Endometriosis

Endometriosis at a glance

  • Endometriosis is a condition in which the tissue that normally lines the inside of the uterus (endometrium) grows on the outside of the uterus, on the ovaries, bowels or tissue lining the pelvis.
  • The most common symptom of endometriosis is pain in the pelvis, abdomen or lower back, but some women do not experience any symptoms.
  • Endometriosis can lead to fertility problems in some women.
  • Treatment for endometriosis typically involves hormonal medication and sometimes requires laparoscopic surgery, depending on the nature and severity of symptoms.

What is endometriosis?

Endometriosis is a condition affecting women of reproductive age in which some tissue from the inner lining of the uterus (called the endometrium) spreads outside of the uterus. This tissue continues to act as it would in the uterus during the menstrual cycle, thickening, breaking down and bleeding. The bleeding tissue becomes trapped in the body and can cause inflammation and pain, especially during a woman’s period.

Most commonly, endometrial tissue spreads to the ovaries, fallopian tubes, outer lining of the uterus and surrounding pelvic tissues. Endometriosis is a chronic and often progressive disease.  A 2011 study indicates that more than 11 percent of reproductive aged women in the United States have endometriosis.

Symptoms of endometriosis

Many women with endometriosis have no symptoms, but those who do commonly experience:

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Causes & risk factors

The causes of endometriosis are currently unknown. However, experts believe that the hormone estrogen causes endometriosis to spread and increases pain symptoms. Endometriosis typically begins to develop and worsen in the months and years after a woman starts menstruating. When women with endometriosis reach menopause and their estrogen levels drop, their symptoms usually subside.

Diagnosis

The pain that women with endometriosis experience is often severe and not relieved with over-the-counter pain medications. Women experiencing severe pain with their periods should schedule an evaluation with their gynecologist, including a full discussion of symptoms, a physical exam and potentially an evaluation with a pelvic ultrasound.

Ultimately, a definitive diagnosis of endometriosis can only be made with surgery and biopsy of abnormal tissue. This surgery is usually performed using a minimally invasive technique called laparoscopy.

Endometriosis treatment

There is no cure for endometriosis, but treatment can help women manage their symptoms. Endometriosis spreads progressively and should be treated as soon as possible after diagnosis. There are surgical and nonsurgical approaches to treatment. A physician can give advice on the best treatment options.

Nonsurgical treatment

While a definitive diagnosis cannot be made without surgery, suspected cases of endometriosis may be managed using nonsurgical treatment methods, particularly if symptoms are not severe. Nonsurgical approaches to addressing endometriosis include:

Surgical treatment

Outpatient laparoscopic surgery can be performed to diagnose and treat endometriosis. The diagnosis and treatment can happen during the same operation. Endometrial lesions (endometrial tissue outside of the endometrium) can be cut away or burned away using a high-energy heat source, such as a laser. Treatment is more difficult with advanced disease or larger lesions that involve other pelvic structures, like the rectum.

Ablation with a CO2 laser allows for more extensive treatment of endometriosis while decreasing risk of injury to surrounding organs. A number of CU OB/GYN surgeons have received specialized training and certification in laser treatment of endometriosis.

Effectiveness of surgery

Laparoscopy and open surgery (laparotomy) are equally effective in relieving pain and improving fertility in patients with endometriosis.

Patients who undergo laparoscopy, however, experience a faster and less painful recovery. Deciding which surgical procedure to use should be based on the patient’s preference and the physician’s experience with the technique.

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Treating endometriomas

Endometriomas are ovarian cysts containing endometrial blood and tissue that may arise in some patients. Endometriomas most frequently occur in the ovary but can also be located in other areas of the body.

Endometriomas may be treated using one of the following three methods.

Puncture and drainage of the cyst

This procedure is completed by draining the fluid from the cyst. Endometriomas have been shown to recur in more than 50 percent of the patients treated with a simple puncture. However, sometimes extensive scar tissue develops around the cyst and ovary after the procedure, preventing complete removal of the cyst wall.

Cutting away of the cyst wall

This is the procedure of choice to decrease recurrence of disease. Women considering this procedure should discuss its risks and benefits with their surgeon.

Hormonal medication

Small endometriomas can be managed conservatively with medication alone, but generally only resolve completely with surgery.