7 Reasons Why Endometriosis is a True Emergency

Endometriosis doesn’t rank very high on the “emergency” list of medical and health problems. No one is calling 9-1-1 for it. This is because it is often an insidious process that becomes evident only after considerable damage has been done. Simply, the glandular tissue of the innermost lining of your uterus (womb) is not meant to be anywhere else but where that innermost lining-type tissue should be. When this tissue type is anywhere else, it creates a considerable amount of inflammation. Inflammation gets the rest of the nearby organs squawking, creating biochemical reactions that can cause tissue to migrate and stick to other tissues. Therefore, besides a biochemical sabotage, there is mechanical obstruction to the normal goings-on of ovulation, conception, implantation, and pregnancy in general.

Why doesn’t endometrial tissue cause the same problems in your uterus?

Simply, it doesn’t cause problems because it leaves. It sloughs and is discarded as menstrual (period) debris. However, inside your pelvis, this tissue is a captive audience and overstays its welcome very quickly. Heavy, painful periods, colic, pelvic pain, and painful sex are just the beginning, and not all beginnings have an end. Therefore, because endometriosis is progressive, sneaky, and unrelenting, there comes a point at which it should be considered an emergency because of what’s at stake:

The above represent six reasons why endometriosis should be considered a true emergency. No, it’s not in the same league as, for example, a ruptured aortic aneurysm, but if infertility results in prevented people—the birth of children—that should qualify as life-threatening to them. If a person is involved in an automobile accident with fractures of his or her femurs, this emergency should garner no greater respect than a condition (endometriosis) which continues as a life of disabling pain for a woman.

1. Emergency: Risk to Fertility.

Fertility is a big deal to those who want children in their future. For many, this generational march through a family’s legacy is a major drive in their lives. It goes way beyond merely legacy, however. It’s a fulfillment—a consummation of one’s existence, giving importance to one’s life. (Those who do not want children don’t get a pass with endometriosis: see Emergencies 2 through 7 [BELOW].)

2. Emergency: Hormonal Function.

Endometriosis, when it implants on or in your ovary, can have its contents accrue as a trapped container of fluid, which is called a cyst. The cysts of endometriosis are called “chocolate cysts” because the fluid trapped there is old blood and cellular debris (menstrual tissue) that has a dark brown color. The ovaries are part of both a positive and a negative feedback system involving a continuity of interrelated functioning structures: your hypothalamic-pituitary-ovarian axis. When there is an inflammatory mass within the ovary, this delicate balance between cyclic stimulation and inhibition (the ovarian, or menstrual cycle) can be mucked up, interfering with ovulation. When ovulation is dysfunctional, the hormones can all get thrown off. Excesses from hormone production stuck in one part of your cycle or deficiencies of same can alter an entire lifestyle quickly.

3. Emergency: Sexual Health

Crucial to a loving relationship between partners is the ability to express intimacy and feelings physically. Endometriosis is commonly the cause of pain that can be evoked by the mechanical act of intercourse. Thus, prohibitively painful sex is more than sexually unhealthy; it is also relationship-unhealthy.

4. Emergency: Employment

Anyone who suffers from inflammatory bowel disease, migraines, or any other unpredictable disabling condition will share the same risk that women with endometriosis have: absenteeism. Unfortunately, in the reality of bottom lines and profit margins, absenteeism does not survive well in the business world. The outcome of such unreliability is the same for all of these conditions—loss of employment. The business must go on, even if you cannot. Your employer cannot allow your problem to become his or her problem. You’re replaceable. It’s not personal…it’s just business.

5. Emergency: Emotional Stability

Pain that comes and goes relentlessly in inconsistent, painful cycles will affect mood directly, but indirectly there are neurological changes that come with pain: anger and depression. This exacts a toll on those closest to you when you lash out or withdraw. It’s not just getting cranky. It’s true emotional pathology.

6. Emergency: Every Other Organ

The inflammatory changes in the pelvis directly damage other tissues but also launches a very robust immunologic counterattack. The body tends to wall off problem areas, and the organs of the pelvis can end up adhered in this process of secluding away these problem areas. This will then interfere with their function, which can be progressive.

7. Emergency: Wear and Tear on Your Biological Clock

Everyone has a hormonal expiration date, whether it’s adequate testosterone production in men or the menstrual cycle in women. As such, this means that if you plan to use your pelvic organs for reproduction, the closer you get to menopause the more your window of opportunity closes. In “Emergencies” 1 and 2 above were discussed the loss of fertility and the hormonal support for the menstrual cycle, respectively. The wear and tear on your biological clock go further than those, however. For example, there are over 200 functions for the hormone estrogen. This means that many aspects of your physiology will convert to a different way of life without it after menopause. Damage done to the pelvic organs not only results in dysfunction during the active ticking of your clock, but may even alter the lifespan of your biological clock itself. In any event, if living with the benefits of hormonal support and all the functions (not just fertility and cyclic) that are dependent on that support is optimum during this time, it is a waste of optimal functioning when suboptimal performance of the pelvic organs is due to chronic disease, i.e., endometriosis.  

What is an emergency?

Merriam-Webster says an emergency a “combination of circumstances or the resulting state that calls for immediate action; an urgent need for assistance or relief.” There is such a thing as an “emergency gap,” the separation of health conditions between things that are and are not an emergency. Before simple remedies like antibiotics, stitches, or splints were developed, almost everything that happened to a person was an emergency. Today, thanks to modern medicine, a lot of the things that fell into the gray area have been pushed down into the “not an emergency” category. As such, we have been misled to think that emergencies are only those things that are immediately life-threatening. Endometriosis bucks that trend, because even though no one dies of it, your quality of life can. Your relationship can. Your employment and means of support can. Also, your fertility, emotions, and non-reproductive organs can. With all of the aforementioned risks and what’s at stake, endometriosis indeed qualifies as an emergency and should be addressed as one.

Dr. Bozdogan knows this only too well, having seen a difference between women with timely diagnoses of endometriosis vs those with late diagnoses, in the thousands of cases for which he’s performed minimally invasive, same-day, outpatient robotic surgery. He’s not afraid of the late cases—in fact, he feels best qualified to handle these “emergencies” because of his expertise and experience. Nevertheless, he feels your fertility, hormones, and cycle, your quality of life and employment, , and your sexual and relationship health have nothing to gain in waiting. That’s the real emergency.

Ulas Bozdogan, MD

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