Endometriosis is a disease that occurs in nearly 7% of all menstruating women. The disorder becomes apparent in the early teens after menses have begun, and its symptoms continue until menopause. It affects a woman's reproductive system and may be responsible for severe pelvic pain, especially during menstruation, and is often thought to be a cause of infertility. In many cases, women who have the disease may not experience symptoms. Treatment, therefore, must be adapted to each woman's specific problems.

What is Endometriosis?

In endometriosis, the tissue that normally lines the cavity of the uterus (also called the endometrium) appears in locations where it shouldn't be - most commonly on the:

  • Ovaries
  • Tubes
  • Outer Surface of the Uterus
  • Bowel
  • Other Pelvic Structures

This disorder occurs at menstruation when normal endometrial tissue backs up with menstrual blood throughout the fallopian tubes and then implants and grows in other places. This endometrial tissue behaves in all of the areas where it happens to end up as if it were still in the uterus and under the control of the hormone estrogen. So, at the end of every cycle, just as the uterus sheds its endometrial lining, the endometrial tissue growing outside the uterus will break apart and bleed.

But unlike menstrual fluid from the uterus, which is discharged freely out of the body during menstruation, blood from the abnormal tissue has no place to go. The body responds to this menstrual-type bleeding of abnormal cells by:

  • Trying to absorb it back into the circulatory system.
  • Surrounding it with inflammation (the tissue becomes red, swollen, and painful around the area). This monthly inflammation ends when the bleeding ends, but usually results in scar tissue being formed and irritating the affected area. 

Month after month, patches of endometriosis are triggered by the female hormones to menstruate blood; the blood is absorbed by the surrounding inflamed area, and scar tissue forms. Endometriosis may also cause adhesions, which is abnormal tissue growth that binds organs together.

Sometimes a patch of endometriosis is surrounded by enough scar tissue to cut off its blood supply. This tissue can no longer respond to the hormones.  Other patches may rupture or burst during menstruation and spread their contents to other pelvic areas, causing new spots of endometriosis to develop. Therefore, symptoms gradually worsen with time, although the symptoms may "come and go".

Endometriosis

Who Can Have Endometriosis?

Endometriosis is most common among women in their 30s and 40s. The disease has never been found in young women who have not yet begun to menstruate since it occurs only after a woman begins menstruation. After menopause, endometriosis is no longer active unless, for some reason, a woman's hormones become active again or she is given hormones for some other medical need.

Little is known about why some women develop endometriosis and others do not.  The condition may be inherited, however, most gynecological studies support the theory that endometriosis is the result of some abnormality of the immune system, which allows these cells to relocate and survive where they don't belong.

Symptoms

Endometriosis may not produce any symptoms at all. In such cases, it is often discovered during some type of abdominal surgery or other examination of the woman.

Typically, however, a day or two before the onset of the menstrual flow and continuing for the duration of the cycle, a woman with endometriosis may experience fatigue, mood changes, and abdominal discomfort.  Depending on where the endometrial tissue has settled, a woman may also experience painful intercourse, painful urination and bowel movements, premenstrual spotting, blood in urine, or low-grade fever. Although the symptoms are in conjunction with menstruation, the pain is chronic for those who have had the disorder for a long time.  Another complication that may occur from endometriosis is difficulty in conceiving.

A number of other problems may be related to endometriosis. If you have any of the symptoms mentioned here, schedule an appointment with our office to discuss these symptoms with our physicians.

Testing and Diagnosis

The physician will review your complete medical history and perform a pelvic examine to look for signs of anything abnormal. You may be examined between menstrual cycles as well as during your menstrual cycle to compare the change in certain findings from the pelvic exam at different times in the cycle.

An accurate diagnosis can only be obtained during a procedure called Laparoscopy is 100% accurate in diagnosing endometriosis.This is done under general anesthesia. An instrument (called a laparoscope) is inserted through a tiny cut made in the lower abdomen. This enables the physician to view the uterus, ovaries, fallopian tubes, and other pelvic structures and actually see if endometriosis is present. A biopsy is often done on any questionable tissue.  

Because endometriosis is affected by hormone production, certain factors are known to influence the progress of the disease:

  • The progress of endometriosis us slowed or stopped during pregnancy since the hormones made by the placenta during pregnancy prohibit ovulation.
  • Oral contraceptives (birth control pills) are thought to halt the progress of endometriosis the same way that placental hormones do during pregnancy.

Treatment

There is no cure for endometriosis, but there are treatments that can help relieve the pain, restore fertility, and shrink the size of the misplaced tissue in as many as two-thirds of the cases. The different types of treatment that the physician may recommend for you may include:

  • Hormonal Therapy:  When using this form of treatment, doses of hormonal drugs, such as GnRH (gonadotropin-releasing hormones), are given to decrease the hormones produced in the brain that stimulate the formation of estrogen (it's estrogen that keeps the endometrial tissue going). This change in the pattern of the normal female hormones slows the growth of the endometriosis but will cause your body to react in a way similar to menopause. Since hormonal therapy shuts off ovulation, you will not be able to conceive during this course of therapy. The body's reaction to the lack of estrogen produces the same symptoms found in menopausal women: hot flashes, insomnia, mild depression, breast tenderness, vaginal dryness, reduced sex drive, and osteoporosis.
  • Conservative Surgery:  Surgery may be performed during which spots of endometriosis are cut away from their abnormal locations.  Good ovarian tissue and normal tubal tissue are left intact as much as possible to aid the chances of achieving pregnancy after the operation. Surgical treatments of infertile patients is often, but not always, successful.
  • Major Surgery: In cases of severe endometriosis, it may be necessary to remove all or part of the reproductive organs to relieve symptoms and stop the production of the female hormones that trigger further growth of endometriosis.

When treating endometriosis by surgery, it is important for you to keep in mind that the decision concerning which type of surgical procedure is best for you can only be made during the surgery itself, when the physician can actually see and evaluate the extent of the endometriosis. Be sure you understand fully what is involved prior to the surgery by talking with our physicians and nurses.