Since as many as 10 percent of women suffer from endometriosis it is no wonder that we get a lot of questions about. Endometriosis is a condition in which the cells that belong in the lining of the uterus (endometrial cells) start growing outside of their normal location. The most common place that these cells grow is inside the abdominal cavity on the lining that covers our abdominal organs called the peritoneum. Endometriosis can also occur in the ovaries or even in other remote locations such as the skin or lungs. A particular form of endometriosis called adenomyosis occurs when uterine lining cells grow inside the muscle wall of the uterus rather than just in the center where they belong. Adenomyosis causes heavy and irregular bleeding as well as pain and ultimately is best treated with hysterectomy.
Since endometrial cells are programmed to bleed every month in response to hormone changes, this results in bleeding in these areas, which commonly causes pain. Sometimes the areas of bleeding can be almost microscopic and other times large collections of blood can build up and form blood filled cysts (endometriomas). Women with endometriosis usually present with pain, mostly around the time of their menstrual cycle, but sometimes occurring at other times, for example during intercourse or with bowel movements depending on the location of the implants.
While much research has gone into trying to figure out why this happens in some women and not others there is still no clear explanation. The diagnosis is often suspected by listening to the patient’s history but can only be confirmed with surgery. In most patients an ultrasound is normal as endometriosis implants are usually too small to be picked up with any radiologic study. When surgery is warranted, generally we will do a laparoscopy which involves putting a small camera through a tiny umbilical incision to view the pelvis and look for implants. With the camera these implants may look like black or red areas which can then be destroyed with a variety of techniques including laser and electrocautery.
Endometriosis can also be treated with a variety of medications which stop the menstrual flow or reduce it. Simple birth control pills can often help dramatically, as can other hormones including progestins which slow the growth of endometrial cells. Another class of drugs can temporarily put the patient into a menopausal state with very low estrogen levels, which results in the menstrual cycle stopping altogether for a view months.
Unfortunately nothing completely cures endometriosis short of removing the source, which is the uterus. Our goal with endometriosis patients is to get through the reproductive years and then a hysterectomy is often the ultimate choice. For patients who are having trouble getting pregnant a short course of medication can sometimes calm down the implants enough to allow for fertility. In other cases if the tubes are damaged in vitro fertilization (IVF) may be the only choice. The good news is that almost every endometriosis patient can achieve pregnancy if she explores all the options available.
If you have questions about endometriosis please talk to one of our providers and we would be happy to help you.
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