Last week we discussed diagnosing endometriosis in young women. This week we will discuss the causes and treatments of endometriosis.
What causes endometriosis?
The medical community doesn’t have an answer as to what causes endometriosis, however, there is a lot of money and research going into having a better understanding of this condition. Nonetheless, we are of the opinion that estrogen, a naturally occurring hormone, causes endometriosis to spread and intensifies the pain.
Endometriosis typically begins developing after young women start having menstrual periods. When endometriosis patients reach menopause, their estrogen levels drop and their symptoms usually subside.
Who gets endometriosis?
Endometriosis occurs in 10% of young women who have begun to have their menstrual period. Even though many patients report noticing symptoms from their first menstrual cycle, they typically aren’t diagnosed until they are at least in their late teens and 20s.
Conflicting research has shown that patients with a mother or sister with endometriosis are 7-10x more likely to develop endometriosis, while other research has estimated that number around 3.0-9.6%. There is a general consensus in the medical community that there is a trend related to the greater familial incidence of endometriosis. However, the debate is how dramatic the familial risk factor is.
When do patients get treated?
If symptoms persist, the patient is given medications that we talked about last week; pain medications (analgesics), NSAIDs, and/or hormonal contraceptives. This means that an otherwise healthy young woman now relies on these medications to function.
We encourage teens to talk to their doctors and parents about the pros/cons of taking medications so that they can make an informed decision.
Do most patients end up getting surgery?
As the endometriosis progresses and the patient experiences years of suffering – most patients will eventually end up getting laparoscopic surgery to get a concrete diagnosis.
Hopefully, the endometriosis is finally staged and diagnosed after laparoscopic surgery. Depending on the severity, the medical provider will recommend additional laparoscopic surgeries to remove endometrial tissue, a hysterectomy, analgesics, or medical forms of therapy (e.g. Orilissa, Lupron, Synarel, Zoladex, etc.).
While endometriosis is not a mental disorder, it can create mental distress in patients. Ultimately, many young women who suffer from endometriosis struggle physically, as well as psychologically. These women typically wonder if they will ever live a pain-free, normal life. This can leave them feeling hopeless, angry, and depressed.
What Can Be Done?
Thankfully, there are many things that can help a young person with endometriosis:
● Early Diagnosis
○ Endometriosis should be considered if the young patient does not respond to mild medications and shows signs of endometriosis during a physical examination. The patient should also be recommended to undergo laparoscopy for an official diagnosis.
● Don’t Overprescribe Medications
○ Patients who have symptoms consistent with endometriosis shouldn’t be subjected to drawn-out periods of powerful medications prior to being diagnosed. Sometimes physical abnormalities can cause painful symptoms but these abnormalities can only be corrected surgically, not by medication.
● Trust the Patient
○ A patient’s support system (parents, siblings, friends, teachers, etc.) should trust them when they communicate their pain and other symptoms. It’s not normal for a well-adjusted child to complain of pain just to get attention.
● Enlist a Specialist
○ The first pelvic exam can be nerve-wracking for patients, especially young patients. It’s important to find a compassionate health care provider who will consider the physical and mental needs of the patient.
What does life look like for patients post-op?
In the majority of laparoscopic surgeries by well-trained surgeons, small incisions are used (¼” long on average) and most patients can go home the same day they have surgery. Knowledgeable surgeons have the potential to keep recurrence rates below 20% by completely eradicating the displaced endometrial tissue.
When the endometriosis has been removed, the postoperative pain relief is typically nothing short of phenomenal. Of course, cramps may persist and some patients continue to report pain with menstruation. Overall, the ability to help endometriosis patients achieve pain relief is one of the most rewarding things a physician can do.
Once chronic pain subsides, many patients report a healthier state of mind. This is because they can live their lives more fully without constantly being plagued by symptoms. “Thank you for giving me my life back,” is one of the best things you can hear as a medical professional and we are honored to have heard that from countless patients.
At Mangrove Women’s Health, we know the teenage years are hard enough without the added stress of a potential endometriosis diagnosis. We are grateful to have the opportunity to provide our patients with significant and long-lasting pain relief.