Endometriosis is a leading cause of infertility. It is a condition in which the uterine lining (endometrium) grows outside the uterus onto abdominal organs such as the ovaries, fallopian tubes, bowels and bladder. Endometriosis is a progressive disease, which tends to advance over time and can reoccur even after multiple treatments.
The endometrial implants respond to hormonal stimulation throughout the menstrual cycle in the same fashion as the uterine lining. The lesions thicken during the menstrual cycle and shed like the normal lining inside the uterus causing bleeding within the abdomen. Consequently, since this cannot be discharged like the menstrual flow, it causes an immune reaction, which eventually produces scar tissue. That scar tissue can modify the anatomical landmarks in the abdomen causing the fallopian tubes to be in an abnormal location, blocked or not in harmony with the ovaries. The blood can also collect inside the ovary, causing an ovarian cyst, or “endometrioma” which can grow very large in size (4-5 inches or more). A byproduct of blood fills the endometrioma. It is brownish in appearance thus termed chocolate cyst fluid. Many times the ovarian cysts can interfere with ovulation or with the appropriate relationship with the tube.
The following are the most common symptoms for endometriosis; however, each individual may experience symptoms differently. Symptoms of endometriosis may include:
- Pain, especially excessive menstrual cramps which may be felt in the abdomen or lower back
- Pain during intercourse
- Abnormal or heavy menstrual flow
- Painful urination during menstrual periods
- Painful bowel movements during menstrual periods
- Other gastrointestinal problems, such as diarrhea, constipation and/or nausea
It is important to note that the amount of pain a woman experiences is not necessarily related to the severity of the disease. Some women with severe endometriosis may experience no pain, while others with a milder form of the disease may have severe pain or other symptoms.
The medical treatment for endometriosis includes the gonadotropin releasing hormone agonist (Lupron), Danazol and continuous oral contraceptive.
Laparoscopy, with either laser or electro-coagulation, has been found to be very successful in women with endometriosis. The treatment not only decreases the number of implants and reduces the presence of scar tissue but also is successful especially in cases where endometriomas (cyst in the ovary composed of a breakdown of blood product) are present. This procedure can restore the normal anatomy of the pelvis and consequently result in pregnancy.
What is Adenomyosis?
Adenomyosis is endometriosis inside the muscle of the uterus itself (adeno means gland and myosis means muscle). The presence of the endometrial lining inside the wall of the uterus (internal endometriosis) can have a major impact on the size of the uterus, the ability to get pregnant and to maintain the pregnancy and on abnormal menstrual bleeding and chronic pelvic pain.
To schedule a consultation to discuss the work-up, diagnosis and treatment of endometriosis please call the office at 610-619-8300.