What exactly is endometriosis?
The lining of the uterine cavity is called the endometrium. When tissue implants are found outside of the uterus and look like the uterine lining under the microscope we call this condition endometriosis. Implants of endometriosis are most commonly found in the pelvic area, on the ovaries, fallopian tubes, the rectum and the bladder dome. There are rare reports of endometriosis outside the pelvis such as in the lung, colon, inside the bladder, and even as far away as the brain.
What causes endometriosis?
Although the exact cause is still to be proven, many believe it may be caused by a back flow of endometrial cells through the fallopian tubes at the time of the period. These cells settle in the pelvic area, normally the immune system should clean these out, but because of a possible failure of immune system function the cells some how attach to the tissues in the pelvis. There appears to be a genetic link, endometriosis runs in families, and supports an inherited problem of the immune system. Because endometriosis is stimulated by cyclic ovarian estrogen and progesterone production symptoms generally subside after menopause.
Is endometriosis cancerous?
Endometriosis itself is not cancer. The incidence of endometrial cancer in women, who have had endometriosis, even if taking estrogen only after a hysterectomy, does not appear very high. There are reports of endometrial cancer arising in endometriosis, so it is possible, but this does not appear to be a contraindication to estrogen for moderate to severe menopausal symptom relief.
What are the symptoms of endometriosis?
The most common symptoms are:
- Worsening menstrual cramps
- Increased days of cramping in the cycle
- Painful intercourse
- Painful bowel movements and/or urination
- Infertility
- Lower back pain
- Pelvic pressure
How is endometriosis diagnosed?
Clinical symptoms, in the absence of other diagnoses such as fibroids, are considered sufficient for discussion and initiation of medical therapy. Endoscopic visual diagnose is still considered standard, however biopsy confirmation is recommended by many, especially in complicated cases of pelvic pain.
There are two ways to diagnosis of endometriosis. They are transvaginal hydrolaparoscopy and transabdominal Laparoscopy
- Transvaginal Hydrolaparoscopy (THL) – This procedure can be performed in the doctor’s office with only minimal pain medication and no abdominal incisions. Most patients receive oral sedation 40-50 minutes before and would have the procedure again with the same protocol. The woman rests comfortably on an exam table with legs in holding supports. Local numbing medication is given and the scope inserted just beneath the intersection between the back of the cervix and the vagina. Injection of local is typically worse than introduction of the scope. The patient can see to her anatomy on the monitor and ask questions during the entire procedure which takes about 30 minutes. Saline solution is infused into the pelvis and causes the bowel float up and out of the way making it easy to see the ovaries, tubes, and pelvic side walls.
- Laparoscopy – This requires small incisions in the abdomen so a scope can be inserted through the belly button to diagnose or treat endometriosis. A diagnostic laparoscopy can be with IV sedation in the office. Operative laparoscopy requires general anesthesia.
How many women get endometriosis?
Available reports suggest that, possibly, endometriosis is a common occurrence and may establish itself in as many as 50% of women, when visual diagnosis is standard for evaluation. Other authors have concluded 10-15% of women have endometriosis. Biopsy diagnosis is best. The condition appears to have some genetic predisposition, but other factor may play a roll. Endometriosis is more common in Caucasian women than other ethnic groups.