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What is endometriosis?

Endometriosis is a common gynecological condition, particularly among women of childbearing age, affecting an estimated 2 to 10 percent of American women in this age group. Endometriosis can be a debilitating disease for some women who experience ongoing pain, while others may be asymptomatic (without symptoms). It is also a factor in infertility. According to the American Society for Reproductive Medicine, endometriosis can be found in 24 to 50 percent of women who experience infertility.

During a woman's regular menstrual cycle, this tissue builds up and is shed if she does not become pregnant. Women with endometriosis develop tissue that looks and acts like endometrial tissue outside the uterus, usually on other reproductive organs inside the pelvis or in the abdominal cavity. Each month, this misplaced tissue responds to the hormonal changes of the menstrual cycle by building up and breaking down just as the endometrium does, resulting in internal bleeding.

Unlike menstrual fluid from the uterus, which is shed by the body, blood from the misplaced tissue has nowhere to go, resulting in the tissues surrounding the endometriosis becoming inflamed or swollen. This process can produce scar tissue around the area, which may develop into lesions or growths. In some cases, particularly when an ovary is involved, the blood can become embedded in the tissue where it is located, forming blood blisters that may become surrounded by a fibrous cyst.

Symptoms

The following are the most common symptoms for endometriosis; however, each individual may experience symptoms differently. Symptoms of endometriosis may include:

  • Pain, especially excessive menstrual cramps which may be felt in the abdomen or lower back
  • Pain during intercourse
  • Abnormal or heavy menstrual flow
  • Infertility
  • Fatigue
  • Painful urination during menstrual periods
  • Painful bowel movements during menstrual periods
  • Other gastrointestinal problems (i.e., diarrhea, constipation and/or nausea)

It is important to note that the amount of pain a woman experiences is not necessarily related to the severity of the disease – some women with severe endometriosis may experience no pain, while others with a milder form of the disease may have severe pain or other symptoms.

Causes

Although the exact cause of endometriosis is unknown, experts believe the following play a role:

  • Retrograde menstruation — When blood containing endometrial cells flows back through the fallopian tubes, the misplaced endometrial cells can attach themselves to the pelvic walls and surfaces of pelvic organs. The cells then thicken and bleed
  • Surgical scar implantation — Following a surgical procedure such as a hysterectomy, endometrial cells could attach to an incision
  • Alcohol consumption
  • Hereditary reasons
  • Uterine abnormities
  • High levels of estrogen in your body
  • Starting period at young/early age

How is it diagnosed?

Diagnosis begins with a gynecologist evaluating a patient's medical history and a complete physical examination, including a pelvic exam. A diagnosis of endometriosis can only be certain when the physician performs a laparoscopy (a minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall). Using the laparoscope to see into the pelvic area, the physician can often determine the locations, extent and size of the endometrial growths.

Other examinations, which may be used in the diagnosis of endometriosis, include:

  • Biopsy ­— a procedure in which tissue samples are removed (with a needle or during surgery) from the body (often during a laparoscopy) for examination under a microscope to determine if cancer or other abnormal cells are present
  • Ultrasound — a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs
  • Computed tomography (CT or CAT scan) — a noninvasive procedure that takes cross-sectional images of internal organs to detect any abnormalities that may not show up on an ordinary X-ray
  • Magnetic resonance imaging (MRI) — a noninvasive procedure that produces a two-dimensional view of an internal organ or structure

Treatment

Treatment options for endometriosis include:

  • Hysterectomy — A hysterectomy is the surgical removal of the uterus.
  • Laparoscopic gynecologic surgery — Laparoscopic gynecologic surgery is a minimally invasive procedure that involves the use of a thin, flexible tube inserted through a small incision in your abdomen.
  • Laparotomy — A laparotomy is a surgical procedure used to open the abdominal cavity.
  • Salpingo-oophorectomy — A salpingo-oophorectomy is the surgical removal of one or more of the fallopian tubes.
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