Endometriosis and adhesions: What do you need to know?
What are adhesions?
Flimsy or dense, adhesions are made up of fibrous bands of scar tissue that can form connections within or between organs, potentially leading to significant pain. In endometriosis, adhesions can result from damage caused by the disease itself, or as the result of abdominal surgery (including laparoscopic surgery that had the aim of improving your symptoms, but also unrelated operations such as c-sections.)
What are some of the possible symptoms?
Adhesions can affect a wide variety of organs and structures, and the symptoms will depend on both their location and severity. They may include:
- Persistent abdominal bloating or swelling
- Cramping or pain
- Nausea and possible vomiting
- Constipation and diarrhea, and sometimes rectal bleeding (especially with bowel movements)
Many patients will notice that the nature and severity of their pain and discomfort changes as they approach their period and while they are menstruating — while the chronic pelvic pain associated with endometriosis (and partly caused by adhesions) is often described as more of a dull ache, menstruation-related pain is more likely to induce a sharp or stabbing sensation. Because adhesions can form abnormal connections, sticking organs together, you may also feel a tugging or pulling when you make certain physical movements, including not uncommonly during sexual intercourse.
How are adhesions diagnosed and treated?
Because imaging techniques — like ultrasound and MRI — cannot definitively confirm the presence of adhesions, and certainly don't have the ability to precisely determine how many adhesions you have and how extensive they are, laparoscopy is the gold standard in diagnosing adhesions. The good news is that this can be both a diagnostic tool and a treatment in one, though the exact surgical option that is best for an individual patient depends on the location of her adhesions.
- Laparoscopic adhesiolysis (the general term for surgery that removes adhesions or breaks them up) is minimally invasive, and can be carried out to eliminate bowel-related adhesions. Laparoscopy is preferred where possible because it is associated with a lower risk of itself eventually leading to new adhesions.
- More traditional open adhesiolysis may also be necessary. In this case, the patient requires general anesthesia and will be in hospital longer during recovery. Healing times are also longer.
No matter what kind of surgery your doctor proposes, it is important to consider the risks and benefits, as well as to be aware that having surgery does not mean that your adhesions won't come back. Surgery itself is, in fact, one of the risk factors — it leads to scar tissue, which in turn increases the risk of adhesions.
Endometriosis and ovarian cysts: What do you need to know?
What are ovarian cysts?
Cysts, in general, are fluid-filled sacs, and ovarian cysts are — of course — cysts of the ovaries. They come in many forms. Some functional cysts quite naturally form and go away again, while others form because of bleeding, adhesions, or scarring. Some cysts, known as simple cysts, are merely filled with fluid. Others, complex cysts, can contain whole structures; even teeth or hair! Some cysts become so large and painful that they have to be removed for your comfort, while others can even become malignant.
Your doctor may adopt a "wait and see" approach to your cyst(s), monitoring your condition without recommending surgery as of yet, if:
- You are dealing with a simple cyst or simple cysts
- The cyst in question is small, less than four inches.
- Your cysts are unilateral, only affecting one of your ovaries.
- You are ovulating at the moment, or are pregnant.
- You are not experiencing symptoms.
- You do not have other accompanying worrying factors, like a pelvic fluid-build up
What should postmenopausal women know about ovarian cysts?
Though most ovarian cysts in women of reproductive age are functional, and do not cause any problems, the situation is different in women who have entered the menopause. Ovarian cysts in postmenopausal women deserve a doctor's full attention as they are much more likely to be dangerous, and the same holds true for uterine fibroid tumors.
What should you know about chocolate cysts?
Ovarian endometriomas, also commonly called chocolate cysts, strike as many as four in 10 endometriosis patients. Filled with old endometrial tissue and blood, opening them reveals a tar-like sticky substance. They're associated with more severe stages of endometriosis (stages 3 and 4) and can sometimes lead to severe pain. Chocolate cysts can be as small as an inch, but may also grow to be larger than seven inches across, and while some women have just one, others have many. Typically diagnosed through ultrasound, ovarian endiometriomas may be removed surgically (usually through laparoscopy) if they are symptomatic, large, suspected to be cancerous (rare), or if they interfere with fertility.
Endometriosis and polyps: What do you need to know?
What are polyps?
Uterine polyps, also called endometrial polyps, are usually benign uterine grows that result from an excessive proliferation of endometrial tissue. Like endometriosis, polyps are dependent on the hormone estrogen. This explains why polyps are more common in women who have endometriosis.
Symptoms of polyps
The majority of polyps are small and remain asymptomatic, but polyps can sometimes grow very large. In this case, they may cause:
- Irregular menstruation: Your periods come abnormally often, your cycle length is unpredictable, and the volume and duration of your flow varies.
- Heavy menstrual periods (menorrhagia).
- Vaginal bleeding or spotting between menstrual periods, including bleeding after sexual intercourse.
- Vaginal bleeding in postmenopausal women.
The approach to polyps is, again, to monitor them. Surgical removal is the treatment of choice in women who have symptoms.