What is endometriosis?
Endometriosis is a condition in which the cells of the inner lining of the uterus accumulate outside the uterus. They can collect throughout the abdomen and pelvis, but classically develop around the ovaries, the fallopian tubes, behind the uterus, and around the bowel. These cells, endometrial glands and stroma, are completely normal and expected inside the uterus of a menstruating woman. The issue is about the location of these cells. Instead of just being restricted to the endometrium, the inner lining of the uterus, the cells grow around other organs.
What are the symptoms?
Cyclic pain is the classic presenting symptom. The pain occurs around the start of the menstrual cycle and may last for days. For some, the pain is debilitating, leading to missed days of school or work. Other symptoms include bloating, pain with bowel movement, or an inability to conceive.
Why are the symptoms often overlooked?
Some women attribute their pain to normal menstrual discomfort. This may be reinforced by family, friends, and even healthcare providers. It may take years for someone to introduce endometriosis as a possibility.
How is it diagnosed?
There is no good screening or diagnostic test for endometriosis. Although the diagnosis is suggested based on symptoms of cyclic pain, the only way to definitively make the diagnosis is through surgery. The surgery is laparoscopy, an outpatient procedure where we put a camera into a small incision in the belly to examine the pelvic organs.
What causes this condition?
There are a few theories about the true origin of endometriosis. Some say the cells are transported through the fallopian tubes, others describe spread through the blood or lymphatic system, and still others describe a change in the cells already in place outside the uterus. There are other theories, but ultimately endometriosis is the result of endometrial cells collecting outside the uterus.
Is it treatable?
Yes. Endometriosis is a chronic condition, so you can’t snap your fingers for a cure. Treatment goals include managing symptoms and preventing progression of the disease. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain. Hormonal therapy can help prevent progression. Severe cases that do not respond to medication may require surgery. Endometriosis can progress and form an endometrioma, a collection of fluid that can form around the ovaries. Endometriomas have various forms and effects. They can be the size of a pea or larger than a grapefruit. Aside from forming a contained collection they can also affect the function of neighboring organs. They can affect the fallopian tubes to cause infertility, block the passage of urine from the kidneys to the bladder, and they can invade the bowel. Surgery is usually indicated in these advanced cases. The goal of surgery would be to confirm diagnosis and restore normal anatomy.
How does endometriosis impact fertility?
Endometriosis can impact fertility in a few ways. One is by acting as a barrier to prevent the egg from reaching the fallopian tubes. Another way is by distorting the fallopian tubes. When endometriotic cells implant on the tubes, they can form abnormal connections or adhesions. These adhesions can make the tubes contort and swell to the point where they become completely obstructed. Once this occurs there is no natural way for sperm and egg to meet.
Will treatment help with infertility?
If a woman has trouble conceiving because she has endometriotic lesions around an ovary, we can free the ovary and she will, it is hoped, ovulate. If there is severe swelling and distortion of the fallopian tubes, they may never function again. In vitro fertilization may be the only option for conception.