Wednesday, November 17, 2010


This is not a disease. This is a curse, like diabetes. It robs people of their lives. Starts young and goes forever. Most cancers get better and more effective treatment. Most of you know that endometriosis is a benign gyn condition where uterine lining is found outside of the uterus. Lots of theories abound how this is possible. The most common theory is that menstrual lining refluxes through the tubes back into the abdomen and becomes like seeds on the sidewalk. A few take hold in the cracks and grow.
Another more recent theory is that of genetic predisposition and metaplasia of otherwise normal tissue turning into endometrium.

At any rate, either way, it is a bitch.
With each menstruation the uterine lining finds itself bleeding, which in the places where it shouldn't be, means pain. The fluid/tissue is irritating and causes moderate to severe pain on a monthly basis. Eventually it causes pain every day which can become debilitating. It sometimes leads to infertility as well.

Diagnosis is only by direct vision of the stuff in your abdomen by the doctor and sometimes a biopsy. No xray or blood test is helpful, however the story of painful menses leading to pain during more times in the cycle, painful intercourse is suggestive of endometriosis.

Treatment has centered around hormonal therapies simulating times when a woman is normal but not menstruating such as pregnancy, breastfeeding or postmenopause. These are commonly known as treatment with birth control pills, progestin only contraception such as Depo Provera, and GNRH analogs such as Lupron and now aromatase inhibitors such as Femara. They all work to some degree, but are temporary fixes.Conservative surgery has been the hallmark of diagnosis and treatment for some time, with hysterectomy being the final assault on the problem.

Conservative surgery includes laparoscopy with ablation/ cautery or excision of endometriosis lesions. The excision is the best therapy, however it can be tricky and sometimes technically impossible. There is always more, so hormonal therapy follow up is what I recommend.

When I was a medical student a million years ago, the professor taught us that young women with difficult periods needed to marry young and have their children early. Still good advice. A life plan is a critical part of this problem. Those words from the professor still ring true. For women with endometriosis, the sooner they complete their families the better. New and improved medical and surgical approaches are coming, but not soon enough for many women.

Until next time.........