Endometriosis

Primary endometriosis is the migration and transplantation of endometrial tissue from inside the uterus into the pelvis.

Between menstrual cycles, the inside lining of the uterus, the endometrium, proliferates and continues to thicken until it sheds during menstruation. Sometimes endometrial tissue migrates through the fallopian tubes and into the pelvis, forming implants that bleed during menstruation. Endometriosis may, but does not always, cause pain.

Secondary endometriosis is also called iatrogenic (doctor made) endometriosis, because it is caused by medical treatment. It is usually caused by cutting into the uterus during uterine surgery.

During a Cesarean Section (C-section) an incision is made in the abdomen and into the uterus, and the baby is lifted out through the abdomen. This may cause endometrial tissue to become dislodged from the endometrium and then transplanted outside of the uterus, in the pelvis. This increases the incidence of endometriosis in women who have undergone a C-Section over women who have given birth vaginally. Endometrial tissue from a C-Section may also grow in the scar tissue that forms in and around the abdominal incision, which can be very painful when the transplanted endometrial tissue bleeds during menstruation.

The first symptoms of primary endometriosis usually begin at menarche, when menstruation first begins, and usually worsen with each menstrual period. By the time a girl who has endometriosis is in her early to middle teens, she may have such severe menstrual pain, nausea, and vomiting that she is unable to get out of bed. These symptoms occur during menstruation, not between menstrual cycles.

Women generally do not develop primary endometriosis later in life. Endometriosis that develops later in life is usually iatrogenic, caused by uterine surgery.

Laparoscopy is not a reliable way to diagnose endometriosis, and it is a major operation with multiple risks. A gynecologist pushes a trocar (a cylinder with a razor sharp end) into the navel, the belly button, and may make two or more small incisions in the pelvis for additional trocars and instruments to be inserted into the pelvis. Next, the abdomen and pelvis are filled with gas/air to expand and tent the pelvis. A long scope called a laparoscope is inserted through the trocar to allow the doctor to see inside the pelvis. There is a risk of complications from anesthesia, perforation of the bladder and bowel, and stress on all of the internal organs, including the heart, as a result of the pressure created by inflating the abdomen.

The only objective and non-invasive way of diagnosing endometriosis is with an MRI (magnetic resonance imaging) of the pelvis. Operating rooms are dangerous places, and you can obtain a diagnosis with a non-invasive MRI of the pelvis. The objective evaluation and report from the radiologist who evaluates the MRI will demonstrate if you have endometriosis without the dangers of unnecessary laparoscopic surgery.

Endometriosis does not always cause symptoms. Sometimes it is found incidentally during surgery that is performed for an unrelated reason. If endometriosis does not cause severe symptoms, there is no reason to pursue treatment.

Symptoms of endometriosis are similar to symptoms of Irritable Bowel Syndrome, which should be diagnosed by a gastroenterologist, not a gynecologist. Endometriosis is one of the most frequently misdiagnosed conditions, so it is important to have an MRI of the pelvis to determine and confirm the diagnosis.

When women tell gynecologists they have severe menstrual cramps they are often told they probably have endometriosis and are offered drugs such as Danazol, Lupron, or a birth control pill to stop menstruation. If the pain does not go away or returns with the next menstrual cycle, gynecologists usually suggest laparoscopy.

It is common after a diagnostic laparoscopy for doctors to tell women they have severe Stage IV endometriosis. Many women have several laparoscopies to scrape or burn away what they had been told were endometrial implants. Every surgery causes scar tissue that may lead to adhesions (tissue that becomes stuck together). For example, the bladder or bowel may adhere to the uterus and cause severe pain when turning, bending, lifting, or any motion that pulls on the scar tissue that is stuck to other organs. This increased pain caused by scar tissue and adhesions often culminates in a hysterectomy (removal of the uterus) and oophorectomy (removal of the ovaries, castration).

After hysterectomy and oophorectomy, many women are told they had severe Stage IV endometriosis. It is often described as the worst the gynecologist has ever seen, so they are grateful their problem was solved.

Sometimes it is not until they go to another doctor searching for solutions to the new problems that have developed after hysterectomy and castration that someone reviews their medical records and asks them why they underwent a hysterectomy. Included with your medical records sent to the new doctor is a Pathology Report from the hysterectomy and removal of your ovaries. It is common for women to discover that no endometriosis was reported in the amputated uterus or ovaries. The organs were normal. There was no endometriosis.

Although hysterectomy may stop endometriosis from growing in women who do not take hormones for at least a year after surgery, the most consistent problems women report after hysterectomy include a 25-pound average weight gain in the first year following the surgery, loss of sexual feeling, loss of vitality, joint pain, back pain, bowel problems, profound fatigue, and personality change.

Acupuncture and exercise can be helpful in managing symptoms, without the risks of drugs or surgery. The most effective, permanent cure is naturally occurring menopause.

With the exception of acupuncture, even the most conservative treatment options may cause serious side effects. None of the conservative treatments such as drugs like Lupron and Danazol are safe for any amount of time. And the longer they are taken, the greater the risk. The treatment of pain associated with endometriosis is often ineffective, short term, and causes a host of undesirable and often severe side effects.

The uterus and ovaries have many important lifelong functions. The ovaries are the female gonads. Removal of the ovaries is castration. Hysterectomy with or without oophorectomy causes numerous well-documented, permanent, irreversible, and life-altering problems.

For more information, watch the short video “Female Anatomy: the Functions of the Female Organs.”