Symptoms and Diagnosis of Endometriosis
Endometriosis is a common, but poorly understood disease. It is believed to affect between 10 and 20% of American women of childbearing age, according to the American College of Obstetricians and Gynecologists. The Endometriosis Association estimates that 5 and a half million women and girls in the US and Canada are affected by this painful disease. While some women with the disease have no symptoms, others may have severe pelvic pain and/or difficulty conceiving. At present, there is no absolute cure.
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.
Common sites of endometriosis include the ovaries, fallopian tubes, ligaments supporting the uterus, the internal area between the vagina and rectum, the outer surface of the uterus and the lining of the pelvic cavity. However, endometrial growths have even been found outside the abdomen.
Symptoms
Pain is the most common symptom. Excessive menstrual cramps, usually in the abdomen or lower back, or pain during sexual activity, are typical. The amount of pain is not always related to the severity of the disease, but symptoms tend to gradually increase as the endometrial areas increase in size. It is a chronic condition that may return after treatment. Symptoms subside and lesions shrink away after menopause, although estrogen-replacement therapy may cause the tissue to grow back.
Diagnosis
The process of diagnosing endometriosis begins with a patient's medical history and complete physical exam, including a pelvic exam. However, a surgical procedure is required to effectively diagnose endometriosis. A laparoscope is inserted into a small incision in the abdomen, and a tiny camera is used to look for endometrial tissue and scarring. In many cases, endometrial tissue can be removed and any abnormalities in pelvic anatomy corrected by laparoscopy.
Endometriosis is considered one of the three major causes of infertility. Infertility occurs in about 30 to 40% of women with endometriosis. Fertility may be affected by severe endometriosis with extensive scarring and organ damage. It is not known why unsuspected or mild endometriosis can affect fertility. Still, most women with endometriosis do not experience fertility problems.
What Causes Endometriosis?
The cause of endometriosis is not known for certain. It is believed that some of the menstrual tissue in the uterus may back up through the fallopian tubes during menstruation into the abdomen, where it implants and grows. Another theory views endometriosis as the tissue development process gone awry due to genetic factors. It is also thought that endometriosis may be related to delayed childbearing. During pregnancy, the progress of endometriosis is slowed or stopped because hormones made by the placenta prevent ovulation. Multiple births limit the opportunities for endometrial tissue to grow.
Stimulating factors such as hormones influence the progression of the disease. The immune system may also play a role by activating cells that secrete growth factors, which may stimulate endometriosis. Current research on endometriosis focuses on better understanding the causes and finding effective new treatments.
Estil Y. Strawn, Jr., MD
Assistant Professor of Obstetrics and Gynecology
Medical College of Wisconsin
Obstetrician and Gynecologist
Froedtert and Medical College Women's Health Center
Article Created: 2001-02-07
Article Updated: 2001-02-07
Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.
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