Endometriosis & its treatments

The uterus (commonly called the womb) contains a lining referred to in medical terms as the endometrium. This is a specialized lining that grows within the uterus each month. Its purpose is to nourish a fertilized egg, and later, the viable fetus. Endometrial growth occurs in response to an elaborate cycle of stimuli produced by hormones secreted by the pituitary gland and the ovaries. If the endometrium isn't utilized (if a fertilized egg doesn't attach to the lining), it will be disposed of by the body's process of menstruation. Endometriosis occurs when endometrial tissue grows somewhere outside of the uterus. Most often this happens in other areas of the reproductive tract.

There are no specific causes for endometriosis. Theoretically, there are several possibilities, including genetic involvement, immune system malfunctions, and the theory of retrograde menstruation. Retrograde menstruation suggests that endometrial tissue "backs up" through the fallopian tubes where they are released resulting in attachment and growth on other tissues and pelvic structures.

Known risk factors for endometriosis include infertility, familial endometrial history, early onset of menstrual cycles, cycle lengths of 27 or fewer days, and periods that extend beyond 7 days. Some commonly encountered symptoms are recurrent abdominal discomfort with menses, constipation, and abnormally heavy and/or prolonged bleeding during the menstrual cycle. In occasional cases, the abdominal pain will radiate to the lower back. Infertility is not uncommon, and painful coitus is periodically encountered.

Evaluation of endometriosis will include a history and pelvic examination. The pelvic exam can be used to eliminate other possibilities that present the same or similar symptoms as endometriosis. Two other procedures can be employed in the evaluation of the patient, resulting in positive diagnosis. One is direct observation and inspection of the reproductive organs. This can be accomplished by utilizing a fiberoptic procedure called a laparoscopy. Another method is doing a uterine biopsy.

In the uterine biopsy, a sample is taken of the endometrial lining of the uterus. This test is usually performed when evaluating abnormal menses, anovulatory bleeding, post-menopausal and/or heavy menstrual bleeding. The procedure can assist in the identification of uterine cancer, endometritis, adenomyosis (endometriosis interna), and uterine fibroids. It is often employed in women already diagnosed with endometriosis as part of a through evaluation.

Treatment is variable. It will be determined based on several factors, including the patient's age, desire for having children, and the severity of the condition. Patients nearing menopause will usually be treated with less aggressive methods since endometrial symptoms will abate or cease on menopause.

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