What Exactly Is Endometriosis? Here's What an Ob-Gyn Wants Every Woman to Know

In recent years, Julianne Hough, Jillian Michaels, Lena Dunham, Whoopi Goldberg, and other stars have shared their experiences with the chronic and often painful disease endometriosis.

According to the United States Department of Health and Human Services, the condition may affect more than 11% of women between ages 15 and 44. Still, many women are confused or embarrassed about their symptoms or feel ashamed of their diagnosis, says Mamie McLean, MD, assistant professor of obstetrics and gynecology at the University of Alabama Birmingham.

Here’s what Dr. McLean wants every woman to know about this debilitating—but often very treatable—condition.

It starts when tissue grows in the wrong place

Endometriosis occurs when the endometrium—the tissue that lines the inside of a woman’s uterus—begins to grow in places it shouldn’t: the ovaries, fallopian tubes, and the lining of the pelvis, for example. (In rare cases, it can grow in other organs throughout the body, as well.)

But endometrial tissue doesn’t function like tissue in the rest of the body. Because it’s involved in menstruation, it thickens, breaks down, and bleeds once a month or so. And that continues to happen, no matter where the tissue is in the body.

In the uterus, broken down endometrial tissue leaves the body each month during a woman’s period. In other parts of the body, it becomes trapped and can irritate surrounding tissues and organs.

It can be extremely painful—or completely painless

When this happens, cysts (called endometriomas) and scar tissue can form. For many women, this can cause severe pain—during their periods, during sex, or during bowel movements or urination. They might also experience symptoms such as heavy bleeding, fatigue, diarrhea, constipation, bloating, or nausea during their periods.

But the disease is different for everyone, says Dr. McClean, and scientists’ understanding of how it affects pain sensation is still poorly understood.

“We’ll see patients who have very advanced disease and lots of scar tissue, and they had no idea they had this condition,” she says. “Either they’ve had no pain, or they figured it was normal and learned to live with it. For others, they’ll have very minimal disease and very severe pain.”

It's a common cause of infertility

Scarring and tissue growth in the ovaries can make it difficult for a woman to get pregnant. “The normal process by which the sperm travels up the fallopian tube to meet the egg simply can’t happen, because there’s too much structural distortion,” says Dr. McClean.

Even if the sperm is able to get through, she adds, underlying inflammation can sometimes lead to poor implantation or poor egg quality.

She does note, however, that not everyone with endometriosis has trouble conceiving—so if a woman is not trying to get pregnant, she should always use protection even if she does have the disease.

It may be caused by "retrograde menstruation"

Doctors don’t know exactly what causes endometriosis, or why certain women are affected. In many cases, doctors think it has something to do with “retrograde menstruation,” when blood containing endometrial cells flows backward into the abdominal cavity rather than out of the body.

“Most women are able to absorb that tissue,” says Dr. McClean. “But in some women, due to immune circumstances or genetic circumstances that we don’t really understand yet, that tissue can implant inside the abdomen and lead to many of these symptoms.”

In any case, endometriosis is not caused by anything a woman did or could have prevented. “That’s what feels so frustrating about this condition,” says Dr. McClean. “When I tell a woman that her ability to conceive will be very challenging and there’s nothing she could have done differently, it really feels like an unfair situation you’re simply just born into.”

Treatments do work for many women

Endometriosis is a chronic condition, and there is no absolute cure, says Dr. McClean. But for many women, treatments can relieve pain and discomfort, improve fertility, and help them live normal lives.

Depending on the severity of endometriosis and its symptoms, treatments can vary from pain medications and hormonal therapies (like birth control pills) to surgery. Women who want to get pregnant may also need to use assistive reproductive technology, such as in vitro fertilization.

Surgery for endometriosis can range from laparoscopic “keyhole” procedures, in which endometrial tissue is cut away or burned with a laser, to a full hysterectomy. For many women, surgery will greatly reduce pain and symptoms. But for about 20% of patients, endometriosis will come back.

Unfortunately, says Dr. McClean, some women do require multiple surgeries—and each subsequent surgery is less likely to solve the problem. “It’s often the first surgery that gives the best relief,” she says.

“Each additional surgery tends to increase your risk of complications and decrease the reward in terms of reduction in pain,” she adds. Complications, especially for women who have had repeat procedures, can include bowel injury, pelvic infection, or damage to blood vessels or nerves.

Other therapies can help too

Therapies today are able to attack endometriosis from hormonal, musculoskeletal, and neurological standpoints, says Dr. McClean, and an experienced physician can help women find the combination of treatments that best addresses their symptoms and needs. This could include medication, surgery, and even pelvic physical therapy.

Dr. McClean recommends that any woman who’s struggling with pelvic pain that’s bad enough to limit their daily activities seek an evaluation from her doctor.

“Women take it very personally when they have a condition or disease that causes this kind of pain or may limit their ability to have children,” she says. “But I think with National Infertility Awareness Week and the availability of support groups—and with celebrities like Lena Dunham speaking publicly about their experiences—more women are now talking about it and getting the help they need."

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

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What Is Bowel Endometriosis? Symptoms and Treatments for the Condition

Heather Guidone was in her early teens when her symptoms first started. She felt sick to her stomach all the time. Excruciating cramps left her bent over with pain, even when she wasn't on her period. She was frequently nauseous, bloated, and had urgent diarrhea. Sometimes, the pain was so severe that she couldn't get out of bed. "It literally, with no exaggeration, ruled my life," she tells Health.

Although she wouldn't know it for several years, Guidone was suffering from bowel endometriosis.

Endometriosis in general is a relatively common condition. It affects between 10 to 12% of people born with a uterus once they reach reproductive age, according to a paper in the International Journal of Women's Health. Bowel endometriosis—a manifestation of endometriosis that occurs on or around the bowels, is less common, affecting anywhere between five and 12 percent of people who have the disease.

What is bowel endometriosis?

To understand how bowel endometriosis happens, you first have to understand how organs fit together in a human pelvis, Murray Orbuch, MD, assistant professor of gastroenterology at Mount Sinai, tells Health. All of the organs in the pelvic cavity — the bladder, the colon, the rectum, and reproductive organs like the uterus, fallopian tubes, and ovaries — are very tightly packed in.

When someone has endometriosis tissue very similar to the tissue that normally lines the inside of their uterus grows outside the uterus. Most of the time, that endometrial-like tissue starts growing around the ovaries, the Fallopian tubes, and the tissue that lines the pelvis. And it acts just like endometrial tissue is supposed to — it swells, breaks down, and bleeds roughly every 28 days. But because the tissue has nowhere to go, it gets trapped inside the body and causes scar tissue and adhesions.

Bowel endometriosis happens when the endometrial-like tissue grows deeper into the pelvic cavity and forms adhesions on or around the bowel. It's very unlikely that the tissue will grow on the bowel alone, however, so bowel endometriosis is considered "deeply infiltrative endometriosis," Ken Sinervo, MD, Medical Director of the Center for Endometriosis Care. This means that the invading tissue grows not only on reproductive organs, but also on other organs in the pelvic cavity.

When tissue grows on the bowel, the adhesions act a bit like glue and "can tether bits of intestine to itself or other organs and cause a mess," Dr. Orbuch says.

What are the symptoms of bowel endometriosis?

The symptoms Guidone experienced are pretty typical of bowel endometriosis. The most common symptoms, Dr. Sinervo says, are: bloating (aka " endo belly"), abdominal cramping and pain, constipation, diarrhea, painful bowel movements, and nausea and/or vomiting. Some patients also complain of rectal bleeding.

These symptoms can sound a lot like gastrointestinal disorders like irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or even appendicitis, which is one reason bowel endometriosis often takes a long time to diagnose. "But when we see them accompanied by pelvic pain, painful periods, backache, infertility, painful intercourse, ovulation pain, or leg pain, it's much more likely that the symptoms are the result of endometriosis and not a GI disorder," Dr. Sinervo says.

How is bowel endometriosis diagnosed?

Bowel endometriosis is "tricky to diagnose and tricky to treat," Dr. Orbuch says. Guidone considers herself "lucky" that it took only a few years and a few doctors to get an endometriosis diagnosis in the 1980s. She was living with near-constant pain for all of her teenage years, and had no reason why, but still she's one of the lucky ones.

Even now, she would be considered lucky. Many people with bowel endometriosis wait an average of seven to eight years and go from doctor to doctor, sometimes seeing four to five gynecologists before getting a diagnosis, Dr. Orbuch says.

The struggle to get a diagnosis is, again, partially because symptoms can look like several GI conditions, but also because the medical community is still learning about endometriosis as a disease. Although knowledge is creeping up, Dr. Orbuch says it needs to "creep faster" since living with bowel endometriosis "can wreck someone's life."

"There needs to be better recognition among gynecologists, gastroenterologists, and even pediatricians," he says. "You can't call it IBS and forget it." Red flags should go up if the bowel symptoms seem to get worse on a cyclical pattern corresponding to the patient's period or if the patient is struggling to get pregnant. "I've had more than a few women in their 30s come in with GI symptoms and also infertility and no one ever recognized that they had endometriosis," Dr. Orbuch says.

Once those red flags go off and endometriosis is added to the list of possibilities, doctors might try to get a peek inside your body with imaging technology like an MRI or a transvaginal sonography — a procedure during which an ultrasound probe is placed inside the vagina to take images of reproductive organs from within. However, your doctor might skip the imaging and suggest an exploratory surgery instead. Laparoscopic surgery with a biopsy for confirmation is considered the "gold standard" in diagnosing endometriosis, Dr. Sinervo says. It's a faster, more accurate diagnosis and tells the doctor exactly how much scar tissue and endometrial-like tissue they're dealing with.

Guidone was diagnosed with "old school" laparotomy surgery in the 1980s, but the procedure is less invasive now. During a laparoscopy, "the surgeon will create small incisions around the belly button and put a camera in to visualize the abdominal cavity," Dr. Orbuch says.

How is bowel endometriosis treated and managed?

Sometimes, bowel endometriosis can be controlled with birth control, Dr. Orbuch says. Hormonal birth control like the pill or IUDs override your brain's signal to release the hormones that trigger a period. So doctors might suggest a hormonal birth control option to tamp down your endometriosis symptoms (if your endometrial lining doesn't build, then it doesn't swell, shed, and bleed). Doctors may tell endometriosis patients on the pill to skip the placebo week in order to not trigger hormones.

Much of the time, especially for people whose endometriosis greatly impacts their lives, doctors will suggest surgery. A laparoscopic surgery, similar to the one used to diagnose endometriosis, is used to cut out the invasive tissue and the scar tissue it creates. "The serosal, or outer layer of the bowel, can often be 'peeled off' leaving the muscularis or muscular portion of the bowel undamaged," Dr. Sinervo says.

While words like "peeled off" may sound scary, the surgery can virtually erase endometriosis symptoms or make them much easier to manage. "My excision surgery changed my life," Guidone says. "I'm not in perfect health and will never be; but I'm free of endometriosis symptoms and the remaining issues I have are wholly manageable."

Some ways people manage endometriosis symptoms are with SSRIs — a class of antidepressants that can actually alter your pain threshold — and pelvic floor therapy, Dr. Orbuch says.

Now, Guidone works as the surgical program director at Dr. Sinervo's office to help others recognize and get treatment for their endometriosis, and she's particularly qualified to spread the word about bowel endometriosis. She says, "No one should be missing work, afraid to leave their home, not being able to be out with their family or friends, have their careers or school goals derailed, have to validate their pain and symptoms to others who don't understand or appreciate them, and feel utterly hopeless because of a disease that is actually treatable."

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

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https://gseasyrecipes.blogspot.com. feel free to view for easy, simple and healthy recipes    
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When I Told My Doctor I Thought I Had Endometriosis, He Said, 'Stop Practicing Google Medicine'

I always considered myself to be in relatively good health. I had annual checkups, maintained a healthy diet, and tried to exercise. Overall, I was happy to be completely average. True, I had very heavy and lengthy periods, along with bad cramps. But so did my mom. So does my daughter. I thought that’s just how it is.

Then in 2011, after two previously healthy pregnancies, I suffered a miscarriage when I was four months pregnant. Soon after, I started having severe back and leg pain. At first, I blamed it on getting older or the fact that, as a lawyer, I sat so much during the day. When the pain didn’t go away, it seemed likely that it was due to sciatica or a pinched nerve. After a normal pelvic exam and ultrasound, my ob-gyn agreed. So did the chiropractor I consulted.

Mysterious, worsening pain

But despite physical therapy appointments and Pilates classes, the pain never completely cleared up. Not until 2014 did I realize that it worsened during and after my period. I also began suffering from other symptoms like frequent urinary tract infections, constipation, and high blood pressure. Even sex became painful. I felt so confused. If nothing unusual was showing up on my exams and tests, then what was causing my pain?

My ob-gyn suggested that I consult doctors who specialized in uterine issues, but I didn’t do so right away. I couldn't imagine that anything I had could be that bad. Plus, by this point, I’d learned to live with the two weeks on, two weeks off pain. (It required carefully timed Ibuprofen, which dulled the pain so I could function but didn't eliminate it.) It was hard to take time off from my demanding job—not to mention find a good specialist who not only took my insurance but was accepting new patients. I waited 14 months to see a specialist. In hindsight, that was a big mistake.

"Stop practicing Google medicine"

In 2015, while researching my symptoms online, I came across endometriosis, a disorder in which uterine tissue grows outside the uterus. It seemed like a possible cause of my symptoms, yet neither of the two specialists I saw that year mentioned it. When I did, I felt like I was irritating them. In fact, one of the doctors told me to “stop practicing Google medicine.”

Although both said they could treat my symptoms with various medications, they blamed the 20 or so extra pounds I was carrying at the time as the cause. I did try going on birth control pills, which they had suggested. But I had to stop because it made me throw up all the time and gave me bad headaches.

I remember walking out of the second specialist’s office on a hot August day. I had to walk several blocks to the train station, and as I walked, I tried to process my frustration. I decided I’d had it with these so-called “specialists.” No more appointments with doctors who didn’t listen to me. I’d simply deal with my two weeks on, two weeks off pain cycle until menopause.

But the pain kept getting worse. In 2017 my ob-gyn, knowing how exasperated I was, suggested I have another ultrasound. I have a habit of looking at techs’ faces when I get tests. They’re not allowed to say anything, but don’t have the best poker faces. As the tech prodded my left side, I saw her whole face drop. I found out later that she couldn’t find my left ovary.

An abdominal ultrasound was ordered, as well as a CT scan. The results showed that I had a condition called hydronephrosis [kidney swelling, caused by a backup of urine.] It was so severe that my kidney had stopped working. I was astonished. Upset. Scared. And I was at a loss about what to do, since doctors didn’t know the cause.

I went back to Google for answers. This time, I found an obscure blog, where a woman described how her kidney had been impacted by endometriosis. I knew I had to have the condition, too. I began searching for an endometriosis specialist near me.

The right diagnosis—and extensive treatment

Three months later, I met with Tamer Seckin, MD, a New York-based gynecologist laparoscopic surgeon. He'd already taken the time to read all my medical files—and he was horrified that no one spotted what he said were classic endometriosis symptoms, such as back pain and pain during sex.

Besides endometriosis, I had adenomyosis (similar to endo, it's when the uterine lining grows into the muscle of the uterus). Dr. Seckin also diagnosed me with a frozen pelvis, a severe complication of endometriosis that caused my pelvic organs to adhere to my bones. In addition to excision surgery [in which abnormal growths and scar tissue are destroyed], my uterus, both my ovaries, and fallopian tubes would all need to be removed.

The surgery took nine hours; it involved not just Dr. Seckin but also a urologist and colorectal specialist. During the procedure, they discovered that my kidney was infected and swollen to four times its normal size. They had no choice but to take it out as well.

No one feels great after this type of surgery, but truthfully, I was happy. The pain was gone. I vividly remember sitting in the waiting room before the operation, signing paperwork, and being unable to put weight on my left side because of the intense pain shooting down my leg. After the surgery, I was achy and groggy, but the pain on the left side of my body had disappeared.

Recovery was not easy—I was home on disability leave for three months—but the mental peace I finally had was worth it.

Putting dismissive doctors on notice

I agreed to open up about my story because I want other women to not wait for years to get diagnosed. Listen to your body. Believe your symptoms. Do your research and come to your doctors prepared.

We need to put medical professionals on notice that they cannot continue to ignore millions of women who have endometriosis. I want insurance companies to hear this, too, and start covering excision surgeries, which are currently out of pocket and very expensive. I don't want anyone else to lose major organs to endo.

Looking back, I didn’t live—I survived between pain cycles—for seven years. Now, I feel I have a life again.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

https://gscrochetdesigns.blogspot.com. one can see my crochet creations  
https://gseasyrecipes.blogspot.com. feel free to view for easy, simple and healthy recipes    
https://kneereplacement-stickclub.blogspot.com. for info on knee replacement