Bleeding of other organs during the menstrual cycle is due to a condition known as ‘endometriosis’.
In this condition, tissue that normally lines the inside of the uterus (womb) is found attached to other organs.
It can attach to the fallopian tubes, ovaries, intestines, lungs and even the brain.
Q: I am a 43-year-old woman and ever since I was a teen, I have had severe period cramps. The pain usually starts a few days before my menses and lasts a few days after they are gone. The menses are quite heavy and occasionally I bleed in the middle of my cycle. For the past 10 years, I have been unsuccessfully trying to get pregnant. After years of investigation, my doctor told me that I have endometriosis of the ovaries. He says that my ovaries bleed during my menses. I am horrified. How is that possible? How can I stop them from bleeding? Will I ever conceive?
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Bleeding of other organs during the menstrual cycle is due to a condition known as ‘endometriosis’. In this condition, tissue that normally lines the inside of the uterus (womb) is found attached to other organs. It can attach to the fallopian tubes, ovaries, intestines, lungs and even the brain. This abnormally placed uterine tissue responds to hormones (just like the lining of the womb) and thus, bleeds every month.
Most women with endometriosis of the pelvic organs (ovaries and tubes), experience pain, heavy menses, bleeding in between the cycle, lower back pain, discomfort when passing stool or urine during the menstrual period, pain after sex and infertility.
A few women with endometriosis do not have any symptoms. Those with endometriosis of the brain may get seizures during their menses.
Endometriosis of the lungs can cause chest pain and coughing up of blood.
Is there a cure for endometriosis?
Unfortunately, for most women, endometriosis cannot be cured. However, the symptoms can be controlled. Treatment options include medication or surgery. Most gynaecologists start with conservative (medical) methods first.
Pain control: For most women with endometriosis, pelvic and back pain is the major complaint. This can be managed with over-the-counter painkillers. A doctor can prescribe stronger pain medication if the others don’t work.
Hormonal therapy: Use of hormonal contraceptives helps regulate the cycle and reduce or even stop menstruation. This proves effective for most women. Hormonal contraception includes pills, injections, implants, patches and vaginal rings.
Another option for hormonal therapy is use of drugs known as ‘gonadotrophin-releasing hormone (GRNH) agonists’ which reduce the production of oestrogen. Usage of these drugs can stop menstruation.
Danazol: This is a steroid drug that has similar effects as testosterone. It stops menstruation and the symptoms associated with endometriosis. However, it has side effects such as acne and male pattern hair growth, for example, growing a beard.
Surgery: This is done as a last resort. Body parts with abnormally placed uterine tissue are cut out without damaging the reproductive organs. Surgery is recommended after all other methods have failed or if endometriosis is preventing someone from getting pregnant.
Surgery can be done either laparoscopically (keyhole surgery) or open surgery that involves making larger cuts on the belly. Laser surgery has become a relatively popular option (in this situation, the areas with abnormal tissue are ‘vaporised’ with laser).
Hysterectomy: This is removal of the uterus, tubes and cervix. Most gynaecologists will also remove the ovaries. This radical approach is normally done as a last resort for women after other options have failed.
Endometriosis and menopause
Usually, endometriosis ceases to be a problem after menopause. This is because of the drop in production of reproductive hormones after menopause. However, if you start on HRT (hormonal replacement therapy) after menopause, endometriosis symptoms may recur.
Endometriosis and infertility
Women with mild forms of endometriosis can successfully carry a pregnancy to term (even multiple times). However, almost half of the women with endometriosis have problems conceiving. Endometriosis distorts the architecture of the reproductive organs, causing blockage and making it difficult for sperm to swim to the eggs and fertilise them.
Most women with infertility related to endometriosis need surgery to remove the abnormal tissue and any scars that are in the reproductive system. If you still cannot conceive after surgery, talk to your doctor about fertility treatment and in vitro fertilisation.
Generally, women with endometriosis are advised to get children earlier in their reproductive lives (it becomes more difficult to conceive as one ages).
Endometriosis and cancer
Endometriosis is not a form of cancer. The areas with endometriosis usually do not become cancerous as one becomes older so this should also not be a concern. Endometriosis has, however, been associated with rare forms of ovarian cancer but the incidence of these cancers is very low (less than one per cent).
