Endometriosis (NIH)

Endometriosis is defined as the abnormal growth of endometrial cells. The same cell that make up the lining of the uterus and are shed monthly in the menstrual process. These wayward cells can position themselves in the lower abdomen on areas such as the cul-de-sac, the rectovaginal septum, the stomach, the fallopian tubes, the ovaries, and the bladder.

However, unlike uterine cells, they have no passage-way out of the body so they stay where they are and continue their cycle. During menstruation, the normal uterine lining is sloughed off and expelled through the vagina, but transplanted tissue has no means of exiting the body. The results is internal bleeding, inflammation, and scarring. One of the serious consequences of this scarring is infertility. These growths are generally not malignant or cancerous. Other complications, the growths can rupture and can spread the endometriosis to new areas.

"Dr. Redwine describes the progressive nature of endometriosis lesions. First seen as clear vesicles, then become red, then progress to black lesions over a period of 7-10 years. Water blisters lesions becoming blue dome cysts over a period of 4-10 years. Clear lesions are seen at the average age of 21.5, while black scarred lesions are seen at 31.9 years. The progression form clear to red to black with age confirms the progressive nature of this disease if left untreated. In 47-64% of the women, this disease will progress without therapy." ( Mark Perloe, M.D., 1995, page 2 )

Researchers are looking into a blood test to assist in examining women with symptoms of endometriosis. CA-125 is a cell protein found in pelvic organs that appears to be elevated in cases of moderate or severe endometriosis. ( Toni T. Mastro, 1996) An ultrasound device can be indispensable in diagnosing large cysts and other characteristics of progressing endometriosis. Laparoscopy, when used correctly, usually 100% accurate in diagnosing endometriosis. Diagnosis of endometriosis is generally considered uncertain until proven by laparoscopy. The laparoscopy indicates the location, extent and size of the growths. The cause of endometriosis is an enigma. It is not known why some women suffer with it while others appear to be perfectly healthy. There is the retrograde bleeding theory. This theory implies that retrograde bleeding through the fallopian tubes during menstruation causes endometriosis.

Endometriosis is more prevalent in women whose mothers were treated with DES hormone during pregnancy and in women who have pain with their menstruation. The most widely held theory states that endometriosis occurs when endometrial fragments attach to nearby pelvic structures and grow. ( Mark Perloe, M.D., 1995 ) Endometrial cells are frequently found in peritoneal fluid in all women at the time of menses, one would expect endometriosis to develop in all women. This is not the case. Women with menstrual abnormalities, heavy bleeding or frequent periods, short cycles, early puberty, are more likely to get endometriosis. Another theory indicates hormonal problems allow this tissue to take root and grow in women who develop endometriosis. ( Mark Perloe M.D., 1995 )

A genetic theory thinks that it may be carried in the genes of certain families or that certain families may have predisposing factors to endometriosis. Bruce S. Lessey has discovered that a deficiency of the protein beta-3, a subunit of the vitronectin receptor integrin, may be a valid method for diagnosing minimal and mild endometriosis. Lessey believes the protein is indeed involved in implantation of endometriosis. ( Gigi Marino, 1994 ) There is evidence that high doses of the environmental toxin, DIOXIN, causes the development of endometriosis. Seven research teams are already following up, including testing dioxin levels in the blood of women with endometriosis. Most people harbor dioxin traces, as a result of exposure to pesticides in their diet, or airborne dioxin released by certain types of waste incinerators. " Dioxin can exert its toxic effects at extremely low doses. Long term exposure to 2,3,7,8-TCDD concentrations as low as five parts per trillion has been associated with impaired neurological development and endometriosis." ( McCally, Orris, Thornton, and Weinberg, July-August 1996, page 11 )
Endometriosis is categorized and diagnosed in four stages based on locations affected. Stage 1, or minimal disease; (superficial and filmy adhesions); Stage 2, or mild disease; ( superficial and deep endometriosis, filmy adhesions); Stage 3, or moderate disease; (superficial and deep endometriosis, filmy and dense adhesions); and Stage 4, or severe disease; (superficial and deep endometriosis, dense adhesions). Even though the stages may seem similar, the sizes and number of areas diseased indicate diagnosis. It would seem that these symptoms should help to ensure a proper diagnosis, but there could be different reasons for the discomforts other than endometriosis. It is also important to note that not all women with the disease suffer from symptoms, even in Stage 4.

Even though some women with endometriosis are asymptomatic, pain plays a large role in a significant percentage of women with the disease. Pain was reported to interfere in some way with all aspects of activities of daily living, at times crippling pain. 78% interfered with sleep, this finding is significant because fatigue tends to potentate the severity of pain. Pain reported by 100% 1-2 days prior to cycle; 71% mid-cycle; 47% other times; 40% pain throughout; and 7% intermittent pain with no pattern. Since the onset of pain; 81% reported pain was progressive. Women were asked to describe their moods and feeling when experiencing pain. 84% reported feeling depressed; 75% irritable; 63% experienced mood swings; 54% feeling anxious; 53% angry; 51% negative; 43% helpless; 35% fearful and powerless; 32% worried; 31% insecure, and 19% hopeless.

Symptoms of this incurable disease are numbers. They included, but are not limited to, chronic pelvic pain, increasingly disabling, repeated miscarriages, painful intercourse, infertility, painful bowel movements, painful urination during menses, chronic fatigue, low resistance to infections, allergic reactions, pain before and during menses, heavy and/or irregular bleeding, lower back pain, diarrhea and/or constipation, intestinal upset, very painful menstrual cramps, bloody cough, skin nodules, pelvic adhesions, premenstrual spotting, PMS, urinary urgency, and rectal bleeding.

Although hormonal treatments may be somewhat effective in relieving symptoms, all of them can have unpleasant side effect. Oral contraceptives are often prescribed to reduce menstrual flow and lessen backflow of blood into the fallopian tubes. Provera, which fools the body into thinking it's pregnant, relieves symptoms but it can also cause bloating, breast tenderness and depression. Danasol, a male hormone, suppresses ovulation, and Lupron, which blocks the production of female hormones and creates a postmentopausal state, both are thought to shrink errant endometrial tissue, Danasol, however has a host of gruesome side effects, including growth of facial and chest hair, acne, depression, fluid retention, decreased breast size, and weight gain. Lupron may cause hot flashes, mood swings, bone loss and increased risk of heart disease. So the side effects of these drugs exceeds the drug's benefits. ( Alice Goodman, 1994 )

Laparoscopic surgery, a surgical removal of endometrial tissue may be the next step. The lesions are removed by cutting, burning or vaporizing with a laser. Laparotomy, an abdominal operation is necessary, although relief following surgery is frequently only temporary. Symptoms returned in a year. Use of laparoscopy for the treatment of endometriosis has claimed success in relieving pain in 60 to 70% of patients. A double blind study compared laser laparoscopoy with diagnostic laparoscopy alone, to see whether the removal of these implants did in fact results in statistically significant improvement or resolution of the pain symptoms. At the 6 month follow-up, 20 of 32 (62.5%) in the laser group were better and the number in the controlled group had dropped down to 7 of 31 (22.6%).

Medical treatment is aimed at controlling pain and shrinking endometrial tissue wherever it's become implanted. When hormonal treatments and painkillers have not relieved the symptoms of endometriosis, surgical removal of the tissue may be the next step. As a last resort, a hysterectomy and removal of both ovaries may become necessary. ( Alice Goodman, 1994 ) Hysterectomy and removal of the ovaries has been considered the only "definitive cure." Menopause also generally ends the activity of mild or moderate endometriosis. Even after radical surgery or menopause, a severe case of endometriosis can be reactivated by estrogen replacement therapy or continued hormone production after menopause.

Endometriosis is a progressive, ongoing and long term disorder. Like most diseases, endometriosis is not fair. It can rob a woman of her ability to have children, it can cause pain that severely interrupts everyday existence. Endometriosis is without question on of the most puzzling conditions that affect women. One assumption about endometriosis is that it is not a serious disease because it is not a killer. However, the havoc it renders on a womans' well being and her life style make it a known chronic, disabling disease. Endometriosis is a condition that can not be prevented or cured. Treatment, however, can help control the symptoms.