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Each month the inner lining of the uterus thickens to prepare for pregnancy. If a woman does not become pregnant, the lining of the uterus sheds and the woman bleeds during her menstrual period.

When a woman has endometriosis, the growths outside of the uterus also bleed during the period. However, there is no way for the blood to leave her body, and inflammation and scar tissue is a common consequence. Blockage or bleeding in the intestines and problems with bladder function may also occur due to endometriosis. Some doctors think hysterectomy could help these patients.

What is endometriosis?

When a woman has endometriosis, the tissue that lines her uterus (endometrial tissue) grows outside of the uterus. No one is sure why this happens, but when this tissue grows outside of the uterus, it is most commonly in, on, or under the ovaries, behind the uterus, on the tissues that hold the uterus in place, or on the bowels or bladder. In very rare cases, endometriosis areas can grow in the lungs or other parts of the body. As the tissue grows, it can develop into tumors or implants. These growths are usually benign, and rarely associated with cancer. Growths can cause mild to severe pain, infertility, and heavy periods.

What are the symptoms of endometriosis?

A common symptom of endometriosis is pain. This pain is mostly in the abdomen, lower back, and pelvic areas. The amount of pain a woman feels does not refer to how much endometriosis she has. Some women have no pain even though their disease affects large areas, or if there is scarring. Some women, on the other hand, have severe pain even though they have only a few small areas of endometriosis somewhere in the body. General symptoms of endometriosis can include extremely painful or disabling menstrual cramps, where the pain may get worse over time. These women also experience chronic pelvic pain, including lower back pain, pain during or after sex, and intestinal pain.
Common symptoms are painful bowel movements or painful urination during menstrual periods, heavy menstrual periods, premenstrual spotting or bleeding between periods, and infertility. In addition, women who have endometriosis may have gastrointestinal symptoms similar to those of a bowel disorder, as well as fatigue following endometriosis symptoms.
There is no cure for endometriosis. Although there are many treatments, each one with pros and cons, still it is most important to build a good relationship with your doctor.

That way you can decide which option is best for you.

Pain medication is recommended for some women with mild symptoms. In these cases, no further treatment is necessary. For women with minimal endometriosis who want to become pregnant, depending on the age and her amount of pain, the best thing to do is to have a trial period of unprotected sex for six months to one year. If she does not get pregnant in that time, then she might need further treatment.

Hormone treatment could help patients who do not wish to become pregnant, but still need treatment for their disease. Their doctors may suggest hormone treatment, because these are most effective when the growths are small. Hormones can come in pill form, by shot or injection, or in a nasal spray, depending on the doctor’s assessment. There are several hormones used for this treatment including a combination of estrogen and progestin such as birth control pills. You could also get a progestin alone, Danocrine or a weak male hormone, and GnRH agonists, which is a gonadotropin-releasing hormone.

Birth control pills control the growth of the tissue that lines the uterus and often decrease the amount of menstrual flow with two hormones, estrogen and progestin. Once a woman stops taking them, the ability to become pregnant returns. However, the problem is that symptoms of endometriosis also may return. Some women take birth control pills continuously, without using the sugar pills that should signal the body to go through menstruation. When a woman is taking the pill all the time, the menstrual period may stop altogether, which can reduce or eliminate the pain entirely. Some birth control pills contain only progestin, which is a progesterone-like hormone.

Surgery is usually the best choice for women with extensive endometriosis and severe pain. There are both minor and major surgeries that can help, but your doctor will suggest the surgical treatment appropriate for you. A common choice is laparoscopy, which also helps with diagnosing the disease. If your doctor is going to treat the endometriosis during this surgery, he or she must make at least two more cuts in your lower abdomen, necessary for lasers or other small surgical tools to pass into your abdomen. Then the doctor will remove the growths and scar tissue or destroy them with intense heat, and seal the blood vessels without stitches. The goal is to treat the endometriosis without harming the healthy tissue around it. Recovery from laparoscopy is much faster than for major surgery, like laparotomy.

Laparotomy is a last resort for endometriosis treatment because it is a major abdominal procedure. During this surgery, your doctor either removes the endometriosis or removes the uterus, which is a process called hysterectomy. The doctor might also remove the ovaries and fallopian tubes during a hysterectomy. This is necessary if the ovaries have endometriosis on them, or if the damage is severe. Having the surgery does not ensure that the disease will not return, however, or that the pain will go away.

Hysterectomy

A hysterectomy is an operation that removes a woman’s uterus. The uterus or womb is where a baby grows when a woman is pregnant. Sometimes the fallopian tubes, ovaries, and cervix should be removed at the same time as the uterus. These organs are located in a woman’s lower abdomen. The cervix is the lower end of the uterus, and the ovaries are the organs that produce eggs and hormones. The fallopian tubes carry eggs from the ovaries to the uterus where the baby grows. If you have not reached menopause yet, a hysterectomy will stop your monthly bleeding or periods. Also, you will not be able to get pregnant.
There are several types of hysterectomy. A complete or total hysterectomy removes the cervix as well as the uterus. This is the most common type of hysterectomy that doctors choose. A partial or subtotal hysterectomy, also called a supra-cervical hysterectomy removes the upper part of the uterus and leaves the cervix in place. A radical hysterectomy removes the uterus, the cervix, the upper part of the vagina, and supporting tissues - a common choice in some cases of cancer. Often the doctor will remove one or both ovaries and fallopian tubes at the same time a hysterectomy is done. When he or she removes both ovaries and both tubes, the procedure is called a bilateral salpingo-oophorectomy. If the doctor chooses to remove ovaries in a woman before she reaches menopause, the sudden loss of her main source of female hormones will cause her to enter a sudden menopause. This is called a surgical menopause, and can cause more severe symptoms than a natural menopause.

How common are hysterectomies?

Hysterectomy is the second most common major surgery among women in the United States, and very common in the world as well. (The most common major surgery that women have is a cesarean section delivery.)

Each year, surgeons perform more than 600,000 hysterectomies. About one third of women in the United States have had a hysterectomy by the age of 60. Hysterectomy is the best choice of therapy for uterine fibroids, common benign tumors that grow in the muscle of the uterus. Fibroids often cause no symptoms and need no treatment, and they usually shrink after menopause, but sometimes they cause heavy bleeding or pain. There are alternatives to hysterectomy in fibroid treatment. This may be especially important for younger women who hope to have children.

Endometriosis is another benign condition that affects the uterus, and is the second leading reason for hysterectomies. It is most common in women in their thirties and forties, especially in women who have never been pregnant. It occurs when endometrial tissue (the inside lining of the uterus) begins to grow on the outside of the uterus and on nearby organs. This condition may cause painful menstrual periods, abnormal vaginal bleeding, and sometimes loss of fertility. Endometriosis is usually not a problem for women after menopause, but the treatment could involve a hysterectomy. Women with endometriosis often receive treatment with hormones and medicines that lower their levels of estrogen. Surgery to remove the patches of endometrial tissue causing the symptoms may succeed by using a laparascope, or through a larger cut in the abdomen. A hysterectomy should not generally be the first choice in endometriosis treatment, but could help when other treatments fail. You should discuss with your doctor alternative treatment options for endometriosis. Try medicine and hormone therapies, as well as laparoscopy. If you do not achieve improvement, then you should consider having a hysterectomy.