Endometriosis is a painful disorder where the lining of the uterus, or the endometrium, grows outside of the uterine wall to other parts of the body. During a normal cycle, the woman’s endometrium builds up, thickens, then sheds and bleeds. When endometrial cells grow outside of the uterus, your brain does not differentiate between the cells inside and outside, so as the month goes on, the cells grow and thicken, then try to slough off. Since there is nowhere for the tissue to go, it becomes trapped, leaving whichever structure, organ, or bone in pain for the remainder of your cycle, also leading to chronic inflammation, pain, discomfort, and possible infertility.
In Doctor Camran Nezhat’s article on “Endometriosis is a whole body disease” (Nezhat, 2015) he introduces his article with a history of endometriosis. He starts off during Hippocratic times almost 2,500 years ago when physicians observed a ‘strangulation of the womb” with symptoms of hysterical lumps, pain in the bladder, vomiting, diarrhea, and back pain as the main symptoms. In later years, women would be subjected to torture such as bloodletting, being hung upside down, accused of being possessed, and being put in straight jackets. During these times it was thought women just ate too much, expressed sexuality, were immoral, or attention seeking, despite thousands of women still claiming otherwise.
To this day, endometriosis is one of the most misdiagnosed women’s diseases. The exact cause is unknown but it is “estimated one out of ten women, approximately 176 million, will develop endometriosis (Endometriosis.org, 2017). I also know this from personal experience. For many years, from my onset of menses to April of 2018, my doctor thought I had scoliosis and prescribed me pain relievers and to visit a chiropractor. After years of my pain not getting better, he finally suggested I go see a gynecologist. Only then, after surgery, was it
discovered I had endometriosis. Signs and Symptoms of this awful condition include severe pain, prior to menses and during, in your back, bladder, uterus, surrounding areas of the pelvis, vomiting, diarrhea, dysmenorrhea, and pain in unusual places (if the cells metastasized). For example, during my surgery, they found the endometrial cells on my bones in my pelvis, on my spine, and bladder, therefore during each month, I experience severe, debilitating, crippling pain in those areas.
The only definitive way to be diagnosed with endometriosis is surgery, and even then, there is no cure. Your gynecologist will want to probably do a pelvic examination before discussing any treatment plans, which will either be pain medication, hormone therapy or surgery. The least effective way to treat your endometriosis would be pain medication. With this treatment plan, this only provides palliative care and alleviate the pain associated; it does not get rid of or slow down endometrial growth. “Hormonal treatments containing progestin, estrogen, or both prevent the release of an egg from the ovaries and reduce the swelling of the endometrial tissue, which can reduce pain and inflammation” (Hormonal Therapy, 2013). Another form of hormonal birth control includes birth control. Depo is an injectable birth control that contains a form of estrogen. Implantable devices such as Mirena and Nexplanon stay in the body for an extended period of time, slowly releasing progesterone, progesterone, or a combination. Daily contraceptives such as Seasonique also contain these same hormones and may reduce menstrual bleeding. For a surgical option, your doctor will perform an exploratory laparotomy. During this procedure, once sedated with general anesthesia, a skin prep of your abdominal and vaginal areas are done, you are positioned in lithotomy, and a
Foley catheter is inserted to keep the bladder empty. To start, a handheld vaginal retractor is placed posteriorly in the vagina and a tenaculum is used to grab the cervix, then a uterine manipulator is placed on the cervix. Using two towel clips, the anterior abdominal wall is elevated where a Veress needle is placed into the midline at a ninety-degree angle to elevate the body plane. The surgeon will stop the needle at the fascia, the position is verified, and the abdominal cavity is entered. The surgeon will then use a #11 or #15 knife blade to make a small cut where a carbon dioxide insufflator is used to expand the abdominal cavity, not exceeding 15mm/Hg. Prior midline incisions are extended from a small stab like wound to approximately one centimeter in length where a laparoscopic trocar and sleeve are placed into the cavity where, once inserted, the trocar is removed and replaced with a laparoscope. A carbon dioxide line is connected to the valve on the sleeve and the laparoscope is connected to a camera and light source that are connected to a monitor for the surgeon and surgical technologist can watch and perform. The surgeon will manipulate the organs and structures while using a Bovie and grasper to resect any endometriosis found. (Endometriosis will appear a dark purple to blackish color) Carbon dioxide is then released from the abdomen and the ports are sutured or steri-stripped. This procedure is typically outpatient and there are no further complications and the individual can return to normal activity within two to four days.
Although the surgeon may have resected the visible endometriosis, chances it will develop and spread to other places are high. The only known cure is to remove the uterus, and even then, most women are on hormones for the remainder of their life. Endometriosis is a
whole body disease and affects millions of women’s lives per year. Endometriosis pain is often talked about, but is far worse than many women know how to describe.
Endometriosis.org. (2017, May 27). Facts about endometriosis « Endometriosis.org. Retrieved December 01, 2018, from http://endometriosis.org/resources/articles/facts-about-endometriosis/
Hormonal Therapy. (2013-2018). Retrieved December 01, 2018, from https://endometriosisnews.com/hormonal-therapy/
Nezhat, C. (2015). Endometriosis is a Whole Body Disease. Retrieved December 01, 2018, from http://nezhat.org/endometriosis-treatment/history-of-endometriosis/