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Tuesday, January 22, 2013

Endometriosis 101: A Primer

Endometriosis is a condition in which the tissue that normally lines the inside of the uterus (endometrium) is found outside the uterus. This condition, which affects up to 10% of reproductive-age women, is described in detail on MedFriendly.com, which you can access by clicking the previous link. An updated review on endometriosis was recently published in the journal, American Family Physician. In the review, the authors noted that endometriosis occurs in 25 to 40% of women with pelvic pain and 70 to 90% of women who are infertile (not able to reproduce).

While some women with endometriosis do not have symptoms, it can be associated with symptoms such as severe pelvic pain, painful menstruation, and pain during intercourse. While patients with endometriosis may initially present to their family practitioner, a referral to a gynecologist typically occurs, especially if the woman remains infertile and has persisting symptoms.

Diagnosis of endometriosis is based on a medical doctor evaluating the patient’s signs and symptoms and can be aided by a biopsy, in which a tissue sample is removed and analyzed under a microscope.

Initial treatment often included medications to reduce inflammation. Birth control medications are also used that effect levels of progestins and/or estrogen levels. These are both types of hormones. Estrogen is believed to promote endometriosis, which is why use of medications that lower estrogen levels can be used to manage the condition. Progestins thin the uterine lining and suppress the natural cycle of the ovary, the latter of which interferes with the menstrual cycle. The authors of the review article noted that there is some evidence that these medications can be helpful and have few side effects.

There are other treatments for endometriosis such as gonadotropin-releasing hormone agonists (GnRH). These medications produce a massive increase in GnRH which overwhelms the body and causes the ovaries it to shut down estrogen production. Another treatment is Danazol, which also reduces estrogen levels and shuts down the estrogen cycle. Surgery is another option, which involves removal of the endometrial tissue. The authors of the review noted that these interventions may control symptoms better than initial treatments but that they can have significant side effects and limits on how long the therapy can last.

For more detailed information on endometriosis discussed in this blog entry, please see the MedFriendly entry on endometrosis and/or the article below. Also, feel free to leave your comments regarding personal experiences with endometriosis in the comment section below.

Suggested reading: 100 Questions & Answers About Endometriosis

Reference: Schrager S, Falleroni J, Edgoose J. (2013). Evaluation and treatment of endometriosis. Am Fam Physician. 87(2):107-13.

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