Endometriosis

What is Endometriosis?

Endometriosis is a common gynecologic disorder associated with pelvic pain and infertility. It affects as many as 1 in 10 women of reproductive age and up to 30-50 percent of women with infertility.

Endometriosis occurs when endometrium, the tissue that normally lines the uterine cavity, develops or implants outside of the uterus.

Endometriosis is thought to form most frequently from retrograde menstruation, or backward flow of menstrual blood and tissue through the fallopian tubes into the pelvis. Normally this tissue will be cleared by the body’s lymphatic system and immune cells. However, endometriotic cells escape these normal clearing mechanisms and instead, may attach to and invade other structures.

Endometriosis is commonly found on the internal surface of the abdominal cavity (peritoneum) and on pelvic organs, such as the ovaries, uterus, fallopian tubes, bladder, and intestines. Some implants are superficial, whereas others can be deeply infiltrating.

Endometriosis responds to the hormonal signals throughout a woman’s menstrual cycle, and may grow and shed similarly to the normal uterine lining, causing internal bleeding, pain, inflammation, and sometimes scar tissue formation wherever lesions exist.

Endometriosis Surgery

Surgery remains the gold standard in the diagnosis of endometriosis and can also be used to treat pain symptoms and improve natural fertility.

Women with suspected or laparoscopically-confirmed endometriosis who are not seeking pregnancy should always use menstrual suppression after surgery to prevent the progression or recurrence of endometriosis and to reduce pain symptoms.

Progestin-only oral agents (e.g. norethindrone acetate), levonorgestrel-secreting IUDs, and the GnRH receptor analogues (e.g. leuprolide) are the preferred hormonal suppressants for women with endometriosis because they generally counteract or inhibit estrogen-stimulated growth and activity in both normal endometrial tissue and in endometriosis. Women, therefore, will have fewer bleeding days and fewer days of pelvic pain associated with their disease when treated with these hormonal therapies.

Endometriosis and Infertility

Endometriosis is not always associated with fertility problems. When women with endometriosis do have difficulty conceiving, however, superovulation plus intrauterine insemination (IUI) and in vitro fertilization (IVF) are excellent non-surgical fertility treatment options. The expected success rates with these treatments match those for similarly-aged women with unexplained infertility.

It is important to be aware that overly aggressive endometriosis surgery can harm future fertility by failing to preserve an ovary or fallopian tube that may have been salvageable by a reproductive specialist, by removing or damaging healthy ovarian tissue during removal of ovarian cysts, or by unnecessary removal of the uterus (hysterectomy) when more conservative treatment may have worked.