Endometriosis

Endometriosis is a condition affecting up to 50% of women of reproductive age. It is strongly associated with infertility and chronic pelvic pain.

During your monthly menstrual cycle, the lining of the uterus builds up in preparation for a possible pregnancy—when no pregnancy occurs, the lining breaks down and you have a menstrual period.

Endometriosis is a condition in which tissues from that lining somehow escape the uterus and grow on other pelvic organs, most commonly the ovaries, uterus or fallopian tubes. No one knows exactly why this happens, but the disorder does run in some families. Doctors say that women most likely to get endometriosis are between the ages of 25 and 40 and haven’t had children.

Endometriosis consists of glandular tissue similar to the lining of the uterus which may either originate in or be transported to distant sites, such as the ovaries, abdominal cavity, and even the lungs. Although the etiology of endometriosis remains unproven, it appears related to the ability of the individual woman’s immune system to regulate the growth of this aberrant endometrial tissue outside of the uterus. 

Clinically, endometriosis may be without symptoms, or it may cause pelvic pain, infertility, ovarian cysts and severe pain with the menstrual cycle. This pain may have little relationship to the location of endometrial implants or the extent of these implants, although their depth of growth of may be related to the severity of pain. Due to the elaboration of excessive amounts of chemicals called prostaglandins, menstrual cramps and other menstrual symptoms can be exacerbated by endometriosis. Some women have excessive gastrointestinal problems with endometriosis. It has even been reported on rare occasions invade the bowel cavity, causing cyclic GI bleeding or bowel obstruction.

Endometriosis Symptoms

Symptoms of endometriosis include the following.

• Painful menstrual periods – sometimes the pain begins several days before a period and lasts for several days afterward
• Occasional heavy periods
• Sharp pain in the pelvis during sexual intercourse
• Bleeding or spotting in midcycle

 

Not all women with endometriosis experience symptoms. Because it can cause scarring anywhere it occurs, however, the condition can have a devastating effect on a woman’s fertility. Sometimes the path a fertilized egg must travel to implant itself in the uterus is blocked by scar tissue, for example. In fact, endometriosis is the most common cause of infertility in women.

It is unclear exactly how endometriosis causes infertility. In severe cases, the fallopian tubes can be blocked or pelvic adhesions may prevent the egg from reaching the tubes. In most cases, however, these mechanical barriers are not the case. In addition, there are many women with endometriosis who have normal fertility. There remains much research to delineate why some people get endometriosis, and why the effects are so different in one person compared to the next.

To date, the only definite way to diagnose endometriosis in most cases is to directly visualize the lesions by surgery, usually laparoscopy. The laparoscope is an instrument which allows visualization and surgery of the abdomen through small holes in the umbilical area and other abdominal sites. In the event that endometriosis is seen, biopsies can be taken and the visible lesions cauterized by a laser or thermal cautery. This treatment is complicated by the fact that there are usually other endometriosis sites which cannot be seen and lesions actually take on different colors and forms during various stages of growth.

Endometriosis Treatments

Treatments for endometriosis include the following.

• Birth control pills, which limit the monthly growth of the uterine lining
• The drug Danazol, which inhibits menstruation altogether
• Surgery to remove scar tissue
• For more severe cases, surgical removal of the uterus (hysterectomy) and ovaries

The limitation of most conservative measures is that the endometriosis may eventually reoccur. Hysterectomy as a last resort usually is curative, but the ovaries also may need to be removed, as they are a common site for residual endometriosis.

Patients with symptoms suggestive of endometriosis should see their gynecologist for an evaluation. There are other serious conditions that mimic endometriosis, including inflammatory bowel disease, ectopic pregnancy and cancer of the reproductive organs.

 

Read more about understanding endometriosis.