Diaphragmatic endometriosis is when endometriosis tissue grows into your diaphragm. Endometriosis is usually painful and there are different types. Diaphragmatic endometriosis is actually quite rare though. 8 to 15 percent of women suffer from Endometriosis, yet of that small percentage, 0.6 to 1.5 percent suffer from Diaphragmatic endometriosis.
Symptoms of Diaphragmatic Endometriosis
As with all types of endometriosis, there is pain involved in diaphragmatic endometriosis. The pain may get worse if you cough or simply breathe.
You may experience pain in these areas:
- right shoulder
- upper abdomen
The pain usually occurs around the time of your period. In very rare cases, it can result in a collapsed lung.
Women with diaphragmatic endometriosis may also suffer from pelvic pain.
If you experience pain in the pelvic area due to diaphragmatic endometriosis, you may experience these symptoms:
- pain and cramps before and during your period
- pain during intercourse
- difficulty conceiving
- heavy bleeding during and between periods
What Causes Diaphragmatic Endometriosis?
It is currently unknown what exactly causes diaphragmatic endometriosis or any endometriosis for that matter. The most common conclusion is retrograde menstruation. Retrograde menstruation refers to a woman’s menstrual blood flowing back into her body during her period. Sampson’s theory proposes that when this occurs, the menstrual debris carries sloughed-off tissue from the endometrium, which is the lining of the uterus that sheds monthly.
However, it is reported that most women experience retrograde menstruation but not all develop endometriosis so the immune system is suspected to play a role.
Other contributors to endometriosis may include:
- Cell transformation: cells affected by endometriosis respond differently to hormones.
- Genetics: endometriosis has been shown to go down the family tree.
- Inflammation: certain substances that have a role in inflammation are found in high numbers in endometriosis.
- Fetal development: these cells may grow in different places since before birth.
How to diagnose Diaphragmatic Endometriosis
The symptoms for diaphragmatic endometriosis are not easy to determine. Often, it gets mistaken to be something else such as a pulled muscle. Endometriosis often gets discovered when a patient is undergoing surgery for something.
As usual, keep note of how this pain/discomfort feels around the time of your period. The most clearest sign of endometriosis is increased pain during these times.
If you suspect you may be having symptoms of endometriosis, conduct with your Doctor and seek their professional advice. An MRI can be a good test to undergo to determine whether you have endometriosis or not.
Often the best way to diagnose diaphragmatic endometriosis is with laparoscopy. This involves your surgeon making a few small cuts in your abdomen. A scope with a camera on one end is inserted to help your doctor see your diaphragm and find the endometrial tissue. Small samples of tissue, called biopsies, are usually collected and sent to the lab in order to look at these cells under a microscope.
What treatment options are available?
If you don’t have symptoms, your doctor might recommend that you wait to treat your endometriosis. Your doctor will check you regularly to see if symptoms develop.
If you do have symptoms, your doctor will likely recommend a combination of surgery and medication to help manage any symptoms you may have.
Surgery is the main treatment for diaphragmatic endometriosis.
Surgery can be done in a few different ways:
In this procedure, your surgeon makes a large cut through the wall of the upper abdomen and then removes parts of the diaphragm affected by endometriosis. In one small study, this treatment reduced symptoms in all women and completely relieved chest and shoulder pain in seven out of eight women.
For this procedure, your surgeon inserts a flexible scope and small instruments through small incisions in the chest to view and possibly remove areas of endometriosis within the diaphragm.
In this procedure, your surgeon inserts a flexible scope and small instruments into the abdomen to remove areas of endometriosis within the abdomen and pelvis.
Your surgeon can also use a laser to treat tissue affected by endometriosis. Surgery may also be necessary to manage scar tissue formation, a common complication in endometriosis. New treatment approaches are often becoming available. Talk to your doctor.
If the endometriosis is in both your diaphragm and pelvis, you might need more than one surgery.
Medication for Diaphragmatic Endometriosis
Medication is another option as well. Two types of medications are used to treat endometriosis: hormones and pain relievers.
Hormone therapy can slow down the growth of endometrial tissue outside the uterus which is the root cause of the pain and problem overall.
Hormonal treatments include:
- birth control, including pills, patch, or ring
- gonadotropin-releasing hormone (GnRH) agonists
- danazol (Danocrine), now less commonly used
- progestin injections (Depo-Provera)
Your doctor may also recommend over-the-counter (OTC) or prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) or naproxen (Aleve), to control pain.
Complications of Diaphragmatic Endometriosis
Rarely, endometriosis of the diaphragm can cause holes to form in the diaphragm.
This can lead to life-threatening complications such as:
- collapsed lung (pneumothorax) during your period
- endometriosis in the chest wall or lungs
- air and blood in the chest cavity
Having surgery to remove endometriosis within the diaphragm may reduce your risk of these complications.
Endometriosis of your diaphragm shouldn’t affect your fertility. But many women with this form of endometriosis also have it in their ovaries and other pelvic organs, which can cause fertility problems. Surgery and in vitro fertilization can increase your odds of getting pregnant.