Some women who have endometriosis have few symptoms, and may not learn that they have this disease until they have difficulty becoming pregnant. Other women with endometriosis experience significant pelvic pain and especially painful menstrual periods.

Many girls and women mistakenly believe that painful periods are normal. It is certainly not normal to miss school or work, need large doses of pain medication or for pain to interrupt sleep during your period.

The pain with endometriosis can begin days before a period starts, and can be felt throughout the pelvis, abdomen and lower back, whereas "normal" menstrual cramps begin when the period begins and are generally felt only in the center of the lower abdomen.

The endometrium is the tissue that lines the inside of the uterus. Normally, it builds up and then is shed each month during the menstrual cycle. In endometriosis, this uterine tissue is found outside the uterus, where it is called "endometrial implants." These implants can be attached to the fallopian tubes, ovaries, rectum, bladder or anywhere in the pelvis or abdomen.

These endometrial implants respond to hormones of the menstrual cycle, so they build up each month. But, since they are not in the uterus, they cannot be shed from the body during the menstrual period. They bleed internally, causing inflammation, scar tissue and pain. This scar tissue can block the passage of eggs from the ovary through the fallopian tube to the uterus and prevent pregnancy.

Besides painful periods and ongoing pelvic pain, women who have symptoms of endometriosis may experience abdominal or low back pain, painful sexual intercourse, pain with bowel movements and headaches.

There are many theories about the cause of endometriosis. It is probably genetic, since a woman that has a mother or sister with the disease is six times more likely to have endometriosis than other women.

A newer theory is that a deficiency in the immune system allows endometrial implants to develop. Also, many researchers believe that environmental toxins such as PCBs and dioxins are "endocrine disrupters" that interfere with human hormones and can cause endometriosis.

The most accurate way to diagnose endometriosis is by laparoscopy. During laparoscopic surgery, a thin tube is inserted into an inch-long incision in the abdomen. The physician can then see the pelvic organs and look for any endometrial implants.

Laparoscopy can also be used to remove endometrial implants, or destroy them with lasers or other techniques. However, this does not always completely eliminate pain or restore fertility. Having a hysterectomy (complete removal of the uterus) is the only way to cure endometriosis.

Besides pain medicines, there are many medical treatments for endometriosis. Birth control pills (estrogen and progesterone) are the most common treatment, and they help control symptoms for many women with endometriosis. Also, treatment with high doses of progesterones (taken orally daily, or by injection once every three months) without estrogen can be helpful.

Another category of drug that can help endometriosis is the gonadotropin-releasing hormone agonists (GnRH-As), which include Lupron, Nafarelin and Goserelin. These medicines stop menstrual periods and reduce the size of endometrial implants. Due to side effects such as bone loss, they can only be taken for a few months. Symptoms may gradually return after the medication is stopped.

A medication called Danazol works by preventing ovulation and reducing the size of endometrial implants. About 85 percent of women have decreased symptoms with this treatment, but it can only be used for six to nine months at a time and has many possible side effects.

Alternative treatments such as acupuncture, traditional Chinese medicine, immunotherapy and dietary changes are very helpful for some women with endometriosis.

Kathryn B. Brown is a family nurse practitioner with a master's degree in nursing from OHSU. Is there a health topic you would like to read about? Send ideas to kbbrown@eastoregonian.com. You can find more local health news and information in the Health section at www.chinookobserver.info.

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