Endometriosis may cause either of two problems, pelvic pain (that usually becomes progressively more severe over time) or infertility. When a woman has persistent and increasing pelvic pain especially during her menstrual flow then endometriosis should be considered as a potential cause. When a couple has otherwise unexplained infertility after a basic noninvasive evaluation, or pelvic factor infertility, then endometriosis should also be considered.
The human body is made up of many different types of tissues and many different organ systems, each with specific functions. When one of these types of tissue grows outside of its usual location, this almost always results in an abnormality that disrupts surrounding tissues.
Endometriosis is a non-cancerous disorder in which the tissue that normally lines the inside cavity of the uterus (called endometrium) grows outside the body of the uterus. An ovarian cyst that involves endometriosis is called an endometrioma. And when endometrial tissue grows within the muscular wall of the uterus this is called adenomyosis.
When endometriosis occurs, the cells that function normally within the uterine cavity grow outside the uterus and they produce problems for the surrounding tissues. This endometrial tissue is hormonally active and changes dramatically during the menstrual cycle in response to estrogen and progesterone. When the endometrial lining within the uterine cavity is shed as the menstrual flow the endometrial tissue that is growing within the pelvis is not directly connected to the vaginal vault so it cannot be shed. Rather the tissue remains in the pelvis and usually causes inflammation and chronic irritation to the surrounding tissues. This inflammation can cause pelvic pain and it can reduce fertility.
Endometriosis can be identified in many different ways.
Symptoms of endometriosis include 1) progressive pelvic pain especially around the time of the menstrual flow, 2) a reduction in ability or an inability to become pregnant, 3) painful bowel movements or painful urination especially during the time of the menstrual flow, 4) painful intercourse, and 5) chronic pelvic pain.
Signs of endometriosis include pain during examination of the gynecologic organs, persistent nonfunctional cysts of the ovary, and pelvic adhesions or scar tissue that glues the pelvic organs in place.
Signs and symptoms may suggest the presence of endometriosis, but definitive diagnosis requires seeing or taking a biopsy of the lesions. Laparoscopy is a very low risk same day surgical procedure that can be used to identify and treat endometriosis.
The treatment of endometriosis can involve surgery, medications or observation depending on the severity and type of symptoms as well as the goals of the patient.
The principle goal of surgery for endometriosis is to remove as many visible lesions as possible to reduce the patient's pelvic pain or enhance the couple's reproductive potential. The outcome of surgery depends heavily on the surgeon and his (or her) ability to remove endometriosis thoroughly with techniques that minimize postoperative adhesion formation. Therefore, it is extremely important to choose a surgeon with considerable experience and expertise in the identification and surgical treatment of endometriosis. It seems unfortunate that most Reproductive Endocrinologist and Infertility experts in the United States now focus their clinic activities within IVF centers and many have little interest in surgical pelvic repair and the surgical treatment of endometriosis.
Medical management of endometriosis is available and it is often effective at reducing pelvic pain, especially when the lesions are small and superficial. Medical management generally fails to reduce the pain that is caused by larger or deeper lesions. Regrettably, the available literature also suggests that the medical management of endometriosis does not significantly improve fertility.
A woman sometimes chooses observation, or the absence of active treatment, if she has few problematic signs or symptoms of endometriosis and especially if she is near menopause.