Endometriosis is a reproductive disorder in which the tissue lining the uterus (endometrium) grows on the surfaces of other organs in the abdomen. During menstruation, instead of being shed through normal menstrual flow, the endometrium is trapped and can irritate surrounding tissue. It also can potentially lead to cysts, scar tissue and adhesions — tissue that attaches two organs to each other.
The result can be extremely painful — even disabling — menstrual cramps. The pain worsens and spreads over time, causing chronic pelvic pain, discomfort during or after sexual intercourse, heavy bleeding, painful bowel movements or urination during menstruation, and spotting between periods.
The National Institute of Child and Human Development estimates as many as 10 percent of women of reproductive age suffer from endometriosis. Because it often is not diagnosed, however, it is difficult to determine an accurate number.
"Although the most common symptom of endometriosis is pain, approximately 30 to 40 percent of women with endometriosis may have fertility problems, making it one of the top three causes of female infertility, following tubal factors, such as a damaged fallopian tube, or ovulatory problems, such as irregular periods," says Dr. Bennie Nobles, an obstetrician and gynecologist at East Jefferson General Hospital.
The actual cause of endometriosis is still unknown, but experts are exploring what role hormones, genetics and the immune system may play in its development.
"Family history and delayed childbearing are the greatest risks we see associated with endometriosis," Nobles says. "We do recommend (to) those women who have severe endometriosis and are contemplating having children, it is better not to delay until the later years of childbearing age if possible."
To determine if you have endometriosis, your physician will ask a number of questions and, if endometriosis is suspected, will look for physical clues through a pelvic exam, ultrasound or MRI. The only way to find out for sure, however, is through laparoscopy.
"A laparoscopy is a minimally invasive surgery during which we insert a small viewing instrument, a laparoscope, into the abdomen," Nobles says. "We can then look for signs of endometriosis and take a ... tissue sample, if necessary, to make a final determination."
There is no cure for endometriosis, but there are treatments. Physicians may suggest an over-the-counter pain medication such as ibuprofen for women with mild to moderate pain. If that doesn't provide full relief, the doctor may suggest hormone therapy or, in more serious cases, surgery.
The most common hormone therapy options include oral contraceptives and Gonadatropin-releasing hormone (Gn-RH) agonists. Birth control pills help regulate the growth of the endometrium, therefore decreasing menstrual flow and alleviating pain. GnRH agonists suppress the pituitary gland.
"The pituitary gland normally produces hormones that affect the ovary," Nobles explains. "By 'turning off' the pituitary, the ovary is also 'turned off.' As a result, the ovaries stop ovulating and no longer produce estrogen. This leads to a menopausal state." Because these medications can lead to bone loss, doctors limit the length of time they can be used.
Laparoscopy can be used to treat endometriosis by removing the growths, scar tissue and adhesions, or by destroying them with a laser. Doctors suggest this option if a woman wants to become pregnant, as it may increase the chances of success.
In very severe cases of endometriosis, a physician may suggest a hysterectomy and removal of the ovaries. This is considered a last resort and is no guarantee the condition will not return.
"Endometriosis often has similar symptoms to interstitial cystitis, which is a loss of the protective coating of the bladder," Nobles says. "Because it's often misdiagnosed, it's important to consult your doctor if you think you have endometriosis. Both conditions can also exist side by side, so discuss all your symptoms with your physician."