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Endometriosis

ENDOMETRIOSIS


What is endometriosis?
Endometriosis is a chronic, progressive disease found in women of menstruating age. It occurs in up to 10% of these women and its incidence has markedly increased in the last several decades. The disease may result from the flow of menstrual blood up through the women_suit.jpgFallopian tubes and into the lower abdomen and pelvis. This menstrual blood contains small amounts of the endometrial (inner) lining of the uterus and, in some women, the tissue implants into areas near the uterus, ovaries, bowels, bladder and connective tissue. Even though the endometriosis tissue is outside the uterus, it acts in the same fashion as normal endometrial tissue. During the first part of the menstrual cycle, the cells involved in endometriosis grow and multiply. During menstruation, the endometriosis tissue bleeds, resulting in inflammation of the pelvic area and considerable pain. This can lead to scarring and adhesions in those areas. 

What are the Symptoms of Endometriosis?
Chronic pelvic pain or pains in the back or legs are the most common symptoms, although some women may have no symptoms at all. There can also be extreme menstrual cramps, heavy vaginal bleeding, pain with urination or bowel movements, pain with sexual activity and, in many cases, infertility. In some cases, a woman can develop larger dark brown cysts in the pelvis that contain old blood that has built up over time. Scar tissue is not uncommon. If a woman has endometriosis on her ovaries, she may experience pain at the time of ovulation. Rectal bleeding occurs if she has deep lesions in the lower bowel. Because endometriosis cells make estrogen, a woman with endometriosis is almost always estrogen dominant. Because of this, the menstrual cycle is often irregular, with spotting before the period and symptoms consistent with PMS. In severe cases of heavy bleeding, anemia can result. 

piggy_back.jpgWhat causes endometriosis? 
The cause of endometriosis is basically unknown. Most researchers believe that the origin of endometriosis is what’s known as “retrograde menstruation” or the flow of blood backward from inside the uterus through the Fallopian tubes. Unfortunately, this occurs to a small degree every time a woman menstruates. What isn’t known is why some women get endometriosis and others don’t. The various theories include a defective immune system and the presence of excess estrogen that promotes the growth of endometriosis cells. The endometriosis cells make their own estrogen which creates a state of even greater estrogen dominance. The presence of xenohormones (hormones from outside the body) significantly contributes to the likelihood that a woman will develop endometriosis.

Traditional Medical Approach: NSAIDs (such as ibuprofen or naproxen sodium) are commonly prescribed to help relieve pelvic pain and menstrual cramping. Gonadotropin-releasing hormone analogs (GnRH analogs) have been effectively used to relieve pain and reduce the size of 
endometriosis implants. 

These drugs suppress estrogen production by the ovaries by inhibiting the secretion of regulatory hormones from the pituitary gland. As a result, menstrual periods stop, mimicking menopause. Nasal and injection forms of  GnRH agonists are available. The side effects are a result of the lack of estrogen, and include hot flashes, vaginal dryness, irregular vaginal bleeding, mood changes, fatigue, and loss of bone density (osteoporosis). 


Oral contraceptive pills (estrogen and progesterone in combination) are also sometimes used to treat endometriosis.  At times surgery may need to be performed if the bowels or other organs are wrapped up with endometrial tissue or adhesions. 


Some physicians may recommend a hysterectomy and then get your permission to take your ovaries out which is a complete  hysterectomy. The ovaries are important for producing hormones and should be left in. This is usually an elective surgery so do not elect if you do not have to. See hysterectomy topic for more information. 

Functional Medicine Approach: Since women are usually estrogen dominant it may be wise to get a baseline of your female hormones. Even if surgery is necessary or has been performed, if you are still having symptoms, you need to determine whether you have a hormonal imbalance. I recommend baseline hormonal testing. 

Recommended Testing

Post Menopausal Hormone Panel (non-cycling females)

Expanded Female Hormone Panel (cycling females)--

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