Endometriosis is a gynecologic condition in which tissue that normally exists inside the uterus, grows outside the uterus, mainly the lining of the pelvic cavity, the ovaries, fallopian tubes, bladder and bowel. Healthy pelvic tissue surrounding the transplanted endometriosis cells become irritated and inflamed and eventually causes scarring leading to pelvic pain and infertility.
The exact cause of endometriosis is unknown.
Most women with endometriosis do not have symptoms. The most common symptoms of endometriosis are pelvic pain and infertility. Pelvic pain usually occurs during menstruation. Some women experience painful sexual intercourse, pain during bowel movements and with urination. Unfortunately, the severity of the pelvic pain does not reflect the extent of the disease. At least one third of women with endometriosis have difficulty conceiving partly due to scar related mechanical problems in the pelvis but also due to direct effect on the sperm and the egg.
Endometriosis can be suspected based on symptoms of pelvic pain and findings during physical examination. Imaging studies, such as a pelvic ultrasound may also suggest the presence of endometriosis but neither symptoms, examination or pelvic ultrasound can definitively diagnose endometriosis. The definitive diagnosis of endometriosis requires a laparoscopy (outpatient procedure looking inside the pelvis).
The management of endometriosis is either medical or surgical depending on the severity of the symptoms and the desire to conceive.
Medical management of endometriosis is best when the goal is to control the pelvic pain and it involves:
- Pain medications such as nonsteroidal anti-inflamatory drugs (Ibuprofen, Naproxen) and sometimes narcotics.
- Hormonal therapy:
- Hormonal contraceptives – reduces the pain by controlling the menstrual cycle.
- Gonadotropin-releasing hormone (Gn-RH) agonists – controls the pain by stopping the menstrual cycle.
- Injectable progesterone – reduces the pain by stopping the growth of the endometriosis cells.
Surgical treatment for endometriosis is preferred when:
- The goal is to get pregnant.
- Symptoms of endometriosis are severe.
- There is inadequate response to medical treatment.
Surgical treatment for endometriosis can be either:
- Conservative – carried out by laparoscopy, during which endometriosis implants are surgically removed but the uterus and ovarian tissue preserved.
- Definitive – involves removal of the uterus (hysterectomy) with or without removal of the ovaries and may require a laparotomy (open abdominal surgery).
Treatment options for infertility due to endometriosis are varied. Surgical treatments are superior to medical treatments, but sometimes assisted reproduction, such as IVF, are preferable to conservative surgery.