Published: April 01, 2009 07:56 am      

Painful condition affects about 5 million women

DEAR DR. MONA: This is pretty embarrassing but around the time of my period I have a burning sensation and need to go to the bathroom all the time. I have had this evaluated and all the urine tests were negative and I was told there was no bladder inflammation syndrome. I often have pain with intercourse as well. To make matters worse, we’ve been trying for three years for a pregnancy. Is this all connected? — Elena

DEAR ELENA: Your symptoms sound typical of endometriosis. This is a painful condition that affects about 5 million women between the ages of 25-44. Occasionally even teenagers suffer from endometriosis.

With endometriosis, the lining inside the uterine cavity spreads outside to the abdominal cavity and attaches to the bowels, bladder, the uterine surface, and the lining of the pelvic cavity. This lining can also attach to the ovaries, the fallopian tubes, and the ligaments that support the uterus. It also could spread to the vagina, the cervix and the vulva, as well as attach to scars from abdominal surgery.

This in itself would not be a big deal; however once this tissue spreads out, it reacts to hormones as if it were still in the uterus. So, unlike the menstrual blood that leaves the body through the vagina, these tissues have no way of leaving the body. This leads to internal bleeding, breakdown of the blood and tissue from the lesions, and inflammation causing pain, infertility, scar tissue formation, adhesions and bowel problems.

Women with endometriosis may complain of painful periods, pain with sex, chronic fatigue, painful urination or bowel movements during their menstrual periods, and difficulty becoming pregnant (25 to 50 percent of infertile women have endometriosis). Some women may have allergies, frequent yeast infections, and lowered immunity to infection.

Why this happens is not entirely clear. There are numerous theories in an effort to explain why some people develop endometriosis and others do not. Some believe it is backflow of excessive menstrual blood during the period into the fallopian tubes and implanting in the abdomen. Others believe that genetic and hereditary factors may play a role, since endometriosis runs in families.

A newer and interesting possibility is the exposure to toxic agents in the environment, such as dioxin, a chemical byproduct of pesticide manufacturing, bleached pulp and paper products, and medical and municipal waste incineration. Recent research by the Endometriosis Association showed that 79 percent of animals exposed to dioxin developed endometriosis, and that the higher the level of exposure, the more severe the symptoms.

As I said, this sounds like endometriosis, but a certain diagnosis can’t be made without laparoscopy, a surgical procedure done under anesthesia to look inside the abdominal cavity and identify the location, size, and extent of the growths of the lesions. This helps the doctor and patient make better treatment choices.

Treatment is individualized, based on the patient’s age, severity of symptoms and reproductive wishes. Suppressive medical therapy or conservative surgery does not effectively cure endometriosis and recurrence of the disease is likely.

The only certain way to prevent the recurrence of endometriosis is to stop ovarian function. So, if the diagnosis is truly endometriosis, we can provide symptomatic relief, medications to suppress further growth of the endometrial tissue, ovulation blocking agents, and gonadotropin-releasing hormone (GnRH) agonists, laser or other ablative surgery to remove the endometrial implants or growths and hysterectomy. Leaving the ovaries may lead to recurrence since the cyclical hormones could theoretically stimulate microscopic endometriosis that is not seen by the microscope and the condition could continue.

So, Elena, my advice is to visit your gynecologist and ask her/him to consider this diagnosis, and to work with you on a treatment plan. Good luck.



Dr. Mona Alqulali is a board certified OB-GYN.