Diagnosis, treatment for silent epidemic: endometriosis

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Marlena Mattingly Masavage

One in 10 women of childbearing age - an estimated 176 million worldwide - suffers from endometriosis.

But, because the symptoms can often be mistaken for other conditions that cause pelvic pain, it's a difficult disorder to diagnose.

Here are answers to some frequently asked questions about endometriosis.

Q. I've suffered for years with painful menstrual cycles. Could it be endometriosis?

A. Painful periods is one of several symptoms of endometriosis, a condition in which tissue from the uterine lining develops outside the uterus in other areas of the pelvis. These lesions can cause inflammation, pain and scar tissue on surrounding organs.

Other symptoms can include pain with intercourse, pain with bowel movements or urination, excessive menstrual bleeding, and infertility. Approximately one third to one half of women with endometriosis have difficulty becoming pregnant.

Q. What causes endometriosis and how is it diagnosed?

A. We don't fully understand why women develop the condition, but scientists believe there might be a genetic link.

The only way to know for certain that you have endometriosis is to undergo laparoscopic surgery that allows the physician to look for signs of endometrial tissue.

Q. Is there any effective treatment?

A. Yes. The conservative approach starts with medication, including nonsteroidal anti-inflammatory drugs, such as ibuprofen, to ease painful menstrual cramps, and hormone therapy, like birth control pills, patches and vaginal rings, to slow the growth of endometrial tissue.

If hormone therapy doesn't alleviate the chronic pelvic pain or if a patient is trying to become pregnant, the next step would be laparoscopic surgery to excise or cauterize the lesions. While the pain will subside for a period of time, the lesions almost always grow back.

After surgery, your physician might recommend a Lupron Depot shot to stop the body's production of estrogen, which causes endometrial tissue to grow. The recommended duration of treatment is no more than six months.

Another option is a new FDA-approved oral medication marketed under the brand name Orillissa. It can be taken for up to two years, but because it reduces the production of estrogen, patients experience menopausal symptoms, including hot flashes, night sweats, headaches and mood swings.

Q. Can endometriosis be cured?

A. Unfortunately, there is no cure. The condition usually develops after the onset of menstruation and the symptoms don't resolve until menopause. The only way to definitively treat endometriosis prior to menopause is performing a hysterectomy.

Dr. Marlena Mattingly Masavage is a board-certified OB-GYN with Beaufort Memorial Obstetrics and Gynecology Specialists in Bluffton and Beaufort.

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