Endometriosis is a condition in which the cells that make up the uterine lining grow outside the uterine cavity.
This induces an immune response and, if not cleared, can lead to inflammation, pain, and scarring in the pelvic cavity. The most common presenting symptom is painful menstrual cycles. Other symptoms include pain with intercourse (dyspareunia) and painful bowel movements. There is a poor correlation between the extent of disease and the severity of symptoms. A woman with extensive endometrial implants in her pelvis may have no symptoms at all. Infertility is common in women with endometriosis.
What Causes Endometriosis?
The most accepted theory for the development of endometriosis is retrograde menstruation. It is normal for a fraction of the menstrual fluid to flow backwards through the fallopian tubes to be deposited in the pelvis. Women with endometriosis are thought to have a type of defect in their immune system that prevents them from clearing these implants.
Once established, these implants can lead to fibrosis (scarring), disruption of normal pelvic anatomy, and pain. Implants are most typically located in dependent (drawn down by gravity) portions of the pelvis including the ovaries, pelvic support ligaments, and peritoneal surfaces.
How is Endometriosis Diagnosed & Treated?
Transvaginal sonogram (TVS) can reveal the presence of an endometrioma (endometrial cyst on the ovary) but cannot identify smaller endometriosis implants. Laparoscopy is an outpatient surgery in which the physician looks into the pelvis through small (1-2 cm) incisions and is the best way to evaluate the extent of disease.
A laparoscopic procedure for endometriosis can also be therapeutic, in that the implants can be either excised (cut out) or ablated (burned off). Patients with mild to moderate disease can have increased pregnancy rates after laparoscopic surgery.
Treatments to alleviate the pain of endometriosis include non-steroidal anti-inflammatories (NSAIDS, like Ibuprofen or Aleve) and oral contraceptive pills (OCPs). Depot-Lupron is a medication that induces a temporary chemical menopause that starves the endometrial implants of estrogen. It has significant side effects however and is not meant to be a permanent treatment. For women wishing to conceive, ovulation induction cycles with intrauterine insemination (IUI) may be used to shorten the time to conception. This approach is better for women with only mild pelvic scarring. For women with severe disease, in vitro fertilization offers the best solution. Once a woman has completed her childbearing, the most definitive cure for endometriosis is removal of both ovaries and tubes (permanent surgical menopause).