Endometriosis

Endometriosis is a condition where endometrial tissue, the tissue that lines the uterus and is shed during menstruation, grows outside the uterus – on the ovaries, fallopian tubes, other pelvic organs and less commonly anywhere in the body.

Endometriosis occurs in about 30-40% of women, and in most women it does not cause a problem. The cells can sometimes trigger an inflammatory reaction and cause scarring, adhesions, or pain. Unfortunately, these misplaced cells can block the fallopian tubes or inhibit the normal sweeping movements of the tubes, making pregnancy difficult.

The cause of endometriosis is unknown. It tends to run in families. It is also more common in women who have a blocked cervix that promotes menstruation into the pelvis (retrograde menstruation). Research toward finding a cure continues.

Diagnosis of endometriosis is made through a laparoscopy, although signs and symptoms sometimes make the diagnosis highly suspected. During laparoscopy, a slender fiberoptic tube is inserted into the abdomen to allow the doctor to look closely for endometrial growths.

Treatment for endometriosis is divided into medical and surgical components. Because endometrial cells respond to hormones of the menstrual cycle, medical management includes birth control pills and medications such as Dannazol, DepoProvera or Lupron. Lupron is most effective, but also has the most noticeable side effects – primarily hot flushes. This is because Lupron interrupts normal menstruation by essentially "shutting off" the ovaries and placing the patient in a menopausal state while on the medication. Without estrogen, the implants shrink.

Surgical management of endometriosis depends on the reason for treatment. If pregnancy is desired, laser laparoscopic ablation is sometimes helpful. If treatment is for pain, laser laparoscopic ablation may also be helpful. However, the most consistently effective treatment for pain from endometriosis is removal of the ovaries. This is not appropriate for women who desire children in the future, but when childbearing is complete, this approach often gives remarkable relief of symptoms.