Dear Alice,

My girlfriend has endometriosis and I want to know more about it. I know some of the basics, but want to learn everything. Can you suggest where I should go? Thanks.

Dear Reader,

Kudos to you for wanting to know more about this health issue that affects your partner.  Endometriosis occurs when some of the tissue which lines the uterus (the endometrium) begins to grow in another part of the body. In most cases, this growth develops in the pelvic area: on the ovaries, the lining of the pelvic cavity, ligaments, or the fallopian tubes.

Because these growths are made of endometrial tissue, they usually behave like the endometrium, responding to the hormones of the menstrual cycle. Each month, they build up tissue and slough it off. As a result, internal bleeding, inflammation, cysts, and scar tissue can develop in the affected areas.

Common symptoms of endometriosis include extreme pelvic pain during menstruation, ovulation, and/or sexual intercourse; excessive menstrual flow; fatigue; lower back pain; infertility; or, no symptoms at all. Endometriosis can also cause other serious problems, such as ruptured ovarian cysts and an increased risk of ectopic (tubal) pregnancy. The disease can be debilitating, even interfering with normal daily activities, for days, weeks, and even months at a time. Fortunately for you and your partner, diagnosis and treatment will make a difference.

A diagnosis of endometriosis can be tricky. It is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may even be confused with irritable bowel syndrome (IBS), which can cause abdominal cramping. Health care providers may try palpating the abdomen or taking an ultrasound to help determine the cause of pelvic pain. But the only way for your provider to diagnose endometriosis for certain is via laparoscopy, a minor surgical procedure that allows the provider to insert a slender viewing instrument to check for endometrial tissue.

The chronic nature of the disease creates enormous amounts of frustration for many of its sufferers. It is difficult to be young and seemingly healthy, but with an often unheard of disease and few, if any, visible symptoms. Adding to the frustration, most people do not know how or why they developed endometriosis, nor is their course of treatment ever clear. Each case of endometriosis is approached differently, usually incorporating trial and error to some extent.

One theory on the cause of endometriosis is retrograde menstruation. This theory suggests that during menstruation, some part of the endometrium backs up through the fallopian tubes and implants itself in the abdomen, where it begins to grow. The research which lends itself to this theory shows that many do, in fact, experience this "tissue back up." This research also suggests that an immune and/or hormonal system problem allows the tissue to take root and grow in those who develop endometriosis.

Unfortunately for women with endometriosis, a few myths about their disease persist. One myth claims that endometriosis is the "career woman's disease" brought on primarily by postponing or foregoing having children. In reality, 60 percent of endometriosis patients experience their first symptoms before the age of twenty-five. Another myth promotes the idea that early pregnancy helps to prevent or to provide immunity from the disease. And, some doctors and health care providers still believe that menstrual pain is psychological, so you can imagine what they think of endometriosis pain when it's first presented to them. All of these myths contribute to overlooked and misdiagnosed cases of endometriosis, as well as to the underfunding for research into the causes, risk factors, and treatments of the disease.

Perhaps your partner can try a few natural remedies (for relief of pain associated with endometriosis), after running them by her primary health care provider, of course. Eating fish rich in omega-3 fatty acids (e.g., salmon, tuna, whitefish, and sardines) may help suppress the production of prostaglandins, hormones that cause the cramping often experienced by endometriosis patients. An Ayurvedic practitioner recommends drinking lots of fresh fruit juices, especially dark grape, mango, papaya, and pineapple, at room temperature, not mixed with other juices, and throughout the day at times other than mealtimes.

One organization, Endometriosis Association International, has done a great job of providing support to people with endometriosis and pushing for more research into the disease. If you want a place to go for more information, not to mention support groups and other help for your partner, this would be the place. Also check out the reproductive health section at any bookstore or library for a few different books on endometriosis.

Wishing you and your partner all the best,


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