Treatment and Research Related to Endometriosis

Up to 20% of American women of childbearing age may have endometriosis, a condition which can cause severe pain or infertility. Endometrium is the tissue that lines the inside of the uterus. In women of childbearing age who are not pregnant, endometrium normally is shed each month as menstrual flow. Endometriosis is characterized by tissue that looks and acts like endometrium, but is located outside the uterus, usually in the abdominal cavity.

This misplaced tissue reacts to the menstrual cycle the same way normal endometrium does. It breaks apart and begins to bleed at the end of each menstrual cycle. However, there is no place for blood to go. As a result, tissue around the area of endometriosis may become swollen and inflamed, producing scar tissue and lesions. Endometriosis is usually relieved by menopause, although estrogen-replacement therapy may cause the tissue to grow back.

For pain control, medications are the first line of treatment. These include a wide variety of non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen and naproxen. A weak synthetic male hormone (Danazol, which is a type of progesterone), medroxy progesterone acetate (Provera) and birth control pills are other options. They stop the ovaries from functioning so that menstruation does not occur.

Injections of a drug like Lupron, known as gonadotropin releasing hormone agonist therapy, may be necessary. This brings on "medical menopause," ending the production of estrogen and progesterone, the hormones that fuel endometriosis. If medication does not alleviate pain, surgery to remove the endometrial material and, possibly, the reproductive organs may be necessary.

Surgery is usually necessary to improve fertility in patients with endometriosis. Attempts will be made to remove endometriotic tissue, restore pelvic anatomy and improve fallopian tube function. Fertility medications are often prescribed. For patients who are trying to control pain and become pregnant, surgery along with anti-inflammatories and fertility medications may be prescribed.

Because ultrasound and magnetic resonance imaging (MRI) results are not diagnostic, surgery is required to confirm endometriosis. A laparoscope, in the form of a narrow tube, is inserted through a small incision in the abdomen. This allows the physician to view areas of endometriosis. Advanced laparoscopic surgery, involving additional small incisions for other instruments, can remove or destroy endometriotic tissue. Sometimes a laser is used in this case.

Open surgery, which involves a larger abdominal incision, is commonly associated with treating very difficult cases of endometriosis in concert with removing the uterus or ovaries. Improvements in laparoscopic instruments and surgical knowledge allow many of these difficult cases to be performed, including removal of reproductive organs, by laparoscopy. Patients who have laparoscopic surgery can usually return to work within 72 hours, but they may be off the job two to four weeks with open surgery.

At the Medical College of Wisconsin, researchers are trying to determine the genetic origin of endometriosis. Researchers question if endometriosis begins as a result of menstruation or if it is entirely independent and develops like a tumor because of a gene abnormality. As part of the study, tissue samples from endometriosis are being compared to normal endometrial tissue in the uterus.

Other researchers are examining the mechanism by which the disease causes pain or infertility. While not yet proven, endometriosis is believed to occur when endometrium backs up into the fallopian tubes and on into the abdomen, causing inflammation.

It appears that sometimes endometriosis can produce chemicals that influence the release of eggs from the ovaries and the fallopian tubes' ability to pick up the eggs. Fertilization and implantation can also be affected by endometriosis. The influence of these chemicals is under study, as is the role of "selective estrogen receptor modulators" in the treatment of endometriosis. Endometriosis is believed to worsen under the influence of estrogen. If these receptor sites could be blocked on the cellular level, a cure for endometriosis might be possible.

Phototherapy, which has been used to destroy brain tumors and other abnormal cells, may hold promise for treating endometriosis. This method involves injecting a light-sensitive chemical agent, such as a dye. When activated by a specific wavelength of light, the agent kills the abnormal cells. This treatment for endometriosis, unfortunately, is still years in the future.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.