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Endometriosis is a very common cause of pelvic pain. The pain is usually cyclic, as apposed to chronic. Cyclic pain occurs in conjunction with a woman's menstrual cycle, usually 1-2 weeks before and during her period. Chronic pain occurs all the time.
The condition occurs when endometrial cells (the cells lining the inside of the uterus), develop outside their normal location. Endometrial cells respond the hormone changes that occur with each cycle. They grow under the influence of estrogen in the first half of the menstrual cycle, and are maintained by progesterone during the second half of the menstrual cycle. If conception does not occur, the level of progesterone decreases and the endometial cells lining the uterus shed, leading to a period.
The misplaced endometrial cells respond to the menstrual cycle in the same way as those lining the uterus. Instead of flowing out of the body through the vagina, the blood shed by the misplaced cells has no way out of the body. The resulting internal bleeding can lead to chronic inflammation and the formation of adhesions and scar tissue.
Areas commonly affected by endometriosis include the ovaries, fallopian tubes, ligaments that support the uterus, the areas between the vagina and rectum, the outer surface of the uterus and the lining of the pelvic cavity.
Interestingly, some women with endometriosis experience no symptoms. It is not uncommon to perform an exploration of the pelvic cavity for an unrelated reason, and realize there is extensive endometriosis implants and adhesions for which the patient had no symptoms. Converesly, some women experience excrutiating pain, and upon laparoscopic exam, are found to have only a few, minute endometrial implants.
Endometriosis can lead to other conditions such as infertility, adhesions, scar tissue that entrap the reproductive organs. Endometriomas (chocolate cysts) are not uncommon. These are ovarian cysts which become affected by endometrial implands, the implants cause bleeding into the cyst, which fills with blood. As the blood ages, it becomes dark and brown (hence the term 'chocolate cyst'). These cysts can be very painful and often removal of only the cyst (cystectomy) is not possible, necessating the removal of the entire ovary (oopherectomy).
Symptoms other than pain are common. These symptoms occur, as does endometriosis pain, in conjunction with a woman's menstrual cycle. Other Cyclic Symptoms include:
- Heavy Periods
- Painful Intercourse
- Ovulation Pain
- PMS
- Mood Alterations and Atypical Behavior / Attitude Swings
- Premenstrual Spotting (spotting before the period)
- Nausea
- Painful Urination/ Frequent urination
- Painful Bowel Movements.
- Low back Pain
- Constipation
- Diarrhea
Depression, Fatigue and Poor Self-Esteem are chronic problems that may results from having to deal with this sometimes debilitating disease.
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CAUSES OF ENDOMETRIOSIS:
The exact cause of endometriosis is unknown. Several theories consider the possibility of:
Retrograde menstruation
- Instead of flowing out, some menstrual cells flow back through the fallopian tubes and into the pelvis.
Environmental
- There may be a link between exposure to chemicals or allergins and endometriosis. There is, however, no conclusive evidence.
Immunological
- This theory proposes that there exists an abnormality in the immune system which allows the endometrial cells that are shed normally to attach and grow elsewhewe. Immunologic changes observed in women with endometriosis can be responsible for their condition, or is the result of the inflammation caused by the disease.
Genetic
- due to the observation that endometriosis tends to run in families. Women with an affected mother or sister are more likely to have severe endometriosis than those without affected relatives.
TREATMENT
Traditionally endometriosis may be treated medically (with drugs) and/or surgically. The goal is to relieve symptoms and eliminate or reduce implants/adhesions.
These traditional treatment options include:
- Pain Medication
- Synthetic Hormone Therapy: Birth control pills, GnRH agonists (Lupron), Cyclic Progestins
- Laparoscopic Ablation: To remove the endometrial implants
- Laparoscopic Excision: Removing areas affected by endometriosis such as Endometriomas, and adhesion tissue.
- Uteral Sacral Nerve Ablation: The nerves innervating the uterus are cut in an attempt to eliminate pain.
- Presacral Neurectomy: Some of the nerves innervating the pelvis are severed.
- Hysterectomy: The removal the the Uterus, with or without the ovaries, and all of the endometrial growths. Hysterectomy does not always eliminate endometriosis because the lesions may not be confined only the the reproductive organs.
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Bioidentical Hormone Restoration Therepy (BHRT), is effective in the management of endometriosis. For example, when a woman with endomtriosis is pregnant, her symptoms disappear. This suggests that the sex hormones produced in pregnancy play an important part in controlling this disease. For BHRT treatment, we will test your hormone levels at critical points during your cycle. Based on your levels, which will reveal where the hormone excesses and deficiencies are, a hormone regimen will be taylored for you.
BHRT is always performed in conjunction with lifestyle choice adjustments. Many risk factors have been identified women with moderate-severe endometriosis. Risk factor reduction is therefore paramount in the management of disease. These lifestyle choice adjustments include.
- Adopting a regimen of Regular aerobic Exercise
- Avoid foods high in chemical estrogens
- Eat regularly, don't skip meals
- Avoid caffeine
- Include high fiber in your nutrition plan. This helps eliminate toxins/high hormone levels through the bowel. Low fiber diets allow these excess toxins and hormones to be reabsorbed into the body.
- Address fatigue and exhaustion
- Adopt stress management techniques
- Keep a positive attitude
- Drink at least 8 glasses of water / day.
- Rest, rest, rest
- Relax, relax, relax
There has been great success with the use of BHRT in the treatment of endometriosis. One will notice diminishing symptoms over several months and reduction of the regimen can occur after 6-12 months. Women are then mainitained on a lower dose. When endometriosis is diagnosed early in the teenage years, early treatment with BHRT had been found in many to make the symptoms disappear. Many young women eventually no longer require BHRT treatment. In women when endometriosis had been diagnosed late, or when treatment is initiated later in life, we are able to naturally and safely manage the debilitating symptoms, but we usually must maintain them on BHRT long term. Most women are pleased with this option as it is safe, effective, and balances other Hormone Imbalances that affected other aspects of their lives.
Hormone Imbalance includes much more than Endometriosis . Other symptoms include:
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