PMS Guide |

Endometriosis, just like menstrual cramps, may exist alone or in combination with premenstrual syndrome, or there is a third alternative—some women have endometriosis, menstrual cramps, and premenstrual syndrome together during every menstrual cycle. These women suffer terribly.

Endometriosis is a disease in which the tissue that forms the endometrium, the lining of the uterus, spreads to the organs outside the womb. During the last half of a woman’s menstrual cycle—the two weeks that begin with ovulation and end in menstruation—the lining of the uterus grows rich in glandular tissue and blood vessels. Steadily, naturally, an emerging vascular layer turns the endometrium into a soft, spongy nest, a bed for a fertilized egg.

At this point, the endometrium exists to nurture fertilization, so if an egg is not fertilized, the body has no reason to keep this enriched lining. The cycle comes to an end. A woman’s uterus begins rhythmic contractions that disturb the blood supply to the uterine lining and cause the unused endometrium to detach from the womb and leave the body as menstrual blood.

When a woman is healthy, the regular contractions of her uterus push the uterine lining, the sloughed-off endometrium, first through the cervix, the mouth of the womb, and then through her vagina. But a woman who gets endometriosis often has a constricted uterus and a tight cervix, which do not let all the menstrual blood escape vaginally. Instead, a portion of the blood-filled uterine lining is pushed backward through the Fallopian tubes and sprayed out the tubes into the abdomen. Such a woman usually has a history of menstrual cramps.

Women with severe menstrual cramps have in their uterine linings high levels of prostaglandins, which can produce contractions similar to the ones experienced during labor and childbirth. In these women, the chances are great that their blindingly painful contractions will push the endometrial tissue into places where it can run wild. Endometrial tissue that has been flushed into the Fallopian tubes and sprayed out into a woman’s abdomen can implant itself on her ovaries, on the outside of her uterus, and in the cavity between the uterus and the rectum called the cul-de-sac. The tissue can begin to grow like a transplant on any of its new locations, and once that happens, endometriosis has begun. It should be noted, however, that even if a woman does not have severe cramps, tissue can still be pushed backward into the abdomen to cause endometriosis.

Each month, the fluctuation of the hormones estrogen and progesterone, which causes the production of the endometrium inside the uterus, is also having an effect on the endometriosis outside the uterus. The tissue thickens, bleeds, and, since it has no escape, spreads throughout the abdominal cavity. Sometimes, as it expands and bleeds, the tissue breaks off in cystic chunks that implant themselves elsewhere and cause severe abdominal pain.

An endometrical mass spreading behind a uterus can pull and tilt the womb backward. The tissue can move into the ovaries and Fallopian tubes, where it causes infertility. Endometriosis can even enter into the bowls and create bloody stools and pain during peristalsis, bowel movement. The tissue can penetrate the wall of the bladder, grow into the bladder, and then attack the kidneys and rectum. There have also been cases where endometriosis has spread to the lungs and—unbelievable as it may seem—the brain. If left untreated for years, endometrial tissue can even become cancerous.

However, if a woman can monitor her body for the distinct symptoms of the hidden disease, as endometriosis is called, she can possibly catch it at an early and curable stage. The symptoms of the disease include a possible painful ovulation two weeks before menstruation, severe cramps during menstruation, and a deep abdominal pain on one side or the other or an unspecific abdominal pain before or after menstruation. Other signs are infertility and pain during sexual intercourse. Many women who are infertile and are told they have no physical defects may, indeed, have endometriosis. During the course of the disease, pelvic pain caused by pressure on a woman’s organs and nerves slowly intensifies.

The main treatment used by knowledgeable doctors today involves a new, breakthrough drug called Danocrine (danazol), a synthetic derivative of the male hormone testosterone, which stops ovulation and gives a woman a “pelvic rest.” Danazol, which is the generic name for the drug, blocks the release of the brain hormones FSH and LH, which set the menstrual cycle in motion. A woman’s ovaries are not stimulated to release an egg, so there is no ovulation and estrogen and progesterone hormones do not increase. Estrogen and progesterone remain on the same steady low levels that are normally found after menstruation, a time when most women feel their best. When a woman does not ovulate and her female hormones do not fluctuate, there is no buildup of the endometrium and no chance for endometriosis to grow.

When a woman takes Danocrine-200-milligram tablets two, three, or four times daily, depending on her symptoms—for six to nine months, the endometrial tissue dies and, like all dead tissue, it is slowly reabsorbed by the body and disappears. Of course, a woman does not menstruate while she is on the medication.

Surgery should be performed as a treatment for endometriosis only when a woman has large masses that must be removed. However, a physician should not attempt extensive surgery with the goal of removing the disease totally, because he will never be able to succeed. A surgeon cannot remove every bit of endometriosis in a woman’s body. After surgery, the disease will come back. A woman’s doctor may tell her that he has cut, burned, or scraped all of the endometriosis away, but if a woman is not placed on danazol after her operation, the disease will always return. A woman ought to be placed on danazol therapy both before her operation, to reduce the endometrial growth, and after it, to prevent a reappearance of the disease.

It is possible that after her endometriosis has been treated a woman might develop mood swings and other symptoms of premenstrual syndrome. Fluctuation of the female hormones estrogen and progesterone affects both endometriosis and premenstrual syndrome. If a woman has—or has had endometriosis, she may also have a hormonal imbalance and may be more prone to PMS than a woman who has never been diagnosed as someone with the hidden disease. Once a woman has endured one form of menstrual distress, she should be on the alert for signs of others, even though they are technically not related.