A: Millions of women of reproductive age are affected by endometriosis, a chronic condition causing abdominal and pelvic pain which is often exacerbated by menstruation. Simply put, endometriosis is when endometrial tissue, or the tissue that normally is found lining the inside of the uterus, is found outside the uterus, usually in the pelvis and abdominal cavity. This endometrial tissue builds up and sheds each month in response to the hormonal changes that occur during a woman’s menstrual cycle. When it grows outside of the uterus it has no place to go, so surrounding tissues become inflamed or swollen, producing scar tissue.
 Endometriosis is associated with a wide variety of clinical symptoms and signs, although most patients show no symptoms. The most common symptoms are painful periods, pain with sexual intercourse and chronic non-menstrual pain. Symptoms often increase prior to a woman’s period. Pain associated with endometriosis generally is cyclical, although the pain may become continuous as the disease worsens. Many women also experience back pain, diarrhea, and pain with urination or bowel movements.
The condition is often diagnosed clinically by a patient’s symptoms. The gold standard for diagnosis is laparoscopy. This is a minor surgery in which a small incision is made to allow a surgical camera to be placed in the abdomen. The surgeon then looks for endometriosis, or signs of it. Blood tests, ultrasounds, computed tomography (CT) scans, and magnetic resonance imaging (MRI) are other exams that can aid in the diagnosis.
Q: “I’ve heard that endometriosis can affect fertility. Is this true, and how prevalent is infertility in women with this disorder?
A: Infertility is a problem for many women with this disorder, particularly if scar tissue from the disease distorts normal pelvic anatomy or impairs the function of the ovaries or fallopian tubes. Up to 40% of women who suffer from endometriosis also have difficulty conceiving.
Q: “My two sisters both have endometriosis; what causes them to suffer from the disorder?”
A: No one knows exactly what causes endometriosis. There are several theories, but none have been proven as the main cause. One such theory is reverse menstrual flow from the uterus, through the fallopian tubes, into the abdominal cavity. Other proposed ways for the endometrial tissue becoming misplaced include spreading through blood vessels or lymphatic vessels. Metaplasia, or the process of one tissue transforming into another tissue, endometrial tissue in this case, has also been proposed. Endometriosis appears to be genetic; women who suffer from the disease often have sisters, mothers or other close relatives also affected.
Q: “I was just diagnosed with endometriosis; what are my treatment options?”
A: There are several options for treating this disease. Over-the-counter pain medications such as nonsteroidal analgesics (ex. Ibuprofen) are the first-line therapy, and often all that is needed for mild cases. Most of the other medical therapies for endometriosis work by suppressing the ovaries, or the effect estrogen has on endometrial tissue. These options include birth control pills; Depo-Provera; danazol, a synthetic androgen that decreases estrogen levels and suppresses endometrial tissue; and gonadotropin-releasing hormone agonists, a group of medications that are active at the level of the brain to block stimulation of the ovaries. There is also evidence that the IUD can be beneficial by inhibiting the growth of endometrial tissue.
Some cases of endometriosis do not improve with medical therapy, and therefore surgical management is necessary. Some can be treated with minimally invasive surgery, such as laparoscopy, an out-patient procedure. Areas with endometriosis can be destroyed by burning, electrocautery, laser, or surgically extracting the diseased tissue. Ovarian cysts containing endometriosis can be removed. The scar tissue often caused by endometriosis can also be removed. Sometimes with very severe cases, the ovaries have to be removed with or without a hysterectomy.
Because endometriosis is a chronic disease with high recurrence rates, women commonly undergo several surgical procedures and/or try different drug regimens to relieve symptoms and may have to live with symptoms or continue medical therapy for many years
Q: “What should I do first if I think I may have endometriosis?”
A: Women who think they may have endometriosis or similar symptoms should see their gynecologist or primary care physician. Women without a regular physician can make an appointment with their closest Planned Parenthood health center and can often be seen within a week.
Endometriosis is a chronic and progressive disease. Earlier intervention may help avoid the more severe effects. For more information, please refer to the following sites:http://www.asrm.org/Patients/patientbooklets/pelvicpain.pdf
http://www.endometriosis.org/
http://www.nlm.nih.gov/medlineplus/endometriosis.html
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