Painful Menstrual Cycles

Painful Menstrual Cycles

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QUESTION: I am 32 years of age and have had extremely painful menstrual
cycles for almost my entire life. I always thought this was normal for me,
but recently my physician advised me that the "tissue" from inside of my
uterus was "out of place." He now wishes to prescribe hormones to treat my
situation and I am confused. Can you explain this disease to me and tell me
what treatments can help?
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ANSWER: The description of your symptoms and the comments of your physician
clearly indicate that you are suffering from endometriosis. The name of this
disease comes from the term endometrium, the medical term for the tissue that
lines the uterus. Each month, when the uterus sheds this tissue, a woman
experiences her menstrual cycle. In endometriosis, the tissue normally
located inside of the uterus is found elsewhere in the body in abnormal
locations such as the ovaries, the lower abdomen, or in the wall of the uterus
itself. This is a common disease and can affect women of all races and of all
ages, although it is seen most frequently in women between the ages of 30 and
40. It is the most common cause of infertility in women over the ages of 25
and almost 15% of all patients who are infertile have endometriosis.
Women who suffer from this disease complain of severe menstrual cramps,
heavy and irregular bleeding, and often experience pain during or after sexual
activity.
The abnormally located tissue follows the same pattern of monthly build
up similar to the normal tissue lining the uterus, but unlike that lining has
no way of exiting the body. This leads to internal bleeding, inflammation,
and the development of fibrotic adhesions and scars. All of these
complications lead to the pain you have experienced. Although the diagnosis
can be suspected by the history you have related, there are really no specific
signs or symptoms that permit the physician to make an accurate diagnosis.
This can only be accomplished through the use of a laparoscope, which is a
long, thin tube equipped with a telescopic lens system, and has its own source
of illumination in the tube. With a patient under anesthesia, a small
incision is made just below the navel and the laparoscope is inserted. This
permits the physician to see all the organs in the abdomen and various
structures such as the fallopian tubes, ovaries, female organs, liver and
gallbladder. The physician is able to determine accurately the extent and
location of the various locations of endometrial tissue which form the basis
for your difficulty.
There are several types of treatment that can help you, frequently
requiring a combination of medical and surgical techniques. Hormonal
treatment is usually attempted first and frequently controls the disease
rather effectively. Hormonal treatments may include the use of female
hormones (estrogen and progesterone) similar to the kinds and quantities
contained in birth control pills. Other hormones which are derived from
testosterone, the male hormone (danazol and cyclomen) are also widely used as
treatments.
It's interesting to note that pregnancy may stop the progress of the
disease, and so if you wish a child, this may be the treatment of choice.
Carefully follow the instructions of your physician and proceed in a step
by step fashion so that you may ultimately control this disease with a minimum
of complications or surgery.