Endometriosis

Our Endometriosis Main Article provides a comprehensive look at the who, what, when and how of Endometriosis

Endometriosis: In endometriosis, cells that normally grow inside the uterus (womb), instead grow outside the uterus.

Summary: Endometriosis is very common; the cause -- and why some women have endometriosis and many others do not -- has not been fully fathomed, although there are several prevalent theories; most women with endometriosis have no symptoms; but pelvic pain during menstruation or ovulation is a frequent symptom of endometriosis; endometriosis may be suspected by during a physical examination; it is confirmed by surgery, usually laparoscopy; the available treatment includes medication for pain, hormone therapy, and surgery.

Endometrial cells line the uterus and are normally shed each month during menstruation. When endometrial cells grow outside the uterus, the cells implant. These implants occur most commonly within the fallopian tubes and on the outside of the tubes and ovaries, the outer surface of the uterus and intestines and anywhere on the surface of the pelvic cavity. They can also be found, less often, on the surface of the liver, in old surgery scars or, very rarely, in the lung or brain.

Endometrial implants respond to the hormones of the menstrual cycle just as does the normal endometrium. The implants build up during the month and then they break down and during menstruation they bleed internally. Blood from the implants cannot leave the body via the vagina (or by other exit). The internal bleeding, tissue inflammation and, later, scarring cause the symptoms of endometriosis.

Endometriosis occurs in the reproductive years. The average age at diagnosis is 25-30. (It has been reported in girls as young as 11.)

The central theory of the cause of endometriosis is retrograde menstruation. Blood and endometrium tissue from the uterus back up into the fallopian tubes and drip into the pelvic and abdominal cavity. Retrograde menstruation may, it is thought, be due to a defect in the uterus or it may be related to the way the uterus contracts when it is expelling the menstrual tissue. Genetic factors and the immune system probably are also important in determining which women develop endometriosis and where the endometrial cells implant.

The common symptoms and signs are pain (usually pelvic) and infertility. Pelvic pain usually occurs during or just before menstruation and lessens after menstruation. Some women experience pain or cramping with intercourse, bowel movements and/or urination. Even a pelvic examination by a doctor can be painful.

The intensity of pain may change from month to month and vary greatly among women. Some women experience progressive worsening of symptoms while others can have resolution without treatment.

Endometriosis can cause infertility. When laparoscopy is done for infertility studies, endometrial implants can be found in some patients, many of whom may not have painful symptoms of endometriosis. It believed that endometriosis bleeding, inflammation, and scarring can cause distortion of the female reproductive organs (such as obstruction of the fallopian tubes), resulting in infertility. However, the severity of the disease is not necessarily directly related to the degree of infertility.

Other symptoms related to endometriosis include lower abdominal pain, diarrhea or constipation, low back pain, irregular or heavy menstrual bleeding, or even blood in the urine. Rare symptoms of endometriosis include chest pain or coughing blood due to endometriosis in the lungs, headache and/or seizures due to endometriosis in the brain.

Endometriosis can become cancerous in less than 1% of women. Most of the cancers found with the condition, however, appear not to be associated with the implants, but rather occur independently of the disease.

How is endometriosis diagnosed?

Endometriosis can be suspected based on symptoms of pelvic pain and findings during physical examinations in the doctor's office. Occasionally, the doctor can feel nodules (endometrial implants) behind the uterus and along the ligaments that attach to the pelvic wall. At other times, no nodules are felt, but the examination itself causes unusual pain or discomfort. Unfortunately, neither the symptoms nor the physical examinations can be relied upon to establish the diagnosis of endometriosis. Imaging studies, such as ultrasound, can be helpful in studying the pelvis, but still cannot accurately diagnose endometriosis. Direct visual inspection and tissue biopsy of the implants are necessary for accurate diagnosis.

Currently, the only accurate way of diagnosing endometriosis is at the time of surgery (either by open standard laparotomy or laparoscopy). Laparoscopy is the most common surgical procedure for the diagnosis of endometriosis. Laparoscopy is a minor surgical procedure done under general anesthesia or in some cases local anesthesia. It is usually performed as an out-patient procedure (the patient going home the same day). Laparoscopy is performed by first inflating the abdomen with carbon dioxide through a small incision in the navel. A long, thin instrument (laparoscope) is then inserted into the inflated abdominal cavity to inspect the abdomen and pelvis. Endometrial implants can then be directly visualized. During laparoscopy, biopsies (removal of tiny tissue samples for examination under a microscope) can also be performed for a diagnosis. Sometimes biopsies obtained during laparoscopy show endometriosis even though no endometrial implants are visualized during laparoscopy.

Common Misspellings: andrometriosis, endometreosis, endometrisis, edometriosis, indometriosis