Endometriosis is when there is a growth of cells, normally found only in the lining of the uterus, in locations outside of the uterus. This cluster of ectopic endometrial cells, called implants, can cause inflammation, scarring and pain. The implants can be found on the ovary, fallopian tubes, on the surface of the uterus, bladder, and intestines, and on the lining covering the abdomen and pelvis (peritoneum). Interestingly, most women with endometriosis will have no symptoms. When there are signs and symptoms due to endometriosis, they can manifest as:
- Pelvic pain, sometimes timed with the menstrual period, or completely separate
- Painful intercourse, or dyspareunia
- Pain with urination or bowel movements
The intensity of pain caused by endometriosis depends on the location of implants. Deeper implants, and those located on or near high density nerve bundles can produce the worse pain. Also, the degree of scarring due to the implants can determine severity of pain.
Endometriosis can also impact fertility. The direct reason for diminished fertility due to endometriosis is not exactly understood. The thought is that scarring my hinder the mechanical process to transfer sperm, egg, or embryo. Also, with inflammation associated with endometriosis, there may be a release of factor(s) that can affect ovulation, fertilization or implantation.
Endometriosis is diagnosed through a non-invasive procedure called Laparascopy, during which biopsies can be performed to confirm the diagnosis.
The treatment for endometriosis can be surgical, medical or a combination of both. Under laparascopic visualization, implants can be excised and scars or adhesion can be released, resulting in improvement of pain.
Implants that cannot be removed, like those overlying organs or major blood vessels, can treated with medical therapies. Antinflammatory agents, or NSAIDs (Motrin, Aleve) can decrease inflammation-related pain.
GnRH agonists can induce a temporary menopause-like state, during which implants regress. Pregnancy creates a similar hormonal state, resulting in a similar therapeutic effect.