Endometriosis

Endometriosis is a gynecological condition that affects up to 10% of women. It occurs when tissue that normally lines the uterus (endometrium) develops outside of the uterine cavity. This occurs because the tissue bleeds and causes inflammation which sometimes leads to scar tissue formation and adhesions.

What is Endometriosis?

During a woman’s menstrual cycle, or period, the inside lining of the uterus (endometrium) sheds if she does not become pregnant. Instead, it can build-up and may cause damage to the underlying tissue. The most common places for endometriosis to develop are the ovaries, fallopian tubes, ligaments, and spaces surrounding the uterus and the lining of the pelvic cavity. Less commonly, it is found on other organs such as the intestines or bladder, in surgery scars or even the lungs.

Can Endometriosis Cause Infertility?

Endometriosis is associated with infertility but does not usually prevent pregnancy all together. It is estimated that 25-50% of women diagnosed with infertility have some degree of endometriosis. Fertility issues are thought to result from inflammation, scar tissue and adhesion formation and possible changes in the pelvic environment that may interfere with fertilization and/or implantation.

Can Endometriosis Cause Cancer?

Endometriosis does slightly increase the risk of certain types of ovarian cancer, but the overall risk is extremely low.

What are the Symptoms of Endometriosis?

There are a variety of symptoms associated with endometriosis, some more severe than others. A percentage of women will experience no symptoms, while others may have difficulty achieving pregnancy and/or experience pain. Other symptoms you may experience include:

• Pain before or after her menstrual cycle
• Pain during or after sex
• Pain with urination and/or bowel movements
• Discomfort from growths on the ovaries (endometriosis)
• Heavy menstrual bleeding or abnormal menstrual cycles
• Infertility
• Fatigue
• Gastrointestinal concerns such as constipation, bloating, diarrhea, or nausea

How is Endometriosis Diagnosed?

Endometriosis is often suspected based on a patient’s symptoms. Sometimes findings on a pelvic exam or imaging study (ultrasound, CT scan or MRI) can aid in the diagnosis. Family history can help as well since endometriosis can be hereditary.

Confirming the diagnosis requires surgery and tissue biopsy. The surgery is often a laparoscopy. This is a minor procedure during which the Gynecologic Surgeon makes a small incision in the stomach through which a scope (a flexible tube with a camera on the end) can be placed to visualize the pelvic region. One or two other small incisions are usually necessary to insert instruments to remove tissue. Once the diagnosis is confirmed, it can be assigned a stage based on the extent of the disease. Stages vary from I to IV (minimal, mild, moderate, or severe). The most common places endometrial tissue develops outside of the uterus includes:

• The ovaries
• The fallopian tubes
• Ligaments that support the uterus (uterosacral ligaments)
• The posterior cul-de-sac, i.e., the space between the uterus and rectum
• The anterior cul-de-sac, i.e., the space between the uterus and bladder
• The outer surface of the uterus
• The lining of the pelvic cavity

How is Endometriosis Treated?

Endometriosis is a chronic disorder that requires long-term management. The goal is to maximize medical therapy and avoid multiple surgeries. However, an initial or primary surgery may be indicated for staging and treating endometriosis, improving fertility, and decreasing pain. Repeat surgery is usually reserved for severe pain or treating symptomatic endometriomas.

What are Non-Surgical Treatment Options for Endometriosis?

Non-surgical treatment options for endometriosis might include:

• Pain medication: nonsteroidal anti-inflammatory drugs, such as ibuprofen or other over-the-counter analgesics
• Hormone therapy, including:
  • Oral contraceptives, with combined estrogen and progestin (a synthetic form of progesterone) hormones, to prevent ovulation and reduce menstrual flow
  • Progestins alone
  • Gonadotropin-releasing hormone agonist, which stops ovarian hormone production, creating a sort of “medical menopause”
  • Danazol, a synthetic derivative of testosterone (a male hormone)

What Surgical Treatments are Available for Endometriosis Removal?

• Laparoscopy is frequently used to diagnose and treat endometriosis. Instruments to remove, excise or fulgurate (burn) the endometriosis are inserted through small incisions in the abdomen.
• Less commonly, a laparotomy is necessary. This involves making a larger incision in the abdomen to treat the endometriosis.
• Ultimately some women will have a hysterectomy, a surgery to remove the uterus. Her doctor may also recommend removing one or both ovaries and fallopian tubes as well.

What Else Can Be Done to Ease the Pain and Discomfort of Endometriosis?

To ease the pain and discomfort of endometriosis, there are many simple techniques you can try, such as:

• Rest, relax and meditate
• Take warm baths
• Prevent constipation
• Get regular exercise
• Use a hot water bottle or heating pad on your abdomen

Some women may also benefit from alternative treatments combined with non-traditional, surgical, and other medical therapies, such as:

• Traditional Chinese medicine
• Nutritional therapy
• Homeopathy

What Causes Endometriosis?

The actual cause of endometriosis is unknown. Retrograde menstruation, the backup of endometrial tissue through fallopian tubes during the menstrual cycle in one theory. Possible contributing factors include genetics, a compromised immune system, scar tissue or hormonal therapy.

Can Endometriosis Be Prevented?

Unfortunately, there is no way to prevent endometriosis. However, lowering your estrogen levels may help reduce your chances of developing endometriosis. Regular exercise, certain birth control medications, and limiting alcohol and caffeine consumption may help lower estrogen levels.

What are Risk Factors for Endometriosis?

While any woman can develop endometriosis, some are at an increased risk, including:

• Women who have a first-degree relative (mother/sister/daughter) with endometriosis
• Women who have never had children
• Having high levels of estrogen
• Disorders of the reproductive tract