What is Endometriosis and how is it Treated?

Endometriosis is a condition which usually affects women in their childbearing years and can lead to pelvic pain and infertility. Endometriosis consists of clusters of endometrial cells (the cells which form the lining of the uterus and are shed each month with menstruation) growing outside the uterus. These clusters of endometrial cells, or implants, can be found most commonly in the pelvis including the ovaries, fallopian tubes, and the surface of the uterus. They can also be found on the intestine, upper abdomen or in other parts of the body such as the lung. Because endometriosis cells are subject to the same monthly hormonal changes that normal endometrial cells are, but cannot be shed, this can lead to scar tissue, cysts, and pain. Women who have  endometriosis may have a higher risk of developing ovarian cancer. This risk has been difficult to quantify and the mechanism of this elevated risk is unknown.

It is estimated that endometriosis affects over one million women in the United States, and most cases are diagnosed in women between 25 and 35 years of age. However, because many women have no symptoms, the exact prevalence is unknown. The condition is uncommon in postmenopausal women. Other risk factors for endometriosis include being Caucasian (compared to African American and Asian), being tall and thin with a low body mass index, being infertile and delaying pregnancy until older ages.

We do not know the exact causes of endometriosis, but there are several theories. It is thought that estrogens contribute to the formation of endometriosis. Other possible causes of endometriosis include: retrograde menstruation – when endometrial tissue is deposited in strange locations because of menstrual flow that backs up into the fallopian tubes and abdominal cavity, immune system problems – causing the body to not recognize and destroy cells or tissue that is growing where it should not be, and cellular metaplasia – the cells of the areas lining the pelvic organs have certain cells that can grow into other forms of tissue such as endometrial cells.

Many women will have no symptoms of endometriosis, and the amount of the endometriosis does not correlate with the degree of symptoms. The predominant symptom of endometriosis is pain. Endometriosis associated pain may be located in the pelvis, lower abdomen, rectum, vagina, or lower back. It may vary with different points in the menstrual cycle. It may also occur during sex, bowel movements, ovulation, or all the time.  Abnormal bleeding is also a symptom of endometriosis. Heavy periods, spotting or bleeding between periods, bleeding after sex, or blood in the urine or stool can occur as a result of the condition. Infertility can also be caused by endometriosis. Disrupted bowel habits such as constipation or diarrhea can also occur.

In order to diagnose endometriosis, a thorough medical history and physical examination will be taken in order to ascertain for the symptoms of the condition. Some health care practitioners will prescribe medical treatments for endometriosis; an improvement in symptoms after medication usually indicates that the problem was endometriosis.  Imaging tests, such as ultrasounds, magnetic resonance image (MRI) tests, and CT scans also may be employed  However, endometrial implants will many times not show up on even the most sensitive of imaging tests. The only way to truly diagnose endometriosis is through directly evaluating the abdominal and pelvic cavity.  This most commonly accomplished through the use of laparoscopy, which is minimally invasive or “belly button” surgery. Biopsies are usually taken in order to rule out other conditions such as ovarian cancer.

Treatment options consist of medical treatments and surgical treatments. The route of treatment will depend on the goal of the woman and can differ if the woman wants to get pregnant or is focused on treating pain. Medical treatments include pain medicines such as NSAIDs (non steroidal anti inflammatory), birth control pills, hormone therapy such as GNRH (gonadotropin-releasing hormone analogs) such as Lupron, Danazol and progestins, and aromatase inhibitors. Many of the medical treatments provide only temporary relief while they are being utilized and can have side effects. Some, like Lupron, can only be used for a limited period of time due to their side effects of bone loss. Surgery may be an option chosen for some women who are attempting to get pregnant or in which medical management has failed. This may consist of ablation techniques or accomplished by excision techniques. This form of surgery, when conducted properly, is quite complex and a gynecologic surgical sub-specialist is encouraged to be consulted. The ovaries and uterus may also be recommended to be removed for some women. This type of surgery, while may be successful in the short run for relieving the symptoms of endometriosis, may not provide long-term pain control for all women,

Take home message:

Endometriosis may be a cause of unexplained pelvic pain, abnormal bleeding, or infertility.

Endometriosis is not an uncommon problem in women.

Diagnosis is usually made on the basis of symptoms and laparoscopy may be used.

Treatments may be either medical or surgical.

If surgery is being entertained as a treatment option, in order to assure that you have the best outcome, consult and expert gynecologic surgeon.

Posted: August 8th, 2010 | Author: | Filed under: endometriosis, general health, gynecology | Tags: | No Comments »

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