Endometriosis
What is
endometriosis?
What are
the symptoms of endometriosis?
Does endometriosis cause endometrial cancer?
Does endometriosis make you infertile?
What is the cause of endometriosis?
How would my clinician know if I had endometriosis?
Can you
cure endometriosis?
Return to Frequently Asked Questions Index
What is endometriosis?
The name
endometriosis comes from the word "endometrium," the tissue that lines the
inside of the uterus. If a woman is not pregnant this tissue builds up and
is shed each month. It is discharged as menstrual flow at the end of each
cycle. In endometriosis, tissue that looks and acts like endometrial
tissue is found outside the uterus, usually inside the abdominal cavity.
The problem is that
this misplaced endometrial tissue acts like it would if it were inside the
uterus. At the end of every cycle, when hormones cause the uterus to shed
its endometrial lining, endometrial tissue growing outside the uterus will
break apart and bleed. However, unlike menstrual fluid from the uterus,
which is discharged from the body during menstruation, blood from the
misplaced tissue has no place to go. Tissues surrounding the area of
endometriosis may become inflamed or swollen. The inflammation may produce
scar tissue around the area of endometriosis. These endometrial tissue
sites may develop into what are called "lesions," "implants," "nodules,"
or "growths."
What are the symptoms of
endometriosis?
Most commonly, the
symptoms of endometriosis start years after menstrual periods begin. Over
the years, the symptoms tend to gradually increase as the endometriosis
areas increase in size. After menopause, the abnormal implants shrink away
and the symptoms subside.
The most common
symptom is pain, especially excessive menstrual cramps (dysmenorrhea)
which may be felt in the abdomen or lower back or pain during or after
sexual activity (dyspareunia). Infertility occurs in about 30 to 40
percent of women with endometriosis. Rarely, the irritation caused by
endometrial implants may progress into infection or abscesses causing pain
independent of the menstrual cycle. Endometrial patches may also be tender
to touch or pressure, and intestinal pain may also result from endometrial
patches on the walls of the colon or intestine.
The amount of pain
is not always related to the severity of the disease-some women with
severe endometriosis have no pain; while others with just a few small
growths have incapacitating pain.
Does endometriosis
cause endometrial cancer?
Endometrial cancer
is very rarely associated with endometriosis, occurring in less than 1
percent of women who have the disease. When it does occur, it is usually
found in more advanced patches of endometriosis in older women and the
long-term outlook in these unusual cases is reasonably good.
Does
endometriosis make you infertile?
Severe endometriosis
with extensive scarring and organ damage may affect fertility. It is
considered one of the three major causes of female infertility. However,
unsuspected or mild endometriosis is a common finding among infertile
women and how this type of endometriosis affects fertility is still not
clear. While the pregnancy rates for patients with endometriosis remain
lower than those of the general population, most patients with
endometriosis do not experience fertility problems.
What is the cause
of endometriosis?
The cause of
endometriosis is still unknown. One theory is that during menstruation
some of the menstrual tissue backs up through the fallopian tubes into the
abdomen, where it implants and grows. Another theory suggests that
endometriosis may be a genetic process or that certain families may have
predisposing factors to endometriosis. In the latter view, endometriosis
is seen as the tissue development process gone awry.
How
would my clinician know if I had endometriosis?
Diagnosis of
endometriosis begins with a gynecologist evaluating the patient's medical
history. A complete physical exam, including a pelvic examination, is also
necessary. However, diagnosis of endometriosis is only complete when
proven by a laparoscopy, a minor surgical procedure in which a laparoscope
(a tube with a light in it) is inserted into a small incision in the
abdomen. The laparoscope is moved around the abdomen, which has been
distended with carbon dioxide gas to make the organs easier to see. The
surgeon can then check the condition of the abdominal organs and see the
endometrial implants.
The laparoscopy will
show the locations, extent, and size of the growths and will help the
patient and her doctor make better-informed decisions about treatment.
Can you cure endometriosis?
While the treatment
for endometriosis has varied over the years, doctors now agree that if the
symptoms are mild, no further treatment other than medication for pain may
be needed. For those patients with mild or minimal endometriosis who wish
to become pregnant, doctors are advising that, depending on the age of the
patient and the amount of pain associated with the disease, the best
course of action is to have a trial period of unprotected intercourse for
6 months to 1 year. If pregnancy does not occur within that time, then
further treatment may be needed.
For patients not
seeking a pregnancy where treatment specific for the management of
endometriosis is required and a definitive diagnosis of endometriosis by
laparoscopy has been made, a physician may suggest hormone suppression
treatment. Since this therapy shuts off ovulation, women being treated for
endometriosis will not get pregnant during such therapy, although some may
elect to become pregnant shortly after therapy is stopped. Hormone
therapies include Danazol, a weak male hormone, and GnRH ( gonadotropic
releasing hormone) agonist. Depending on the severity of the endometriosis
and fertility, some women may seek surgical treatment to removed the
diseased tissue without risking damage to healthy surrounding tissue. This
surgery is called laparotomy and is performed in a hospital under
anesthesia. New surgical treatments are being developed that further
utilize the laparoscope instead of full abdominal surgery.
Some patients may
need more radical surgery to correct the damage caused by untreated
endometriosis. Hysterectomy and removal of the ovaries may be the only
treatment possible if the ovaries are badly damaged. In some cases,
hysterectomy alone without the removal of the ovaries may be reasonable.
from
The Office On Women's Health - US Department of Health and Human Services
Return to Frequently Asked
Questions Index
|
