THE ENDO GIRL | for all you uterus having humans: Endometriosis & Adenomyosis – what it is & how it looks like (typically)

Endometriosis.

A chronic & potentially debilitating and crippling condition that will be diagnosed in 1 in 10 women during their reproductive years. I like to call it “the silent emotional murderer” I know, sounds a bit dramatic don’t it? but if you’ve felt the stabbing/ squeezing pains that no amount of narcotic can quench then you’ll agree.

Adenomyosis.

another chronic & potentially debilitating & crippling condition. This one is there to stay. Unlike endometriosis, Adenomyosis cant be scraped off in a laparoscopic surgery. Nope! These rogue endometrial cells will colonize the myometrium & claim it. Want it out? Guess you’re going to have to give up your uterus altogether, since that’s the only real way to get rid of this monster.

Ok, so let’s talk. For those of you who might have stumbled upon this post & don’t really know what these conditions are & how they look like, I’ll try to explain. But first, let’s talk a little bit about the anatomy of our uterus.

Our uterus, has three layers (from the innermost to the outermost)

• Endometrium – this is the innermost layer of the uterus. It’s composed of … you guessed it … endometrial cells. These cells, in response to hormones such as estrogen, proliferate, shed & bleed every month giving us our beloved menstrual period. Yewp! The monthly bloodshed that we love to hate.
• myometrium – this is the muscular layer of our uterus.
• perimetrium – the outermost & will ignore for now, layer

So that being said, what the F*ck is Endometriosis & Adenomyosis?

Endometriosis occurs when the endometrial cells start popping up in places where they shouldn’t be. You see, these pesky cells are supposed to keep their buts in the endometrium! But they rebel & decide to colonize places such as our ovaries, fallopian tubes, bladder, they can even get to your rectum! So, what’s the problem you ask? … remember that I mentioned how these cells proliferate, shed & bleed every month in response to hormones like estrogen? … well these cells retain that function even tho they are not where they are supposed to be. You see, when this happens in the endometrium the blood has a place to go & by “a place to go” I mean our pads or tampons ( insert any other method of menstrual blood collection here) You see, the blood & the lining that’s being shed travels through our vaginal canal and it leaves our bodies. When this happens elsewhere that blood has nowhere to go & so it accumulates leading to inflammation & ultimately some of the symptoms experienced by women with endometriosis. Every month the same thing happens, all the inflammation that’s taking place, monthly, ends up creating scar tissue which can translate into fertility problems later on.

Adenomyosis is no different. Same concept. Endometrial cells where their NOT supposed to be. But this term is specifically used for when these cells penetrate the muscular layer of the uterus, the myometrium. The shedding & blood accumulates in the wall of the uterus causing it (sometimes) to become enlarged & tender.

How the heck are these diagnose?

Well, diagnosis can be tricky. Both of these have to potential for being misdiagnosed. Therefor, if you have any sort of pelvic pain I HIGHLY encourage you to keep a “pain diary” make sure you monitor the following:

• when the pain comes
• when the pain goes away
• where the pain is located
• does the pain spread anywhere else?
• are you experiencing any other symptoms associated with your pain?
• what makes it better? what makes it worse?

All this information will come in handy at the time of having this discussion with your physician.

Typically when you go to your doc, with a complaint of pelvic pain the following exams may be done:

• pelvic exam: this one will NOT show endometriosis or adenomyosis. Of course. But it’s helpful in assessing any other possible signs. Some women in Adenomyosis experience a increase in the size of their uterus along with tenderness. A pelvic exam might show these prompting your doctor to do further tests.
• Ultrasound: This one won’t confirm endometriosis either. But it’s a helpful tool in assessing the overall state of your pelvic zone. It may not show endometriosis lesions but it can show endometriosis associated cysts. Again prompting your doc to do further testing.
• MRI: this is a good one for observing endometriosis lesions.
• Laparoscopy: this invasive procedure allows your physician to really take a look inside your abdomen / pelvic region to physically asses the presence of endometriosis lesions. This is not necessarily done upon suspicion of adenomyosis since those lesions are inside the uterine muscular layer and cannot be physically visualized.

So, how exactly are these treated?!

well well, It saddens me to say that both Endometriosis & Adenomyosis are . . . well, incurable. Al though there are some hypothesis / theories on the possible causes the actual cause of these conditions have yet to be uncovered and with no certainty of a cause a proper therapy is hard so decipher. In all honestly, treatment becomes more of a way to manage symptoms rather than an actual cure. Either way, there are soma ways physicians opt to treat these conditions and we are going to talk about some now.

1. Anti-Inflammatory drugs are often use to manage the pain. However it is important to note that often times, women have severe pain to the point where more potent drugs need to be prescribed.
2. Hormonal Medications such as Oral contraceptives or other form of hormonal based contraceptive: These are given with the goal of minimizing the heavy bleeding associated with these conditions. Some women experience heavy bleeding to the point of developing anemia. Other forms of hormones that tend to stop the period are also considered with the hope that stopping the period might offer some relief.
3. Removal of lesions by Laparoscopic surgery: often times, when a person finally gets a diagnosis of endometriosis the best option is to surgically remove the lesions. This will give some relieve but often the lesions return. Unfortunately, this particular method of treatment is not useful for Adenomyosis which brings us to the next “treatment” option.
4. GnRH agonists or antagonists: this! Menopause in a shot! Gonadotropin releasing hormone agonist & antagonists are drugs design, to summarize it as best as I can, to stop your estrogen production in your ovaries. Without estrogens, technically speaking, endometrial cells cannot be “fed”. Unfortunately the decrease in estrogen means that you will experience menopause symptoms such as hot flashes, maybe some weight gain, tiredness etc. There has been a lot of controversy with these drugs but from personal experience, if you are experiencing crippling pain to the point where your life and mental health are declining Id say, give it a shot! I did and I was finally able to experience some relief! Obviously, with this option theres a lot of supplementation and lifestyle changes that should go along with this form of therapy, its not easy and it certainly comes with con’s but It was worth it for me.
5. hysterectomy: this one is a hard. No woman wants to have to come across the decision of removing their reproductive organs, specially if you are a little younger. Unfortunately a lot of times this is the only way to guarantee relief. This is especially true for women who have very severe symptomatic adenomyosis. Since, there is no way to remove the lesions and often the therapies available provide little to no relief and even in the best of cases the relief is still temporary, the story ultimately ends up in hysterectomy.

I hope that this shed a little light on these conditions and how hard they can be to manage and to deal with. Do keep in mind that sometimes these do not look like the typical, common picture. Disease/ conditions don’t always present in a “cookie cutter” type of way. You might still have these and have symptoms that look completely different. You know your body best so if you are feeling uncertain, if you are experiencing pain during, before or after your period along with symptoms that are impacting your life do not just deal with it, because you shouldn’t have too. Find someone who listens to you and explore every option until you can find your answer. You should never live in pain.