Women’s Health: Breaking Down Endometriosis, Ovarian Cysts, and Fibroids

For many women, it can still be difficult to openly talk about sexual and reproductive health, even when they feel something is off. This is partly due to the patriarchal origins of western medicine that often devalue women’s health concerns, and partly because many of the topics are still taboo today. Vernee Edwards, a doctor specializing in obstetrics and gynecology (read: women’s sexual and reproductive health), wants to move this conversation forward. She is helping us break down three common health concerns specific to females: Endometriosis, Ovarian Cysts and Fibroids.

“Not only are women’s sexual and reproductive health concerns valid, but even a lot of the ways we look at symptoms in women today is still based on only how they present in men and not how they present in women,” says Edwards. “For example, the symptoms of a heart attack in a woman are different than they are in a man,” points Edwards, who practices out of Crusader Health, in the greater Chicago area.

Edwards underscores: “Women’s sexual and reproductive well-being is an important issue because research tells us that when women are healthy, societies flourish. We have a direct impact on how our society functions.”

So what exactly are endometriosis, ovarian cysts, and fibroids? If you’ve been experiencing frequent pelvic pain, these may be at the root.

DISCLAIMER: This advice is not intended as a substitute for the advice of a qualified healthcare practitioner. Always seek medical advice that is specific to you and your situation.

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Endometriosis

Endometriosis is an often-painful disorder that develops as a result of abnormal uterus lining growth. It is what happens when tissue that normally only grows inside the uterus (endometrium) grows outside the uterus.

This growth can involve your ovaries, fallopian tubes and the tissue lining inside your pelvis. Rarely, it can also include tissues beyond your pelvic organs.

This tissue continues to behave as it normally would inside the uterus by thickening, breaking down and prompting menstrual bleeding with each cycle. This tissue can become trapped, leading to scarring, and may cause fertility problems, though effective treatments are available. Endometriosis can cause severe abdominal pain - especially during periods, but this is just one of the symptoms.

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What are the symptoms for Endometriosis?

- Menstrual pain that appears far worse than typical, lasting longer and can include the lower back (it can also worsen over time)
- Nausea, fatigue, diarrhea during periods
- Painful intercourse
- Pain with bowel movements or urination
- Bleeding that is heavier than normal, and may occur between periods
- Infertility

There are several risk factors that make a person more susceptible to having Endometriosis.

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Some of the risk factors of endometriosis include:

- Never giving birth
- Starting your menstruation at an early age
- Late onset of menopause
- Shortened menstrual cycles (less than 27 days)
- Heavier than typical bleeding during menstrual cycles, which lasts longer
- Being exposed to higher levels of estrogen or for a longer exposure over the course of a woman’s life
- A history of endometriosis in the family (mother, sister, etc.)

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What you should know about endometriosis:

“Endometriosis is complex,” says Edwards. “Often, women’s pain is mismanaged or not managed very well, and patients can become frustrated. This is partly due to how unique each case is.” Edwards also says that there ought to be room for Eastern medicine as part of pain management. Endometriosis can also impair a woman’s ability to bare children. About a third to half of the women with endometriosis have a hard time getting pregnant. Delaying pregnancy may lower chances further.

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Ovarian Cysts

Ovarian cysts are often harmless fluid-filled sacs attached to the ovaries (women typically have two ovaries, on either side of the uterus). There are different types of cysts, crudely grouped into two categories: functional cysts (related to normal function of the menstrual cycle) and other types (including cysts linked to endometriosis). “Ovarian cysts are very common,” says Edwards. Many women experience ovarian cysts at some point in their childrearing years. Most are not even noticeable. “A lot of the time, these cysts will resolve on their own within a few months.” However, cysts can occasionally be quite painful, especially if they rupture, and can on rare occasions cause serious symptoms.

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What are the symptoms for Ovarian Cysts?

Most cysts don’t have symptoms. Occasionally, large or ruptured cysts do produce the following symptoms:

- Large cysts can cause pelvic pain (dull or sharp ache on the side of the ovary with the cyst)
- Fullness in the abdomen
- Bloating

If the following symptoms occur, seek immediate medical attention:
- Sudden, severe abdominal pain
- Pain with fever or vomiting
- Cold, clammy skin
- Rapid breathing
- Lightheadedness or weakness


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Some of the risk factors of Ovarian Cysts include:

The most common ovarian cysts develop as a result of normal menstrual cycles. However, they can also develop due to:

- Hormonal problems
- Pregnancy
- Endometriosis
- Severe pelvic infection
- Prior ovarian cysts (if you’ve had them before, you’re likely to have them in the future)

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What you should know about Ovarian Cysts:

Doctors may occasionally find other less common types of cysts during pelvic exams (one reason why regular exams are important). Cystic masses that develop following menopause may be cancerous. Other complications include ovarian torsion (when cysts become so large they can cause the ovary to move out of its position, potentially causing it to twist).

Sudden severe pelvic pain, nausea or vomiting is a sign that this is happening, and this can cause a decrease or complete stop of blood flow to the ovary. Cysts can also rupture, particularly the larger ones.

Keep track and note any changes in your monthly cycle, including unusual menstrual symptoms that last more than a few cycles. “Putting women on birth control pills temporarily may help control the occurrence of cysts, but if they’re already present, taking birth control won’t necessarily make them go away,” cautions Edwards.

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Uterine Fibroids (also known as leiomyomas or myomas)

Many women develop uterine fibroids at some point during their child-rearing years, and may not even know it. Fibroids are commonly noncancerous growths that develop in the uterus, and can range in size from tiny, undetectable seedlings to bulky growths that can distort the uterus. A woman can have a single fibroid or many growths. At its extreme, multiple fibroids can expand the uterus so much that it reaches the rib cage.

Fibroids almost never develop into cancer, but they can be related to ‘subfertility,’ making getting pregnant more difficult (though not always impossible).

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What are the symptoms for Fibroids?

Most fibroids don’t cause symptoms. Occasionally, women who do experience symptoms note:

- Heavier than normal menstrual bleeding
- Longer periods (lasting more than a week)
- Pelvic pain, more notable than usual
- Frequent urination
- Difficulties completely emptying the bladder
- Constipation
- Backache or leg pains
- Sometimes, fibroids can cause sharp pains when it outgrows its blood supply and starts to die off

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Some of the risk factors of fibroids include:

- Black women are more likely to have fibroids than are women of other races. Black women also have fibroids at younger ages, and are more prone to having larger fibroids and more noticeable symptoms
- Hormone changes (estrogen and progesterone fuel fibroid growth)
- Other growth factors that help the body maintain tissues
- Genetics matter. If her mother or sister have fibroids, a woman is more likely to have fibroids
- Like with endometriosis, early onset of a girl’s period is also linked to fibroids
- Other factors include obesity, vitamin D deficiency, and a diet high in red meat and lower in green vegetables, fruit and dairy
- Alcohol drinking, including beer, also appears to increase the risk of fibroids.

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What you should know about Fibroids:

There are three different types of fibroids, depending on where they are growing (within the uterine wall, in the uterine cavity, or outside of the uterus). Fibroids can grow and shrink at different rates, and can disappear altogether, especially following pregnancy.

While fibroids in and of themselves usually aren’t dangerous, the heavy bleeding and loss of red blood cells may lead to anemia. Also, most fibroids shouldn’t pose a problem to getting pregnant. However, submucosal fibroids (fibroids that bulge into the uterine cavity) may cause infertility or pregnancy loss. “With cases that become more complex, and have more significant symptoms, seeing a specialist is going to be very important to get more information and gage the next steps in terms of management,” says Edwards.

Bottom line: it’s important to be an advocate for your health and wellness. Don’t be shy to ask for support.

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