Endometriosis occurs when cells that normally line the uterus (endometrial cells) grow in other areas of the body, such as the ovaries or the pelvis. The areas of cell growth may be called implants, nodules or lesions.
Endometriosis is present in approximately 40 percent of infertile women and is a common cause of pelvic pain. Women with endometriosis often experience severe pain. However, significant endometriosis can be present and produce no endometriosis symptoms.
Endometriosis causes
There are several theories as to the cause of endometriosis. Some believe that it is caused by a “back flow” of menstrual blood into the pelvic cavity during menstruation. Menstrual blood is rich in endometrial cells since it is formed from the breakdown of the lining of the uterus (endometrium).
There also appears to be a genetic component since daughters of women with endometriosis have a higher incidence of the disease.
What kind of pain does endometriosis cause?
Endometriosis symptoms often involve pain in the pelvis. Pain can be constant, or it may occur during or after:
- Urination
- Bowel movements
- Sexual intercourse
- Menstrual periods
Experts believe the pain from endometriosis is caused by the effects of areas of endometrium outside the uterus. These areas react to changing hormones throughout a menstrual cycle. During a period, the tissue swells and may release tiny amounts of blood. Since that blood doesn’t have a way to leave the body, it lands on nearby tissues causing irritation, pain and cramps.
What are the stages of endometriosis?
Doctors assign a stage to endometriosis based on a complex scoring system. The stages of endometriosis are:
I. Minimal
II. Mild
III. Moderate
IV. Severe
Your level of pain may not match the stage assigned to your endometriosis. Endometriosis treatment may vary depending on its stage.
Endometriosis diagnosis
Because endometriosis symptoms do not always appear, or may be caused by other conditions, a diagnosis cannot be based on symptoms alone. Laparoscopy is the only definitive method for diagnosing endometriosis. However, a trial using a hormonal drug may be used to confirm or rule out endometriosis.
PCOS vs. endometriosis
Having endometriosis may increase the risk for PCOS (polycystic ovary syndrome). Both conditions are chronic, may cause infertility and may require treatment with medicines. However, their effects and causes are different.
With PCOS, you develop cysts on your ovaries that interfere with the release of eggs, which may lead to infrequent or irregular periods. PCOS is caused by hormone imbalances.
With endometriosis, abnormal cells grow outside the uterus. Endometriosis isn’t caused by hormone imbalances, and its actual cause isn’t completely known.
Endometriosis treatment
In mild cases, medical intervention with medications such as Lupron may be effective, however, laparoscopic surgery is usually the best endometriosis treatment option.
Endometrial cells depend upon the hormone estrogen for growth. Reducing the amount of estrogen inhibits endometrial cell growth so drugs such as Lupron are effective in treating the disease. Lupron suppresses the production of follicle stimulating hormone (FSH) and luteinizing hormone (LH) which ultimately leads to lower estrogen levels.
Endometriosis and infertility
Endometriosis is often removed surgically by laparoscopy, especially for people who are infertile. If a laparoscopy is performed, it is very important that all areas of endometriosis be removed as some authorities believe that small amounts can create an inflammatory environment in the pelvis.
Many specialists prefer to move into aggressive infertility treatment such as ovarian stimulation with intrauterine insemination (IUI) or in vitro fertilization (IVF) rather than proceed to surgery. IVF success rates in patients with endometriosis are excellent.