March is Endometriosis Awareness Month—Here’s What to Know About Endo
If you’re not totally sure what endometriosis is, you’re not alone. The tissue disorder affects an estimated 1 in 10 women during their reproductive years—approximately 176 million women worldwide—but at the same time, it’s considered taboo to talk about, like many other women’s health issues. While celebrities like Gabrielle Union, Chrissy Teigen, and Lena Dunham have spoken openly and vulnerably about what it’s like to have endo, the disease still carries a stigma, making it difficult to diagnose and treat.
Let’s end that stigma together. In honor of Endometriosis Awareness Month this March, here’s everything you should know about endo—plus, how birth control can be used to help alleviate some of its symptoms.
What is endometriosis?
Endometriosis is a disorder in which tissue similar to the kind that typically lines the uterus (a.k.a. the endometrium) grows outside of the uterus, causing chronic inflammation and pain. The imposter tissue tends to grow on the ovaries, fallopian tubes, and the pelvic lining.
While regular endometrial tissue thickens, breaks down, and bleeds out during the menstrual cycle, the fake tissue has no exit strategy and stays trapped in the body (hence, why the most severe pain usually happens during menstruation). If the tissue becomes irritated enough, it can form scar tissue and adhesions, which are abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick together.
What are the symptoms of endometriosis?
The most common symptom of endo is pelvic pain, but the specific type of pelvic pain can vary from person to person. Painful menstrual cramps, chronic low back pain, pain during or after sex, and pain while going to the bathroom are also often reported by people with endo.
Outside of the ouch, other symptoms can include heavy bleeding or bleeding outside of the menstrual cycle, fatigue, and infertility.
What causes endometriosis?
Honestly, doctors aren’t totally sure, but there are a lot of plausible theories. One of the longest-held hypotheses is that endometriosis happens because of something called retrograde menstruation, which is when menstrual blood doesn’t flow out through your vagina. Instead, it goes back up through your fallopian tubes and into your pelvic cavity—kind of like pulling a U-turn on a one-way street.
Other potential causes of endometriosis include genetics, immune system issues, hormonal imbalances, and complications from C-sections.
How do you diagnose endometriosis?
Endo can often be confused with similarly-presenting diseases, like ovarian cysts or pelvic inflammatory disease. Your doctor will diagnose you by taking a detailed history and performing a pelvic exam. Then, they might do an ultrasound or an MRI to get a look at the reproductive organs affected by endometriosis and to search for evidence of that tissue growth. Finally, your doctor might refer you to a surgeon for a laparoscopy, which is a minor surgical procedure where the doctor can view the tissue directly and, in the same procedure, remove it.
How birth control pills can help treat endometriosis
While there’s no cure for endometriosis, there are ways to treat the symptoms and manage the pain. The most common way to treat endometriosis is with hormonal birth control pills.
If you’re not actively trying to get pregnant, most doctors will advise hormonal contraception as the first step in treating endo—it’s cost-effective, accessible, and can be taken for several years, if necessary. And most importantly, it helps manage endometriosis symptoms effectively. That’s because hormonal BC regulates the body’s hormonal cycle, which makes periods easier to manage and often lessens the severity of typical period side effects. The progestin-only pills in particular can inhibit endometrial growth, which makes it less likely that you’ll experience symptoms.
Depending on how the symptoms present, a doctor will probably recommend a 21-day pack of birth control followed by one week of placebo pills and a light period. In some cases, however, the doctor might recommend taking the pill continuously for a few months at a time, resulting in one period every three or four months (and, as a result, less endometrial pain). In fact, one study, focusing on people whose symptoms weren’t addressed by the 21-day pill pack, found that 80% of the people were satisfied or very satisfied with symptom management while taking the pill continuously.
Once endo symptoms are under control and periods are pretty consistent, the patient can easily stop taking birth control (but hey, don’t forget a condom if pregnancy isn’t something you’re planning for right now). While birth control pills are the most common way to treat endo, other hormonal options include patches, rings, or IUDs.
Other treatment options for endometriosis
If you are trying to get pregnant, your best bet is gonadotropin-releasing hormone (GnRH) agonists and antagonists. Yep, it’s a mouthful—but basically, this stops the body from making the hormones (like estrogen) required for ovulation, the menstrual cycle, and the growth of endometrium. The downside is that it causes a temporary menopause, complete with all the fun side effects like hot flashes and vaginal dryness. But, once the medication is stopped, your period and ability to get pregnant return.
If medication doesn’t seem to be making an impact, surgery is an option. Laparoscopy is a minimally invasive surgery that removes or destroys out-of-place endometrial tissue. For the most severe cases of endometriosis, a hysterectomy might be recommended; however, this choice comes with the knowledge that the patient won’t be able to get pregnant as a result.
While there’s still a lot to learn about endometriosis, the best way to make scientific progress and erase the stigma around it is by speaking up and advocating for yourself. If you think you’re experiencing symptoms of endometriosis, talk to your doctor and see if birth control pills might help relieve your symptoms.
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