Endometriosis is the abnormal growth of endometrial cells in a location outside of the uterus. Endometrial cells are cells that are shed each month during menstruation. The cells of endometriosis attach themselves to tissue outside the uterus and are called endometriosis implants. These implants are most commonly found on the ovaries, the fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. Endometrial implants, while they can cause problems, are not cancerous.
Who is affected by endometriosis?
Endometriosis affects approximately 5 to 15% of women. It is one of the leading causes of pelvic pain and reasons for laparoscopic surgery and hysterectomy in this country. Estimates suggest that between 20 to 50% of women being treated for infertility have endometriosis, and up to 80% of women with chronic pelvic pain may be affected. Most cases of endometriosis are diagnosed in women aged around 25 to 35 years.
Interestingly, many women who have endometriosis, in fact, do not have symptoms. Of those who do experience symptoms, the common symptoms are pelvic pain and infertility. Pelvic pain usually occurs during or just before menstruation and lessens after menstruation. Some women experience painful sexual intercourse (dyspareunia) or cramping during intercourse, and or/pain during bowel movements and/or urination. Even pelvic examination by a doctor can be painful. The pain intensity can change from month to month, and vary greatly among women.
Diagnosis of endometriosis
Endometriosis can be suspected based on symptoms of pelvic pain and findings during physical examination. For a definitive diagnosis, a direct visual inspection inside of the pelvis and abdomen are necessary. This is usually performed by a minimally invasive procedure called laparoscopy. During laparoscopy, biopsies can also be performed for a diagnosis.
Treatment of endometriosis
Endometriosis can be treated with medications and/or surgery. The basis of medical treatment of endometriosis involves pain relieving medications and/or numerous types of hormonal modification.
Surgical treatment for endometriosis can be useful when the symptoms of endometriosis are severe or when there has been an inadequate response to medical treatment. Surgery is the preferred treatment when there is anatomic distortion of the pelvic organs. Surgical therapies for endometriosis may be either classified as conservative, in which the uterus and ovarian tissue is preserved, or definitive, which involves hysterectomy (removal of the uterus), with or without removal of the ovaries.
Recurrence of endometriosis
While surgical treatments can be very effective in the reduction of pain, the recurrence rate of endometriosis following surgical treatment has been estimated to be as high as 40%. Many doctors recommend for women who have had surgery for endometriosis to take oral medications after surgery to help maintain symptom relief.
Fertility and endometriosis
Endometriosis is more common in infertile, compared to fertile, women. Treatment options for infertility associated with endometriosis are varied, but surgical treatments are generally considered superior to hormonal or medical treatments for endometriosis when the goal is enhancement of fertility. Assisted reproduction techniques may also be used in combination with surgical therapy.