Cause of Endometriosis Still Unknown but Affects Millions of Women Each Yearby Jennifer Wider, M.D.
Endometriosis, a disorder that occurs when cells from the lining of the uterus grow in other areas of the body, affects millions of women each year. Unfortunately, many women suffer in silence without a proper diagnosis or the right information.
Each month, during a woman’s menstrual cycle, the ovaries produce hormones that trigger the thickening of the uterine lining. If a fertilized egg doesn’t get implanted, these extra cells slough off, and cause a woman to get her period. In a woman with endometriosis, the uterine lining cells grow outside the uterus and may implant on the ovaries, bladder, lining of the pelvis, bowel and/or rectum. These “transplanted” cells do not slough off each month and can bleed a little and cause discomfort in a variety of different areas in the body.
Pain is the hallmark symptom of endometriosis but a woman may also experience: cramps, heavy periods, chronic pelvic pain (which may include the abdomen and/or lower back), pain during or after sex, painful bowel movements and infertility. Some women report that the pain is so intense that it disrupts their day-to-day activities. But it doesn’t affect everyone the same way. Some women who have endometriosis report having no symptoms and may only find out that they have it after trying unsuccessfully to get pregnant.
Endometriosis is one of the top three causes of infertility in women. According to statistics from the Cleveland Clinic in Ohio, roughly thirty to forty percent of women with endometriosis are infertile. But some women don’t realize that this is the underlying cause of their fertility problems.
“Many women are not getting proper information on endometriosis, particularly on how it can affect their fertility," says Dr. Christina Williams, Director of Williams Fertility at the Crossroads Clinic in Vancouver and Member of the BC Women's Centre for Pain and Endometriosis. "Each woman experiences endometriosis symptoms differently, depending on the location and severity of the condition. Patients should seek a complete diagnosis with their health provider, and decide on the best treatment option."
The cause of endometriosis is unknown, but there are several theories. One theory is that endometriosis results from retrograde menstrual flow, blood that goes in the wrong direction during a woman’s period, and for one reason or another, in some vulnerable women, cells implant outside the uterus. Another theory involves genetics, because the disease runs in families, some researchers have focused on inherited genetic errors. Other possible causes include: the role of hormones and the immune system. More studies are necessary to discover the underlying cause.
Endometriosis is often diagnosed in women between the ages of 25-35, but can occur in women of all ages. Women are more likely to develop endometriosis if: their period started at a young age, they never had children, have periods that last more than seven days, and a first degree relative with the condition.
Treatment depends on several factors including: severity of symptoms, extent of disease and desire to have children in the future. For women with mild symptoms, the condition can often be managed with nonsteroidal anti-inflammatory drugs and exercise and/or relaxation techniques. These women are often checked every 6-12 months to make sure that the disease isn’t getting worse. For women with more severe disease, treatment may include: medication to control the pain which can include birth control pills therapy and possibly laparoscopic surgery to remove certain areas of endometriosis, if necessary. For women who want to have children, different fertility options may be explored.
“There have been many cases throughout my practice where in vitro fertilization is the only medical option to enable endometriosis patients to conceive," says Dr. Williams. The cost can be prohibitive for some patients, so Dr. Williams hopes that by bringing awareness to this common gynecological condition patients will be able to afford treatment in the future.
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