Healthy Memphis: Fibroids and endometriosis can cause heavy menstrual pain and bleeding

What you should know

Many women suffer from heavy or painful periods. Others have bleeding between periods. Pain and bleeding might result from two conditions — fibroids or endometriosis — which cause extra tissue to grow in the pelvic area.

Fibroids and endometriosis are linked to estrogen, a female hormone. Estrogen is essential to the menstrual cycle. Every month, hormones cause the lining of a woman's womb (uterus) to build up. Too much or too little estrogen can affect fertility. Estrogen also affects many female characteristics such as low body hair, breast size, and the amount of fat in the hips and pelvis. Research shows that estrogen helps to maintain bone density and high-density lipoproteins (HDL, the "good" cholesterol). Regular exercise decreases body fat and the amount of estrogen the body produces.

Most American women will develop fibroids at some time. These non-cancerous uterine tumors are very common among women before age 50. After menopause, fibroids often shrink. African-American women over 35 years old also seem to be more likely to have fibroids.

Fibroids can be small or large. Many women do not realize they have fibroids until they have painful symptoms.

Fibroids can become so large that they press on surrounding tissue or even project outside of the uterus. Fibroids can cause an enlarged abdomen or painful sexual relations. Some women develop constipation or urinary problems. Others may suffer backaches from the pressure. Fibroids that grow inside the uterus can cause very heavy periods. Fibroids might also lead to multiple miscarriages or early labor.

Endometriosis occurs when tissue that normally lines the uterus grows somewhere else. Laparoscopy is often the best test to diagnosis endometriosis. The misplaced tissue might grow around the ovaries or fallopian tubes, at the bladder, or around the colon. Endometriosis can reduce or block fertility and create severe pain and bleeding.

Some women have a higher risk of endometriosis. It is more common among women who have never had children. Endometriosis also seems to run in families. Pelvic infections or injuries can create scar tissue or damaged cells that can block blood flow or encourage tissue growth.

There are many treatment options for both fibroids and endometriosis. Over-the-counter pain medication helps many women. Medical treatment might include birth control pills, an IUD (intrauterine device) that releases hormones, or other hormone prescriptions to change hormone levels. In severe cases, laparoscopy or laparotomy could be recommended to remove excess tissue or to cut off the supply of blood that feeds the misplaced or excess tissue. Other surgical procedures can include endometrial ablation or a D&C (dilatation and curettage) to remove the lining of the uterus. In extreme cases, a hysterectomy surgically removes the uterus altogether.

Fibroids are an important public health concern. They distress many women. Experts suspect that too many hysterectomies are done to treat the symptoms. Newer and less invasive techniques may work best for many women.

What you should do

Get a checkup for distressing symptoms of fibroids or endometriosis. A pelvic exam is likely. An ultrasound of the uterus and the ovaries may reveal the cause of heavy bleeding, pain, infertility or bloating. It is possible that your doctor will recommend a diagnostic laparoscopy if symptoms are severe.

Get help for cramps so bad that you often miss work or school or if you have pain or bleeding between periods.

Do your homework before agreeing to treatment options. Some treatments control symptoms. Other options can shrink excess tissue. Some choices are irreversible. Early menopause can occur if the ovaries are removed. A hysterectomy removes the womb (uterus).

Consider your age, severity of symptoms, condition, budget, and whether you want children later. For young women who might want start a family later, do not wait too long to get help for endometriosis. Severe endometriosis can make it harder to have children in the future.

Think about tactics to improve your pelvic area and lower your estrogen. Keep your body fat low. Exercise daily. Get pelvic muscles in shape. Work on your posture. Avoid foods and drinks that might increase estrogen.

Learn about causes of abnormal bleeding. Just before menopause and when it begins, women might not ovulate every month. This can cause heavy, lighter or irregular bleeding. Also, bleeding can be due to pregnancy or cancer.

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Better Health: TAKE CHARGE! is provided by the Healthy Memphis Common Table: This article supports the care and advice of your doctor.