Endometriosis

Menstrual cramps, alas, are an inevitable part of being a woman. Few things in life are as predictable or as unwelcome. But constant monthly pain may be a warning sign that something isn't right. You may need to investigate other sources of pelvic pain.

Endometriosis is one of the most common causes of lower pelvic pain, believed to affect 5 million women, or one of every seven of child-bearing age. When the lining of the uterus, normally shed during the menstrual cycle, grows outside the womb, it sometimes attachs to the bladder, bowel, or kidneys. The misplaced tissue can cause inflammation and pain.

Symptoms: Endometriosis is sometimes silent, sometimes savage. The most common signs are progressively worsening menstrual cramps, pain during sex, lower backache, constipation, and painful bowel movements. Many women with endometriosis also report infertility.

Diagnosis: A careful medical history with a pelvic exam or laparoscopy can diagnose endometriosis. Laparoscopy is when a surgeon inserts a narrow tube with a lighted microscope into an incision near the bellybutton to see inside the pelvis and abdomen.

Treatment: Doctors first try to control endometriosis with birth-control pills or drugs called GnRH analogs. These agents block the production of female hormones, disrupting the menstrual cycle. Danazol, a steroid that suppresses ovulation, also may be used, but its side effects--including weight gain and facial hair--may be permanent.

Endometrial growths can be removed with a laser during laparoscopic surgery. In severe cases, a hysterectomy is performed. If ovaries also are removed, patients are six times less likely to have pain return.

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