Conditions and Management

Endometriosis is a common disorder of a woman’s uterus. It typically affects the pelvic organs ovaries, fallopian tubes, bowels, bladder, rectum, and the tissue lining your pelvis, but it can affect any other organ in your body.

Endometriosis implants respond to changes in estrogen, a hormone in a woman’s body. Endometriosis cells respond to your menstrual cycle and bleed just like the normal endometrial cells lining the inside of your uterus. Endometrial cells in your body or on your organs cause inflammation and discomfort and can interfere with the normal functioning of the affected organs.

In some cases, endometriosis can block your fallopian tubes and it can also cause cysts in your ovaries (endometriomas). It can form scar tissue and adhesions that can bind your organs together in ways that can cause significant pain and quality of life issues for you.

Common Causes of Endometriosis

Endometriosis affects about 10% of American women between 15 and 44. It is not a condition that can be prevented. Despite the prevalence of the disease, medical researchers are uncertain about the precise causes of endometriosis; however, it tends to run in families. It also occurs more often in women with certain menstrual patterns. Common theories of the causes of endometriosis include:

Retrograde Menstruation

One long-standing theory on the cause of endometriosis is called “retrograde menstruation”.
In a normal ovulation cycle, your uterine lining—the endometrium— thickens just before ovulation to provide a cushion for an egg released from your ovary. If the egg is not fertilized, the endometrium breaks down and bleeds with your menstrual cycles. Your body expels the endometrial tissue along with any unfertilized egg through the vagina.

Retrograde menstruation occurs when menstrual blood flows back through your fallopian tubes into your pelvic cavity instead of leaving your body through the vagina. That could allow endometrial cells to reach other organs of your body and attach to them.

Embryonic Cell Transformation

Another possible cause of endometriosis is cell transformation. The theory is your hormones transform the cells outside of the uterus into cells like the endometrial cells lining the inside of your uterus.
Embryonic cell transformation is the theory that small areas of your abdomen convert into endometrial tissue. The basis for that theory is that cells in your abdomen grow from embryonic cells. Embryonic cells can change shape and become endometrial-like cells.

Surgical Scar

Another theory for the cause of endometriosis is a surgical procedure that can release microscopic particles of menstrual blood into the pelvic cavity. It can be any procedure involving the pelvic area, such as a Cesarean section (c-section).

Immune System Malfunction

A faulty immune system could be another culprit. When the body cannot expel the cells through the menstrual process, the body’s immune system may destroy them. However, an immune system that is not healthy may be unable to destroy renegade endometrial cells. In that case, the cells eventually will attach themselves to other organs.

Lymphatic System

Your lymphatic system may transport the endometrial cells out of the uterus and into other parts of your body.

Mullerian Theory

This theory holds that endometriosis actually starts in the woman’s fetal period during the development of her sexual organs. Abnormal cell development of certain ducts (known as Mullerian ducts) may occur and endometrial cells grow outside of the uterus. Those cell tissues then respond with the onset of puberty and hormone releases.

How to Diagnose Endometriosis

You should discuss your symptoms with your doctor. To diagnose it, your doctor may perform one or more of the following procedures:

• Pelvic exam, where your doctor may feel for large cysts or scar tissue behind your uterus.
• Ultrasound or MRI to detect ovarian cysts.
• your doctor may prescribe hormonal medications to reduce pain and lower the amount of estrogen in your body.
• Laparoscopy, a surgical procedure that allows the doctor to observe any growths and take tissue samples for analysis.

Talk to the Experienced Gynecologists at Raleigh Gynecology and Wellness

Endometriosis is a common condition in many women. Symptoms can include pelvic pain, pain with intercourse, abnormal menstrual bleeding, and abnormal bowel or bladder function. It also can interfere with your ability to become pregnant, and if left untreated, can result in infertility. The specialists at Raleigh Gynecology and Wellness are available to answer your questions about endometriosis and talk to you about symptoms and treatment. Contact them today for more information about endometriosis or any other women’s health matter and schedule an appointment.

Endometriosis can be a painful condition for many women. It occurs when microscopic bits of endometrial tissue escape from your uterus, attach to other organs in your body and grow. It usually affects organs in your pelvic area such as ovaries, fallopian tubes, and the tissue lining your pelvis, but it can affect other organs in your body.

Medical experts are not sure exactly what causes endometriosis. Some experts believe that small amounts of menstrual blood containing endometrial cells find ways to pass back through your fallopian tubes and spill into your pelvic cavity, where they can attach themselves to your organs. Other experts believe that women have a genetic predisposition to the condition.

Symptoms of Endometriosis

The symptoms of endometriosis resemble symptoms for other common disorders. Also, some women with extensive endometriosis will have few symptoms, while other women with a mild case can experience severe symptoms. All of this makes diagnosing endometriosis difficult.

How do you know if you have endometriosis? Some of the most common symptoms are:

Unusual Pain and Cramping

Many women experience cramps during their menstrual period. With endometriosis, the cramping may be so painful that it interferes with your daily activities.

The pain and cramping are caused by the endometrial-like cells that are growing outside of your uterus on other parts of your body. These cells create inflammation that can irritate your organs and cause them to stick together.

This endometrial-like tissue acts like the normal endometrial tissue lining your uterus. It thickens, breaks down and bleeds just like the healthy endometrial tissue. However, the healthy endometrial tissue lining your uterus is expelled through your vaginal canal during menstruation; this is not the case with the endometrial tissue growing outside of your uterus. Your body has no way to expel that tissue residue once it breaks down. The spent tissue becomes trapped and with no way to escape the body, it can form cysts, called endometriomas, irritate other organs and tissue, and develop scar tissue and adhesions.

You may also have pain and cramping during sexual intercourse and with bowel movements or urination when you are menstruating.

Excessive Bleeding

Women with endometriosis often experience heavy menstrual periods, longer than normal periods, or bleeding between periods.

Lower Back Pain During Menstruation, Bloody Urine or Stools, or Bleeding from the Rectum
If you only experience these symptoms during menstruation, or if they worsen during menstruation, one possible cause could be endometriosis.

Infertility

As many as 40% of women who have trouble getting pregnant have endometriosis. The exact reason is unclear, but medical experts suspect that inflammation plays a role. The inflammation caused by endometriosis damages the sperm or egg or makes it harder for them to move. Also, endometrial scar tissue might block your fallopian tubes.

Other

Other symptoms of endometriosis include fatigue, nausea, diarrhea, or constipation and bloating.

As noted earlier, these symptoms can be vague and sporadic. The severity of the symptoms is not indicative of the severity of the case. If you experience the symptoms frequently or regularly during your menstrual cycle, you should be examined for endometriosis.

How Endometriosis Is Diagnosed

Diagnosing endometriosis can be difficult, especially when you have few if any symptoms. You cannot safely self-diagnose it; the symptoms make the condition easy to mistake for other types of health disorders such as irritable bowel syndrome or ovarian cysts.

Diagnosis and subsequent treatment involve a multiple-step process:

Pelvic Exam

The first step in diagnosing endometriosis is a pelvic exam by your gynecologist. Your gynecologist will manually examine your pelvic area for abnormalities.

Ultrasound of Your Pelvic Region

An ultrasound test uses high-frequency sound waves to create images of the inside of your pelvic region. It may be performed by pressing a device called a transducer against your abdomen or inserting it into your vagina.

Magnetic Resonance Imaging (MRI).

An MRI uses a magnetic field and radio waves to create detailed images of the organs and tissues within your body. It can give your gynecologist a detailed view of cysts and scar tissue that can help in treatment.

Laparoscopy

The best diagnostic exam for endometriosis is a laparoscopy. It is a surgical procedure that allows a surgeon to view inside your abdomen using a slender viewing instrument called a laparoscope. During a laparoscopy, your surgeon may be able to fully treat endometriosis possibly eliminating the need for another surgery.

Contact Raleigh Gynecology

Endometriosis is a serious health condition that often escapes early diagnosis. It can cause infertility and other health problems. It also may raise your risk of ovarian cancer or another cancer called endometriosis-associated adenocarcinoma.

If you are having any symptoms of endometriosis, it is important to get it diagnosed and treated as soon as possible. Contact the women’s health and reproductive specialists at Raleigh Gynecology and Wellness for more information and to schedule an appointment.

Emergency Contraception Explained

The term “emergency contraception” refers to a post-coital birth control regimen that is administered to a woman for the purpose of preventing a pregnancy. They work by delaying a woman’s ovulation. Emergency contraception should not be used to terminate a pregnancy. Also, emergency contraception pills will not treat or prevent sexually transmitted disease.

Events that warrant emergency contraception include a failed birth control method such as missing two or more birth control pills during a monthly cycle. Emergency contraception is also appropriate after a woman has unprotected sex, such as a condom failing during sex, or rape.

Forms of Emergency Birth Control Used to Prevent Pregnancy

Emergency contraception is administered in one of two ways: pills given orally, or intrauterine device (IUD).

Some pills require a prescription and may only be sold to women over the age of 17. Other brands of contraceptive pills are available without a prescription.

Common Types of Emergency Contraceptive Pills

Different types of emergency contraceptive pills are available. Which ones are best for you depends largely on how much time has elapsed since your unprotected intercourse? Other factors are relevant, too, as explained below.

Hormone-Based Pills

Several brands of emergency contraceptive hormone-based pills are available without a prescription. These pills contain the hormone levonorgestrel. Only one dose of one pill is needed. It works by temporarily blocking the woman’s eggs from being released, by stopping fertilization, or by keeping a fertilized egg from becoming implanted in the uterus. Common brands include:

• Plan B One-Step®
• My Way
• Take Action

To be most effective, it should be taken as soon as possible after unprotected sex but no more than 72 hours afterward. When taken as directed, levonorgestrel can reduce the chance of pregnancy by close to 90%.
If you are over age 17 and want to use the two-dose version, you can ask your pharmacist for it. It is sold under the brand name of Next Choice®. You need to take one pill as soon as possible within 3 days after unprotected sex and the second pill 12 hours later.

Levonorgestrel will not terminate a pregnancy.

For women who are overweight, however, levonorgestrel may not be effective. The better contraceptive regimen for these women is an IUD. An IUD will prevent pregnancy by preventing a fertilized egg from implantation in the uterus. The IUD must be inserted within 5 days of having unprotected intercourse. IUDs are also highly effective at preventing pregnancy.

Ulipristal Pills

Contraceptive pills containing ulipristal require a prescription. Ulipristal is a non-hormonal drug that works by interfering with key hormones necessary for conception. The brand name for this drug is Ella®. Only one tablet in one dose is needed. It can be taken up to 120 hours after sex.

If you may be pregnant, consult with your healthcare provider about taking Ella®. The effect of the drug on the fetus is unclear.

Birth Control Pills

Birth control pills can also be used as emergency contraception, but they are not as effective as those described above. Using birth control pills in this way can also make you nauseous because you have to take more than one pill at a time to prevent a pregnancy. If you opt for this treatment, you will need to consult with your healthcare provider to acquire a prescription for the correct pills and dosage.

What Are the Side Effects of Emergency Contraceptive Pills?

Contraceptive pills are safe, but they can cause side effects. They include nausea, abdominal cramps and pain, fatigue, headaches, and irregular menstruation. Your healthcare provider can discuss these and any other risks with you.

You should not use emergency contraceptive pills as a form of birth control. Moreover, you should be careful when taking emergency contraceptive pills along with birth control pills. Be sure to discuss this with your healthcare provider.

Is the Cost of Emergency Contraceptive Pills Covered by Insurance?

Yes, most health insurance plans cover FDA-approved prescriptions for emergency contraception and birth control at no cost to you. Since you can buy Plan B One-Step® without a prescription, talk to your health insurance provider to find out if your plan covers over-the-counter emergency contraception. Your plan may require you to get a prescription if you want your insurance plan to pay for it.

If you have Medicaid, check with your state’s Medicaid program for information about coverage for emergency contraception. Coverage varies between states.

Another way to find emergency contraceptive pills at low or no cost is to contact a local family planning clinic. You may be able to get emergency contraception from them for free or at a significantly lower cost than you would pay at the pharmacy.

Consult with Raleigh Gynecology and Wellness

For more information about emergency contraception and the best birth control option for you, be sure to contact the women’s health specialists at Raleigh Gynecology and Wellness. They can answer any of your questions about these and any other women’s health issues and schedule an in-person appointment.