Endometriosis affects one in ten women in the United States, and can cause fertility problems.
At InVia Fertility, we have treated many women who have this condition over the years. Here are the top ten most common questions we've received about it:
What is Endometriosis?
Endometriosis is a condition when the lining of the uterus (endometrium) is found outside the uterus. These misplaced tissues are referred to as “endometrial implants”. Endometriosis occurs most commonly in women between the ages of 25 and 44. It can also occur in teenagers, although this is less common. Women who have given birth after the age of 30 may also be more prone to develop it.
What are the common sites of endometriosis?
The commonest site is in the abdomen on the ovaries, fallopian tubes, on the pelvic sidewalls, the area between the vagina and rectum (cul de sac) and the outer surface of the uterus. Other sites for these endometrial growths may include the bladder, bowel, vagina, cervix, vulva, and in abdominal surgical scars. Less commonly they are found in the lung, arm, thigh, and other locations.
What then happens to the endometrial implants?
These misplaced tissues develop into growths or lesions which respond to the menstrual cycle in the same way that the tissue of the uterine lining does: each month the tissue builds up, breaks down, and sheds. Normally, menstrual blood flows from the uterus and out of the body through the vagina. However, the blood and tissue shed from endometrial implants has no way of leaving the body. This results in internal bleeding, breakdown of the blood and tissue from the lesions, and inflammation -- and can cause pain, infertility, scar tissue formation, adhesions, and bowel problems.
What are the common symptoms of endometriosis?
Pain before and during periods (dysmenorrhea)
Pain with sex (dyspareunia)
Are there other endometriosis symptoms?
Other symptoms include:
Painful urination during periods
Painful bowel movements during periods
Other gastrointestinal upsets such as diarrhea, constipation, nausea.
In addition, many women with endometriosis may suffer from: allergies, chemical sensitivities, frequent yeast infections.
How is endometriosis diagnosed?
Laparoscopy is the commonest technique used to diagnose endometriosis. This is a procedure where a fiber-optic telescope is inserted through the belly button (umbilicus) to look at the pelvic structures. A video camera is attached to the laparoscope and the surgeon will observe the pelvic findings on a television screen. Pictures can be taken and sometimes a biopsy can be done to confirm the diagnosis of endometriosis. A laparoscopy usually shows the location, size, and extent of the growths. This helps the doctor and patient make better treatment choices.
Ultrasound can suggest the presence of endometriosis when there is a typical ovarian cyst (endometrioma) present, but most imaging methods cannot show other types of endometrial growths.
What causes endometriosis?
The cause of endometriosis is unknown. There are several theories that have been proposed.
The retrograde menstruation theory suggests that during menstruation some of the menstrual tissue backs up through the fallopian tubes, implants in the abdomen, and grows.
Some experts believe that all women experience some menstrual tissue backup and that an immune system problem or a hormonal problem allows this tissue to grow in the women who develop endometriosis.
Another theory suggests that endometrial tissue is distributed from the uterus to other parts of the body through the lymph system or through the blood system.
A genetic theory suggests that it may be carried in the genes in certain families or that some families may have predisposing factors to endometriosis.
Surgical transplantation has also been cited in many cases where endometriosis is found in abdominal scars, although it has also been found in such scars when accidental implantation seems unlikely.
Another theory suggests that remnants of tissue from when the woman was an embryo may later develop into endometriosis, or that some adult tissues retain the ability they had in the embryo stage to transform reproductive tissue in certain circumstances.
How is endometriosis staged?
The commonest staging system used was the one proposed by the American Society for Reproductive Medicine in 1996. This is based on the laparoscopic appearance of the pelvis. The visual appearance of the extent of the implants, and the presence of scar tissue are evaluated.
The disease can be minimal, mild, moderate or severe (Stage I – IV). The presence of an endometrioma or obliteration of the cul de sac is automatically considered as severe (Stage IV) endometriosis.
What are the risk factors for endometriosis?
Apparent risk factors for endometriosis also include a low body mass index (BMI), alcohol use, and smoking. African-American women are less likely than Caucasian women to have endometriosis.
Can endometriosis be prevented?
There are certain steps that a woman can take to either help prevent endometriosis or keep it from becoming worse:
Women who have a problem with their reproductive organs that obstructs the menstrual flow should consider surgery to relieve the obstruction.
A woman with a family history of endometriosis should be aware that she is at increased risk for developing endometriosis.
There is evidence that taking oral contraceptives (birth control pills) may help keep endometriosis from developing.
Since endometriosis is associated with childlessness, childbearing may give a protective effect. Therefore, women at risk for endometriosis may want to try to have children before their late 30s
Dr. Karande is Board Certified in the specialty of Obstetrics and Gynecology as well as the subspecialty of Reproductive Endocrinology and Infertility. He is a Fellow of the American College of Obstetricians and Gynecologists and Member of the American Society for Reproductive Medicine.