Endometriosis is commonly encountered in the conversation of female pelvic pain or infertility, although many patients with endometriosis have no symptoms at all. So, what is endometriosis? The uterus is a muscular organ with a cavity on the inside called the endometrial cavity. The surface of this cavity is lined with specialized cells called endometrial cells that responded to the hormones the ovaries produce in the process of ovulation. Endometriosis is when these cells that are normally inside the uterus are, instead, found outside of the uterus on the ovaries, tubes, appendix and intestines. Further, these endometrial cells are not aware of their abnormal location and continue to respond to ovarian hormones. As a result, at a microscopic level, these cells bleed into the abdomen when menstruation occurs. This promotes an inflammatory response inside the abdomen which in turn causes pain and scarring. Given enough time, this microscopic process that starts of the surfaces of pelvic organs, grows to larger size and create pools of old blood and endometrial cells called endometriomas.
Endometriosis implants in the pelvis can create pain and discomfort. In its early stages, it may cause normal periods to feel worse with greater pain and cramping. As it progresses, the pain will escalate to anytime during the month as well as pain with sexual intercourse (dyspareunia) or with defecation (dyschezia). Unexpectedly, the amount of endometriosis present does not always match up with the amount of pain. Even a small amount of disease can cause a great deal of pain. Similarly, some patients may discover large amounts of endometriosis at the time of a surgery even though they were not experiencing pain.
Some patients discover they have endometriosis in the process of being evaluated for infertility. Since endometriosis does not always hurt, it can be a cause of infertility even if there is no pain. Unlike the relationship of pain and endometriosis, there is a strong relationship to the amount of endometriosis and the difficulty of getting pregnant. AS a results, a staging system for endometriosis is used to predict the fertility success of surgeries to treat endometriosis. Minimal and mild stages of endometriosis respond well to surgery to assist in infertility. Moderate and severe stages are not usually amenable to surgery to improve fertility. In those cases, alternatives such as IVF may be preferred to address infertility.
Because endometriosis begins as a microscopic disease on the surface of organs in the pelvis, diagnostic tests such as CT scans and ultrasound does not detect endometriosis. Likewise, there are no blood tests to detect endometriosis. As a result, surgery is the only way to confirm the diagnosis of endometriosis. Laparoscopy is a minimally invasive technique to diagnosis and often, treat endometriosis. At the time of surgery, samples of the implants are removed and set aside for the pathologist to confirm the diagnosis.
Because endometriosis feed off the estrogen that the ovaries make, suppressing the ovaries from ovulating is an approach to deal with pain from endometriosis. Birth control pills may be used to skip periods and DepoProvera is also used to suppressive ovarian function. However, for endometriosis patients that are seeking pregnancy, contraceptive techniques may be counterproductive. Consequently, pretreating endometriosis before surgery is sometime utilized. Using GnRH agonists such as Lupron, induce a temporary menopause by shutting the ovaries down. Usually, the amount of disease decreases under the influence of GnRH agonist and pain improves. However, this medicine will interfere in the ability to get pregnant while its being used and it causes symptoms of menopause including hot flashes, night sweats, vaginal dryness and irritability. Apart from its expense, it is only used as a temporary agent for most patients in anticipation of surgery.
The final solution for endometriosis is no longer having ovaries that feed its growth with estrogen. Ovaries stop producing hormones at menopause which occurs between the ages of 45 to 55. When women have completed their reproductive plans and pain is sufficient to promote surgical intervention, removing the ovaries (and uterus) offer a permanent option for many patients. However, hysterectomy does not always solve pelvic pain, especially in patients with significant pelvic scarring from endometriosis. In addition, younger patients will have to consider the burden of the symptoms of menopause and the use of hormone replacement when choosing hysterectomy to manage their endometriosis.