Endometriosis is a health issue that can cause pain and infertility in women of childbearing age. The name comes from the tissue that lines the uterus, called the endometrium, but endometriosis can be found on or in the ovaries, fallopian tubes, lining of the pelvic cavity, and on the uterosacral ligaments. Although rare, it can also be found in the bladder, colon, on the pericardium (sac that encloses the heart) and pleurae (membranes around the lungs). It has been found in every organ except the spleen.
“The cause of endometriosis isn’t entirely known,” says Dr. Lovera Wolf Miller, a NAMS-certified menopause practitioner at Health 4 Her in Michigan City, and the coauthor of Womenopause, Stop Pausing and Start Living [O-Books, London, UK, 2010]. “The most common theory is that when a woman has her period, it goes backwards into the fallopian tubes, but that doesn’t explain why it goes into other places. Another thought is that it moves through the lymphatic and vascular system.”
Endometriosis has a familial component, says Dr. Miller; therefore, a woman has a greater chance of having the condition if it’s found in her family history. “It’s also connected with people who have a poor immunological system,” she says. “It’s also more common in women who put off having children or have never been on cycle control pills (also known as birth control pills). They have a higher risk because they don’t have the protection of resting the endometrial lining, and therefore resting the endometriosis. Ironically, the cycle control pills preserve fertility, making it easier to get pregnant when the time is right."
Although the growths are benign, they can cause debilitating pain and infertility. Dr. Miller says that endometriosis can be difficult to diagnose, because doctors can’t know for certain if a woman has endometriosis unless she has a laparoscopic procedure, which means they view the area through keyhole surgery. Ultrasound and MRI scans are helpful for diagnosis, but they aren’t as definitive as the results from laparoscopies.
Women with endometriosis, even severe endometriosis, can be asymptomatic and only discover the condition when undergoing infertility treatment. “Other women can have severe pain with their period or at odd times or have no pain at all,” Dr. Miller says. “The common symptom is pain—usually pelvic pain—cramping or a steady ache. If endometriosis is in the bladder or colon, there can be bleeding.”
One of the best treatments, if fertility isn’t an issue, is pregnancy. Dr. Miller says this is because pregnancy puts endometriosis into remission by canceling shedding of the endometrium for the next 9 months. Another treatment is surgery to remove the lesions, which helps with pain and fertility in more severe cases. Birth or cycle control pills also put the lining to rest and give relief. “Cycle control pills will help a lot of girls, but more are helped by taking active pills only and skipping the inactive pills that bring on the period,” Dr. Miller says. “Skipping the inactive pill doesn’t cause any harm to the body because there is no ovulation, which makes a thick endometrium that has to be shed. Of course this isn’t an option if you’re trying to get pregnant.”
Postmenopausal hormones, estrogen and progesterone, also can help with symptoms. “You want to make sure the estrogen is transdermal and the progesterone is Prometrium,” Dr. Miller says. “Both are body-identical FDA approved, which is important.”
Leuprolide injection is another treatment that puts the body into false (Lupron) menopause by decreasing hormones in the body. But Dr. Miller says this is full of side effects, such as loss of libido, low hoarse voice, acne and hot flashes. “I don’t ever use it, but some women really need it for a short period of time.”
Endometriosis in the ovaries (endometriomas or chocolate cysts) can decrease fertility greatly. In this case surgeons can remove the cyst or the entire ovary.
Symptoms can be helped with exercise, 150 minutes a week (22 minutes a day). Also eat plenty of vegetables—especially the bright-colored ones. “This is all to keep you healthy, and when you are healthy the body is able to fight off health problems,” Dr. Miller says. “The healthier the body, the better under control your symptoms will be.”
Treatment ultimately depends upon what the woman wants. Dr. Miller says, “If she is in severe pain and doesn’t want any more kids, a total hysterectomy with ovaries removed and adding back with menopause hormones can be the answer.”