Endometriosis and Chronic Pelvic Pain

Chronic Pelvic Pain – defined as pain originating below the belly button and lasting more then 6 months – can deeply impact women’s lives. So, diagnosing the cause is key to improving your life and health. The leading cause of chronic pelvic pain is a condition called Endometriosis.
What is Endometriosis?
Endometriosis is an often painful and frustrating condition where the tissue which lines the uterus – know as the endometrium- begins to grow outside in the abdominal cavity often involving the ovaries, bowel and pelvic lining.

The endometrium is the tissue which responds to a woman’s hormonal cycles and fills with blood then sheds it through the cervix during her menstrual cycle. When endometrial tissue that is outside the uterus tried to shed this blood it becomes trapped in the tissue can causes sever pain and abscesses.
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Symptoms include the following:

• Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before and extend several days into your period and may include lower back and abdominal pain.
• Pain with intercourse. Pain during or after sex is common with endometriosis.
• Pain with bowel movements or urination. You’re most likely to experience these symptoms during your period.
• Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
• Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.
• Other symptoms. You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

However the severity of the symptoms is not an indication of the severity of the condition. Someone with a mild case may have severe pain while someone with an advanced case may had little or no discomfort. If you are having symptoms it is important to see your GYN to avoid complications if the condition becomes advanced.

There are also several risk factors women should aware of.

• Never giving birth
• One or more relatives (mother, aunt or sister) with endometriosis
• Menstrual cycles shorter than 27 days with bleeding lasting longer than eight days
• Any medical condition that prevents the normal passage of menstrual flow
• A history of pelvic infection

How is Endometriosis Diagnosed?
Be prepared when you go into your GYN’s office do disrobe the type and location of the pain you are experiencing. This will help them eliminate other causes of your pelvic pain.

If your symptoms fit Endometriosis there are a number of tests that doctor may order to try and diagnose the condition and determine the best course of treatment:

• The Pelvic exam. You doctor may manually check your vagina and like they would for a normal yearly exam. This may allow the doctor to find any obvious abnormalities – however unless the endometriosis has caused large cysts it may be impossible to tell if it is there.
• Ultrasound. The Doctor may also order a vaginal and abdominal ultrasound.  The abdominal ultrasound is done by placing a wand like device on the abdomen. A vaginal ultrasound involves inserting a smaller wand like device into the vagina. In both tests use sound waves to provide a video image of the uterus, fallopian tubes and ovaries. Although this test is not conclusive it can tell if you have developed cysts which may indicate endometriosis.

• Laparoscopy. The only way for your doctor to know for certain that you have endometriosis is by looking inside your abdomen for visual signs. This is usually done with a minor surgery called a laparoscopy.
  
  

For a laparoscopy patients normally have a small does of general anesthetic so that they sleep through the procedure. Using a special needle, your surgeon expands your abdomen with a harmless gas so that the reproductive organs are easier to see. By making a small incision in the bellybutton the doctor inserts a tiny camera. By moving the laparoscope around, your surgeon can view the pelvic and other abdominal organs, looking for signs of endometrial tissue outside the uterus.
If you have endometriosis, laparoscopy will provide you and your doctor with information about the location, extent and size of the endometrial buildup. This will allow you to make a definitive plan to treat your condition effectively.
How do you Treat Endometriosis?
You and your doctor will discuss what treatments might be most helpful if you are diagnosed with endometriosis. Every case is different and so every treatment plan will vary according to your conditions and concerns. However, there are three main approaches to treating this condition.
Pain Medication: The most basic approach to endometriosis is to treat the symptoms with pain medication. Many over the counter medications which are commonly used for regular menstrual discomfort can ease the pain associate with endometriosis, however if this does not work then other approaches may be better for you.
Hormone Therapies: There are a number of different hormonal therapies which have been found to slow or stop endometriosis. Medications which control or block estrogen levels or the production of ovarian stimulating hormones can be an effective treatment in some cases. Oral contraceptives, Depo provera, Gn- RH antagonists and agonists or Danazol may be recommended depending on your medical history. These medications work in different ways to reduce the stimulation and production of endometrial cells which will help reduce symptoms. These treatments do not cure endometriosis – but they do help control symptoms.
Surgical Interventions: Conservative approaches to surgical treatment of Endometriosis are generally done through Laparoscopic surgery to remove cysts, adhesions and build up of endometrial tissue outside of the uterus. This is usually recommended for patients who wish to become pregnant because it preserves the uterus, fallopian tubes and ovaries. More radical approaches to surgical intervention would be a total hysterectomy – or removal of the uterus, cervix and ovaries. By removing the reproductive system – particularly both ovaries – the hormonal cycle which cause endometrial pain is also stopped. This is will cure the condition but is usually the last resort because after this procedure the patient will no longer be able to have children.

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Endometriosis – Don’t Suffer in Silence: AAGL urges Dr Vigilance and Patient Persistence

Almost 10 million American women between the ages of 16 and 40 suffer chronic pelvic pain, gastrointestinal problems, unitary track problems and infertility due to endometriosis – but this does not have to be the case according to the speakers at the 40th AAGL Global Congress of Minimally Invasive Gynecology November 8th, 2011.
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"Endometriosis is one of the most treatable, but least treated of women's health problems. Like me, many women suffer debilitating pain and other symptoms for as long as a decade before receiving an accurate diagnosis and proper treatment," stated Padma Lakshmi, Key-note speaker, Model, TV personality and co- founder Endometriosis Foundation of America.

Pelvic pain can have many different causes including appendicitis, bowel obstructions, ovarian cysts, pelvic inflammatory disease, diverticulitis, ectopic pregnancy, fibroids, IBS and many others.  Correct treatment is often delayed because endometriosis is often not immediately diagnosed.

Endometriosis is a complex condition where the cells that usually line the uterus and produce blood expelled as a menstrual cycle ever month move outside the uterus and start growing on other organs. Treatment of this disease was the focus of this year’s conference.
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For example, in women with endometriosis on the intestines, symptoms may prompt a physician to suggest GI tests, which will not reveal the true problem.

Lakshmi continues saying: "If a woman wants to have children, it's critical to get an accurate diagnosis and treatment as soon as possible. Endometriosis is one of the top three causes of infertility. Many women are delaying childbearing into their 30s and even 40s these days, but if you have had untreated endometriosis for many years, it may be too late. And that is a real tragedy."

The currently most effective treatment is laparoscopic excision surgery as alternative medical therapies for endometriosis are extremely limited.
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Although the cause of endometriosis is unknown, researchers suspect a strong genetic component because daughters of women suffering from the condition have a seven times higher risk of developing the disease themselves.

What is Abortion?

The Merriam Webster Dictionary defines abortion as the spontaneous or induced expulsion of an embryo or fetus resulting in or closely followed by its death.

Obviously this is the simplest definition of what has become a complex and contested term in our culture. However, the medical definition remains the same. So whether a fertilized egg passes through a woman’s body naturally and does not properly implant in the uterus, if a pregnancy stops developing properly and passes out of the uterus in a miscarriage, or if after a decision is made the pregnancy is surgically removed an abortion has occurred.

When medical professionals discuss abortion they are primarily discussing the surgical abortion procedure which is performed by Electrical Vacuum Aspiration (EVA). This is primarily done in the first 12 wks of pregnancy using a gentile suction to remove the pregnancy tissue from the woman’s uterus. After 12 weeks of gestation the procedure is usually called a dilation and evacuation / extraction done also with gentile suction. In most cases and under most conditions these procedures no longer involve scraping of the uterine walls the way they once did in the past.

Abortions can also be performed using a series of medications (Mifepristone and Misoprostol) which induce a controlled miscarriage. While this is not considered a ‘non surgical abortion’ it is still an abortion because an embryo is bring expelled from the uterus and ends the pregnancy.

A more complex question is whether the ‘morning after pill’ or Plan B should be considered an abortion. The morning after pill is actually a high dose of the hormone levonorgestrel which is contained in many birth control pills in lower doses. A high dose of levonorgestrel helps keep a woman from ovulating if she has not already done so. It also makes the lining of the uterus less likely to allow a fertilized egg to implant and continue to develop. Most medical professionals do not consider this an abortion because the fertilized egg, if there is one, is a Zygot. A zygote is a group of rapidly dividing cells that forms when a male sperm meets a female egg. It is not considered an embryo until after 2 weeks. Some people still consider the zygot the beginning of life, particularly religious people who believe life begins at conception. For these people the prevention of implantation is also considered an abortion – but this is a religious and cultural opinion – not medical opinions.