Endometriosis: an invisible illness with a major impact

A patient gets an ultrasound checkup for her uterus in this file photo. According to government data, 111,214 women were diagnosed with endometriosis in 2017. /Korea Times file

By Bahk Eun-ji

Endometriosis is a common gynecological condition that affects about 60 percent of women in their 20s to 40s, but if the pain is unusually serious, doctors advise them to be checked for lesions in their uterus, ovaries or fallopian tubes. For those with endometriosis, coping with period cramps often requires more than just taking a pain reliever such as ibuprofen or acetaminophen.

Kim Hye-won, 31, living in Songpa-gu, Seoul, recently felt her period pain becoming more severe. When Kim's younger sister, who had surgery to remove fibroids in her uterus a couple of years ago, said she had similar symptoms, Kim immediately visited her gynecologist and she was diagnosed with endometriosis.

“I became accustomed to period cramps to a degree over the years, but this time, the pain was sharp and suddenly became unbearable. I initially thought it was probably because I was under a lot of pressure at work, but my sister said I might need a doctor's help,” Kim said.

Endometriosis is a disorder in which tissue similar to that lining the inside of the uterus grows outside of it. This endometrial tissue most commonly grows in the pelvic area and while it can occur elsewhere, it is rare. This endometrial tissue works the same way outside the uterus as it would inside and where it would usually be expelled during menstruation, it becomes trapped in the body, leading to physical symptoms such as severe pain.

“The period cramps women get during their period can be tough, but if she has endometriosis, the pain can be so intense that it can even affect her daily routine,” said Sang Jae-hong, professor of Soonchunhyang University Medical Center.

The number of patients in Korea diagnosed with the condition is steadily increasing. According to data from the Korea Health Review and Assessment Service (KHRA), 111,214 women were treated for endometriosis in 2017, a 31 percent increase from 84,583 in 2013. Among those treated in 2017, more than 90 percent were in their 20s to 40s.

How it affects pregnancy

When the cells which grow outside of the uterus break down and bleed, as it would in the womb, it can cause inflammation and pain. Some women with endometriosis have trouble getting pregnant.

“The main cause is that the endometrial cells cause inflammation, which interferes with the delicate balance of hormones that women need to become pregnant,” Sang said.

Other complications include an increased risk of developing ovarian cancer, ovarian cysts, and intestinal and bladder complications.

Treatment

“Treatment for endometriosis should take into account the severity of symptoms, age, and future pregnancy plan of the patients. Even after treatment, there is a high chance of recurrence, so the direction of the treatment should be set up to preserve reproductive function if she plans to get pregnant,” Sang said.

Over-the-counter medications such as ibuprofen and acetaminophen can help minimize the pain even if it doesn't go away completely. Surgery and hormonal therapy can also help reduce the discomfort from the illness.

Hormones can be effective in treating the symptoms as hormones causes endometriosis patches to go through a cycle similar to the menstrual cycle. Hormone therapy is used to ease the pain. Patients will be treated with the hormones in the form of a pill or an injection. The treatments stop the ovaries from producing hormones, such as estrogen, and usually prevent ovulation. This can help slow the growth and local activity of both the endometrium and the endometrial lesions.

Surgical treatment can be recommended by doctors to treat severe pain from the disorder. Patients should understand the risks before the operation because some procedures cannot be reversed, and can affect a woman's fertility.

“Therefore, patients should discuss all available options before making their final decision about surgical treatment,” Sang said.