What is Endometriosis
Endometriosis is defined by the deposition of endometrial glands and stroma (tissue normally found inside the uterine cavity) outside of the uterus, most commonly behind the uterus in the pelvis. The most common mechanism for the formation of endometriosis is the backflow of endometrium at the time of a patient’s menstrual cycle, which either implants and grows in the pelvis or induces other pelvic tissues to differentiate into endometrial tissue.
Endometriosis is a common disorder often resulting in painful menstrual periods, pelvic pain at other times in the cycle, as well as infertility. Roughly 10% of all women develop endometriosis, most commonly in their late twenties. This condition is highly associated with both chronic pelvic pain as well as infertility, affecting a large percentage of women who undergo laparoscopy for either pelvic pain or unexplained infertility.
Diagnosing endometriosis can be challenging, and sometimes requires laparoscopy. Laparoscopy is a procedure in which a scope is placed into the abdomen generally through the umbilicus (belly button), to look for and biopsy the endometrial lesions on the ovaries, behind the uterus, on the bladder or elsewhere in the pelvis or abdomen.
An ultrasound that may show the classic echogenic ovarian cysts or endometriomas that are common in advanced cases of endometriosis, but in more mild cases of endometriosis there generally are no obvious signs on ultrasound. But mild endometriosis is less likely to be causal in chronic pelvic pain or infertility.
There is a variety of treatment options for patients suffering from endometriosis. Most of the treatment of endometriosis involves laparoscopic removal of the endometriosis. Additionally, some medications have been proven to reduce the pelvic pain of endometriosis including GnRH agonists that turn off the ovarian stimulation that makes the estrogen that stimulates endometrial growth. Also a variety of synthetic progesterones, including norethindrone acetate, depo-provera, and progesterone containing IUDs are effective as they reduce the number of receptors for estradiol on the endometrial tissue.