Monthly cramping is normal for most women but what about when it goes beyond the realm of normal? Sometimes this means endometriosis.
Credit: Big Stock PhotoWhen the lining of your uterus, the endometrial layer, sheds every month during menstruation sometimes things go awry. This shedding process can lead to the endometrial tissue finding its way outside of the uterus and into the abdominal cavity. The tissue can then implant on other areas in the abdomen like the ovaries, the intestines or internal organs. In fact, during surgical procedures doctors have found endometrial tissue as far away from the uterus as the base of the heart. Treatments for the pain and cramping associated with endometriosis are confusing so here we have simplified it for you to understand your options. Partner with your care provider to find out what choices are right for you then they can help you get back to normal.
Decades ago when endometriosis was not as well understood as it is today, doctors would often recommend women get pregnant as a solution to their severe pelvic pain. There are many challenges to this suggestion though, including the fact that some women may not want to get pregnant at that time in their lives. If pregnancy would be a welcome development, then this option is a good one, but the endometriosis can often make it more difficult to get pregnant which means that until the woman gets pregnant she still has to deal with the pain.
Contraceptives can help control some pain from endometriosis. By taking the birth control pills or using the patch or ring your doctors prescribes, you are giving your body a consistent dose of hormones daily to help keep your body at an even level. This makes you less susceptible to the extreme highs and lows that contribute to endometriosis. Consistent use of contraceptives has even shown the ability to reduce the size of endometrial tissues.
Injected Hormonal Treatments
If contraceptives help you with your endometriosis pain, but then they are not working as well, your doctor might suggest higher doses of hormones. These higher levels of hormones are often given via injection and can have significant side effects. If your doctor recommends these treatments make sure you do your homework before committing to a treatment.
Intra Uterine Devices
The Mirena intra-uterine device is not your typical IUD, it also has progestin in the device that is slowly released into the body. The progestin is one of the hormones that are used with good success to treat endometriosis. Doctors implant this IUD during a regular office visit and you feel almost no discomfort. Once implanted, this device can stay for up to five years and emits small amounts of progestin throughout that entire period.
Laparoscopic surgery is one performed with the help of cameras and small instruments that are inserted and manipulated through small incisions in the abdomen. Once simpler treatments are tried without success, some doctors move on to this type of surgical treatment to not only give a firm diagnosis but also remove as much of the endometriosis as they can find. While laparoscopic surgery may seem like the best option available, it is not 100 percent successful. Many bits or plaques of endometrial tissue migrate throughout the abdomen and pelvis, meaning they can be hiding in areas you would not expect and be almost impossible to find with a laparoscopic surgery. Many women who have endometriosis will have multiple laparoscopies to enhance and maintain their fertility while also treating the endometriosis and associated pain. This is the best option for women who want to maintain their fertility.
Ablation is a medical term for what you might call burning. When your doctor suggests endometrial ablation, it is usually an outpatient procedure done under general anesthesia. Your doctor will use special instruments that will burn the lining of your uterus. Because you are put to sleep for the procedure, it is possible for your doctor to do it without any incisions inserting the necessary tools through your cervix and into your uterus. This type of treatment also allows your doctor to view the uterus and see if there are any other concerns. Because of the nature of this treatment, it is only for women done having children. While you may not become sterile from the procedure there is no guarantee you will still be able to get pregnant. Endometrial ablation is not a particularly common treatment for endometriosis, however, because it does not address the issue of the endometrial tissue that has migrated out of the uterus. It is often used as a treatment for other things like problematic bleeding.
The extreme option for treatment of endometriosis is to have your uterus removed. Sometimes doctors will also want to remove your ovaries, called an oophorectomy. If you remove your ovaries, it puts you into menopause so this is a treatment that is frowned upon by many doctors and patients alike. Usually hysterectomy is only considered as a possible treatment for endometriosis after you have tried and failed multiple other types of treatments. If you are considering hysterectomy as a treatment for endometriosis, it is crucial that you get a second opinion of your treatment options. This way you know a doctor who prefers to treat patients one way or another is not just treating you, but you are truly getting the best treatment options for your own circumstances. The good news is that if you do end up needing a hysterectomy, you can have it performed with minimal incisions and while the doctor is operating the tools used will give a good view of other patches of endometrial tissue that might be located elsewhere in your abdominal cavity. By removing as much of the endometrial tissue as possible, you lower the chance that you will have a reoccurrence of pain and related complications. Because hysterectomy removes the uterus, you remove the source of added endometrial tissue and control the problem by cutting off the source.
With so many options available, it is critical to make sure you are making the right choice in treatment for endometriosis. Talk with your doctor, get a second opinion if you feel the need, and make an informed choice. You owe it to yourself to get some treatment for your chronic pelvic pain, so do not hesitate to address this issue.