What is Endometriosis?

Kimberly Marshall, MD – Grapevine OBGYN

Endometriosis is a common disease affecting up to 10% of all reproductive aged women. It is the culprit behind many cases of chronic pelvic pain, painful periods, and infertility. However, most people are largely unfamiliar with what it is and how this condition impacts women.

Endometriosis is a condition in women that occurs when the cells lining the uterus migrate to other parts of the body. Endometriosis is often found attached to areas in the pelvis, such as ovaries, bowl, bladder and rectum. Endometrial cells can also attach to tissue that lines the inside of the abdomen and pelvis called the peritoneum. In rare cases endometriosis can also be found in remote areas of the body such as the lungs.

Endometriosis responds to hormones just like normal endometrial tissue. This leads to a recurring cycle of bleeding and healing, and ultimately to the development of scar tissue or adhesions. Adhesions can cause mild to severe pelvic pain before and during menstruation; pain during bowl movements, urination, and sex. In some women endometriosis has no symptoms at all, and they may only be diagnosed when they have trouble getting pregnant.

Symptoms of endometriosis can occur any time between puberty and menopause, but most often occurs in women during their 30’s and 40’s. Endometriosis occurs more often in women who have never had children. Women with a mother, sister, or daughter with endometriosis are also more likely to have it.

Endometriosis can only be diagnosed by looking directly inside the body. This is most often accomplished by laparoscopy, which is a surgical procedure that uses a small lighted camera to observe the pelvic organs. Sometimes when other causes of pelvic pain have been ruled out you may receive treatment for endometriosis without surgery.

Treatment of endometriosis depends on the severity of your symptoms, the extent of your disease, and whether or not you want to have children. Your doctor may recommend medication, such as ibuprofen or naproxen for pain relief. Some people are prescribed birth control pills to control the menstrual cycle and shrink areas of endometriosis. Surgery to treat endometriosis can involve simply removing or burning endometriosis and adhesions, or in patients who don’t want more children, surgery to remove the uterus and ovaries can result in a permanent resolution.

Surviving The Change

Kimberly Marshall, MD – Grapevine OBGYN

Menopause marks the end of a woman’s reproductive years and usually occurs between the ages of 45 and 55. Like puberty and pregnancy, menopause is a normal female life event, and symptoms vary from woman to woman. Perimenopause, the period leading up to menopause, has been described as constant torture, but that doesn’t have to be the case. With proper care and treatment, you can effectively manage the changes of menopause.

What is Menopause?

Levels of estrogen, progesterone and testosterone fluctuate throughout a woman’s life, influencing the reproductive system in many ways. What most people refer to as menopause is actually a process involving three stages: perimenopause, menopause and post-menopause. Perimenopause usually begins sometime in the late 40s and can last up to eight to ten years. During this time the ovaries start to decrease their production of estrogen. Periods may become unpredictable, and the menstrual ow can be heavy. Some women may not notice symptoms until the last few years of perimenopause when the decrease in estrogen accelerates. Perimenopause lasts until the ovaries stop releasing eggs completely.

Menopause is medically de ned once a women has gone 12 consecutive months without a period. In this way, you can only distinguish menopause once it is over and post-menopause has begun. For this reason, it is helpful to keep an accurate record of your menstruation, including the number of missed periods.

What is Hormone Therapy?

Hormone therapy is used to supplement the body with either estrogen alone or estrogen and progesterone in combination. Estrogen and progesterone are hormones that are produced by a woman’s ovaries. When the ovaries no longer produce adequate amounts of these hormones, hormone therapy can be given to supplement the body with adequate levels and alleviate symptoms.

How Does the Body Use Estrogen and Progesterone?

Estrogen and progesterone together thicken the lining of the uterus, preparing it for possible pregnancy. Estrogen also influences how the body uses calcium in the building of bones, and helps maintain healthy levels of cholesterol in the blood.

As menopause approaches, the ovaries reduce most of their production of these hormones. Fluctuating or lower estrogen levels often cause menopause symptoms such as hot ashes, vaginal atrophy, and other medical conditions such as osteoporosis. Hormone therapy helps to restore the estrogen, relieving some of the symptoms of menopause and helping to prevent osteoporosis.

Why is Progesterone Taken?

Women who have their uterus are given progesterone with estrogen to protect the uterus against endometrial cancer. Estrogen, if taken without progesterone, can increases a woman’s risk for endometrial cancer by causing an overgrowth of cells in the uterus. Progesterone reduces the risk of endometrial cancer by making the endometrium shed each month. As a result, women who take progesterone may have monthly bleeding. In some cases, monthly bleeding can be eliminated by carefully balancing progesterone and estrogen together continuously. Women who have had removal of the uterus through surgery, or hysterectomy, usually do not need to take progesterone.

What are the Types of Hormone Therapy?

Estrogen Therapy is estrogen taken alone. Women are most often prescribed a low dose of estrogen as a pill, cream or patch to be taken every day. Progesterone-Estrogen Therapy, also called combination therapy, combines doses of estrogen and progesterone. Progesterone and estrogen may be given continuously to prevent the monthly bleeding which can occur when combination hormone therapy is used. The American college of OBGYNs recommends you take the lowest dose of estrogen needed to relieve menopause symptoms and to prevent osteoporosis for the shortest time required.

What Menopausal Symptoms can Hormone Therapy Relieve?

Estrogen hormone therapy during menopause can be beneficial to alleviate many of the symptoms of menopause. The hormone is prescribed to relieve hot ashes and night sweats, painful intercourse as a result of vaginal dryness or atrophy. Other benefits of taking Estrogen as hormone therapy include a reduced risk of developing osteoporosis and broken bones, also improvement of mood and overall sense of mental well-being in some women, decreased tooth loss, and lowered risk of colon cancer.

Is Menopausal Hormone Therapy Safe?

When taking any medication, it’s important to weigh the benefits and risks. Scientists continue to study long term effects, but millions of women have done well on hormone therapy. The key is to tailor hormone therapy to each woman’s individual needs. If you are concerned about menopausal symptoms and treatments, talk to your doctor.