Endometriosis is a common disorder that affects women during their reproductive years. It occurs when endometrial tissue, which lines the uterus, grows outside the uterine cavity. This misplaced tissue may implant and grow anywhere within the abdominal cavity, or rarely in distant sites such as the naval or lungs. This tissue may grow in small, superficial patches called implants; in thicker, penetrating nodules; or it may form cysts in the ovary called endometriomas.
Endometriosis is highly unpredictable. Some women may have a few isolated implants that never spread or grow, while in others, the disease may spread throughout the pelvis. Many women who have endometriosis experience few or no symptoms. However, in some women, it may be the underlying cause of infertility.
Endometriosis can usually be treated by medication or surgery designed to preserve fertility. Fortunately for most patients, these treatments help to counteract the effects of endometriosis.
Many specialists believe that endometriosis is more likely to be found in women who have never been pregnant. For this reason, the condition is sometimes labeled as a “career women’s disease” because working women often delay pregnancy. But endometriosis cannot be so easily generalized. Sometimes it affects women who have had children, and it can also occur in teenagers.
There are many different symptoms that may present themselves to women who have endometriosis. Those include painful menstrual cramps, pain during intercourse, abnormal uterine bleeding and/or infertility. Endometriosis may hinder conception in various ways. Endometriosis in the pelvis, for example, may inflame surrounding tissue and spur the growth of scar tissue or adhesions. Bands of scar tissue may bind the ovaries, fallopian tubes, and intestines together. Adhesions may interfere with the release of eggs from the ovaries or the pick-up of the egg by the fallopian tubes. If the ovaries are pulled away from the tubes, eggs may fail to enter the tubes on a regular basis after ovulation. Studies have shown that the risk of miscarriage is higher for women with untreated endometriosis than in those without it. The increased risk does not seem to be present for women who have been treated. It is not known why women with endometriosis have an increased risk of miscarriage; however, chemicals which can be toxic to the embryo have been found in the abdominal fluid of women with endometriosis. Possible changes in the immune system might also explain the increased risk.
The diagnosis of endometriosis cannot be made from symptoms alone. Your physician may suspect the disease if you are having fertility problems, severe menstrual cramps, or pain during intercourse. Remember, however, that many patients with the condition report no symptoms at all.
Certain findings of a pelvic examination can lead your physician to suspect endometriosis. A sign that strongly suggests endometriosis is nodularity along the uterosacral ligament. The nodules are often tender to the touch. An enlarged ovary can indicate the disease, especially if the doctor finds that the ovary is also fixed in position. Occasionally, endometriosis implants may be visible in the vagina or the cervix. A physician may suspect endometriosis based on the history and results of a pelvic exam, but cannot confirm its presence without additional studies.
Laparoscopy, a surgical procedure that enables a physician to see inside the pelvis and inspect the reproductive organs, can verify the presence of endometriosis. Most doctors will confirm the diagnosis of endometriosis through laparoscopy before treating the disease. In fact, since endometriosis is often without symptoms, many doctors advise laparoscopy as part of the diagnostic process for all infertile women. The amount of endometriosis is assigned a numerical score at the time of laparoscopy. The score is based on the amount of superficial or deep disease found in the pelvic lining, the ovaries and the fallopian tubes, and the amount of adhesive disease present in the pelvis. Assigning a numerical score is called staging the disease into minimal, mild, moderate, and severe. For example, a score of 1-15 indicates minimal or mild endometriosis, and a score of 15 or greater indicates moderate to severe disease.
Your doctor will consider all the symptoms, physical findings, test results and your goals and concerns before advising therapy. Women with endometriosis who have few or no symptoms may require no treatment. Doctors frequently advise patients with endometriosis to proceed with their plans to conceive. Many think that pregnancy inhibits the growth of endometriosis and causes it to regress. Endometriosis can also be treated with hormone medication, oral contraceptives, danazol, GnRH analogs, progestins and surgery.
Endometriosis is a disease affecting millions of women throughout the world. For many, the condition goes unnoticed. But for others, it demands professional attention, especially when fertility is impaired or pain affects the lifestyle. Choosing a qualified physician who is familiar with the latest developments in endometriosis management is your best strategy. The physician you choose will recommend the most appropriate course of treatment based on your personal situation.