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 Endometriosis
is endometrium in the wrong place. It contains endometrial glands and stroma.
In other words, it is uterine-like tissue that is growing outside the uterus
causing pain and/or infertility. Its cause is unknown. There are many theories
and people who will tell you they know what causes it, but every answer has
contradictions. It could be genetics. It could be retrograde menses. It could
be congenital. It could be all of the above or none of the above. We simply
don't know.
It is important to know that Endometriosis should be treated for
pain. However, for most women, none of the treatments enhance fertility.
Endometriosis
is common. The generally accepted percentage of women with Endometriosis is
15%. However, many women have Endometriosis and don't have the symptoms
(usually pain) or the pressing need to be diagnosed (usually infertility).
Additionally, Endometriosis can be diagnosed as very mild to severe. There are
likely many more people with very mild Endometriosis, which does not cause
infertility.
The
only way to diagnose Endometriosis with complete accuracy is to see it. The
only way to see it is through surgery. There are symptoms and tests that can
give a physician clues, but Endometriosis is a very elusive disease. The adage,
seeing is believing, is the safest and most effective route to pursue diagnosis
and ultimately treatment.
Treatment
Options: Medication and surgery can be given to treat the symptoms of
Endometriosis. They do not cure the disease, but they can suppress the
symptoms. Some of the more common treatment options are:
Oral Contraceptives
Estrogen is commonly known as a stimulant to Endometriosis tissue. Birth
control pills can prevent ovulation, and subsequent additional estrogen
production. Birth control pills are progestin dominant. Progestins usually
suppress estrogen's effect. However, birth control pills contain estrogen. For
some patients, the estrogen in the pills may just be a trade-off for the
suppression, and no benefit is gained.
Progesterone (Depot Provera)
Progesterone, a synthetic progestin, can also prevent ovulation and does not
include any estrogen. However, Depot Provera has caused long-term and permanent
loss of ovulation after medication was stopped. If a woman still has
childbearing interest, Depot Provera is not recommended.
GNRH Analogs
Lupron, Synarel and Zoladex are medications that create a "reversible
menopause" state, and subsequently reduce estrogen production. These
medications are only approved for 6 months of continued use. They are not a
long-term solution to Endometriosis.
Surgical Removal of Endometriosis
A telescope-like device, called a laparoscope, is inserted into the belly button
to visualize pelvic structures. A small incision is made to insert an
instrument to remove the Endometriosis. It is important to remove
"all" the visible Endometriosis and retain the organs unless a
hysterectomy is chosen. Please note there will also be microscopic
Endometriosis too small to see. This, as well as all treatments, should be
discussed at length with your physician.
Common
Myths about Endometriosis
Pregnancy cures Endometriosis ... false
Pregnancy may reduce symptoms of Endometriosis and may make one feel like she
is cured, but the symptoms will be back.
You cannot conceive with Endometriosis ... false
Endometriosis can impair fertility. Many women conceive with various degrees of
Endometriosis.
Surgery cures Endometriosis ... false
Surgery may provide long-term elimination of symptoms, but it does not stop
whatever is causing Endometriosis. Endometriosis and its symptoms return in
about 20% of all cases. Surgery for Endometriosis does not enhance fertility.
Lots of Endometriosis means lots of pain ... false
There is a correlation between the amount of Endometriosis and pain. But small
amounts located at nerve endings results in crippling pain.
Definitions
Lesions, adhesions, cysts and endometrioma are words that are often used in
discussions involving Endometriosis. The following definitions will help clear
up any confusion.
Lesions:
Officially, a lesion is an injury or an illness. When physicians are talking
about Endometriosis and use the word "lesion", just remember it is
another word for Endometriosis.
Adhesions:
Endometriosis (tissue) can bleed. The scar tissue that forms as a result is an
adhesion. The word "adhesion" is related to the word
"adhesive", meaning to stick. Adhesions have the tendency to make
organs stick together.
Cysts:
The enclosed space within a tissue that is filled with some fluid.
Endometrioma:
A cystic mass growing discreetly behind a walled-off area of Endometriosis and
adhesions, usually within an ovary.
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