Endometriosis

By: Bradley G. Goldberg, M.D.

The definition of endometriosis is the presence of implants of endometrial tissue (the tissue that normally lines the uterus) occurring in abnormal places in a woman’s body. These abnormal implants can occur in places such as the ovaries, the fallopian tubes, the colon, or just about any other organ in the abdomen and pelvis.

Although the exact cause of endometriosis is unclear, several theories exist. The most popular theory is that of retrograde menstruation, which attributes the disease process to the reverse flow of menses through the fallopian tubes. This means that there is spillage of the normal menstrual flow into the woman’s pelvis, where the endometrial cells can come into direct contact with the ovaries and other organs previously mentioned. It is also likely that the integrity of the woman’s immune system plays a key role in determining who is affected.

Endometriosis is a common cause of pelvic pain in women. It is most common among women in their 30s and 40s, although much younger women are often affected as well. It is estimated that up to 10% of reproductive age women (those 15 - 45 years of age), are affected to some degree. The incidence is higher among women who suffer from infertility, affecting somewhere between 20-50% of women in this category. Chances of ever being affected are increased by seven to ten times the average if a woman has a first degree relative (mother or sister) who is already affected.

Typical symptoms of this condition include painful periods, pain with intercourse, problems with infertility, and problems with pelvic pain in general. Different women experience varying degrees of these symptoms, and some women have no symptoms at all, and only become aware that they have endometriosis when they see a doctor for conditions like infertility. Although these symptoms can be highly suggestive of endometriosis, the true diagnosis can only be obtained through the direct visualization of a woman’s pelvis with laparoscopy ("belly-button surgery").

Treatment is available. The mainstays of treatment include medical therapy with various hormonal medications, and surgery. Surgeries performed include minimally invasive procedures such as laparoscopy, and hysterectomy for advanced disease in women who no longer wish to become pregnant. Surgery should be reserved for those patients who have failed medical therapy, or for those who have severe disease.

Endometriosis can be treated best when detected early. If you experience the symptoms previously described, report it to your doctor, who can help you to explore your options.

Bibliography

1. Novak’s Gynecology, Twelfth Edition, Jonathan S. Berek, MD, Williams &Wilkins,

Baltimore, 1996.

2. "Getting Help For Endometriosis," Fredric D. Frigoletto, Jr., MD, ACOG Woman’s

Health Column, September 9, 1996.

3. Clinical Gynecologic Endocrinology and Infertility, Fifth Edition, Leon Speroff, MD,

Williams & Wilkins, Baltimore, 1994.

4. "Endometriosis," ACOG Technical Bulletin #184, September 1993.

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