By Tim Taylor

Five million women

Variety of symptoms

Download this episodeEndometriosis, the condition in which tissue that forms the lining of the uterus is found outside of the uterus, or endometrium, has a variety of symptoms. Unfortunately, in many cases, women with the disorder display no symptoms at all. Having trouble getting pregnant may be the first sign that you have endometriosis. The most common symptoms are pain, usually in the abdomen, lower back and pelvis, and a heavy menstrual period. Some women may even have problems with bleeding between periods as well as extremely painful menstrual cramps. Women with endometriosis may experience pain during or after sex and have painful bowel movements during menstrual periods. For some women, the pain associated with endometriosis gets milder after menopause due to estrogen deficiency, but this is not always the case. Hormone therapy such as estrogen, given to reduce menopausal symptoms, may cause these symptoms to continue.

Problem with pain

Download this episodeResearch has shown that pain is a primary symptom of endometriosis, but it remains a mystery as to how pain arises in women with the disorder. The severity of pain does not correspond with the number, location, or extent of endometriosis lesions. Some women with only a few small lesions experience severe pain. Other women may have very large patches of endometriosis, but only experience little pain. Areas of endometrial tissue, often called implants, respond to changes in the female hormone known as estrogen. Estrogen is the main sex hormone in women and is essential to the menstrual cycle. The implants may grow and bleed like the uterine lining does during a woman’s menstrual cycle. Surrounding tissue can become irritated, inflamed and swollen. The breakdown and bleeding of this tissue each month may also cause scar tissue to form. The bleeding, inflammation and scarring can cause pain before and during menstruation.

May need a biopsy

Download this episodeThe only surefire way to know if a patient has endometriosis is a surgical procedure called a laparoscopy. Dr. Gloria Richard-Davis, a specialist in reproductive endocrinology and infertility specialist at UAMS, says the procedure uses an instrument to slightly inflate the abdomen with a harmless gas. After making a small cut in the abdomen, the surgeon will use a small instrument with a light called a laparoscope to review the patient’s reproductive organs, intestines and any other surfaces for samples of endometriosis. Sometimes a small amount of tissue is removed during the procedure and studied under a microscope. This is known as a biopsy and is done to confirm the diagnosis. Dr. Richard-Davis says some imaging tests, such as an ultrasound, may help detect endometriomas which are ovarian masses that occur in severe cases of endometriosis, but is not effective in locating small patches of the tissue.

Relieving symptoms

Download this episodeThere is no cure for endometriosis but certain steps can be taken to relieve its symptoms. Pain relievers such as ibuprofen or naproxen may be recommended for mild discomfort. Hormonal medications help slow the growth of endometrial tissue and may keep new tissue from growing although they do nothing to get rid of tissue that already exists. Surgery is usually recommended for severe cases or if the patient is having problems with getting pregnant. The surgery involves locating the affected areas and removing the tissue. Hormone treatment may be used after surgery unless the patient is trying to get pregnant. A hysterectomy and oophorectomy, which involves removing the uterus and both ovaries, is done as a last resort. The pain of endometriosis decreases after menopause. As the body stops making estrogen, the growths begin to slowly shrink. Any woman having symptoms after menopause should see her doctor about treatment options.Trusted by thousands of listeners every week, T. Glenn Pait, M.D., began offering expert advice as the host of UAMS’ “Here’s to Your Health” program in 1996. Dr. Pait began working at UAMS in 1994 and has been practicing medicine for over 20 years.