensive they are.

While a girl is
under anesthesia, the doctor makes a small cut near her belly button and
inserts a thin, lighted tube (known as a laparoscope) that acts as a
tiny video camera so that the doctor can view the pelvic organs. During
the procedure, the abdomen is filled with a gas to help the doctor see
the organs better. The doctor may also do a biopsy, which means removing
small pieces of the growths for examination under a microscope. If
endometrial implants are seen, the doctor might be able to remove them.

Even
if symptoms point to endometriosis, the doctor might not want to
perform a laparoscopy right away, and instead may order scanning tests
that can create images of the pelvic region, such as ultrasound or
magnetic resonance imaging (MRI). This helps to rule out other possible
causes of the symptoms. Doctors also may start by telling a girl to take
ibuprofen. Oftentimes, doctors will prescribe birth control pills, not
as a method of contraception but because they reduce painful periods,
especially those associated with endometriosis.

If these approaches don't work for a girl with endometriosis, then the doctor will probably order the laparoscopy.
What Do Doctors Do?

Endometriosis can't be cured, but its symptoms usually can be controlled.

Doctors
often prescribe birth control pills because they use hormones to
prevent ovulation (the monthly release of an egg from an ovary). If a
girl doesn't ovulate, then the endometrial implants won't build up as
much, and this can make endometriosis less painful.

Other
medications used to treat endometriosis work in a similar way as birth
control pills to modify the hormone-driven buildup and breakdown of
endometrial tissue. Doctors often don't recommend these treatments for
teens until well after puberty is completed, though.

Surgery is
often helpful if medications don't work. A doctor can remove endometrial
growths with the help of a laparoscope. After this treatment, many
girls find relief from their symptoms, but some may experience pain
again if the growths return over time. Laparoscopy is the usual surgical
treatment for endometriosis, although in rare cases more extensive
surgery may be needed.

Doctors often suggest lifestyle changes
for teens who have endometriosis, too. A healthy diet, moderate
exercise, and relaxation techniques such as yoga and meditation can
sometimes help.
What's It Like to Have Endometriosis?

Apart
from the pain, other things can make living with endometriosis a
challenge. Some girls find it difficult explaining to friends and
teachers why they miss school, sports, or other activities, for example.
If you feel embarrassed, ask your doctor to write a note you can give
to teachers and coaches so you don't have to explain yourself. You can
then work with them to be sure you don't miss out on key assignments —
or fun.

You don't have to go into detail about your condition to
friends or classmates unless you want to. If you think someone won't
understand, just tell that person you're not feeling well. You have no
obligation to provide them with a detailed explanation.

These
days, doctors are more likely to recognize endometriosis. Once they're
diagnosed, many girls find that medication limits the extent of their
endometriosis. It also controls pain so they can take part in the
activities they enjoy.

Reviewed by: Larissa Hirsch, MD
Date reviewed: August 2010