What is endometriosis?
Endometriosis is a fairly common benign condition that results when the lining of the uterus (endometrium) is found outside the uterus (-osis) and grows typically on the surface of the surrounding organs in the pelvis but can also be found outside the pelvis. The most common locations of endometriosis include the ovaries, fallopian tubes, surface of the uterus, cul-de-sac (the space behind the uterus), bowel, bladder and rectum. Endometriosis is primarily a disease of reproductive years though it can affect women at any age. It is estimated to occur in 5-10% of all women in reproductive years, but is found much more frequently in women complaining of chronic pelvic pain or infertility. Since the endometriosis tissue is similar to the endometrium, the endometriosis cells behave similarly to those that line the womb, so every menstrual cycle they grow and then shed blood. But in the endometriosis, this blood has no way of leaving the body, it is then trapped which leads to all the symptoms that may result from endometriosis.
What are the symptoms of endometriosis?
The most common but not universal symptom of endometriosis is pain or discomfort in the area where the endometriosis tissue is growing and bleeding, although some women have few or no symptoms at all. In this latter case, endometriosis is only found incidentally when surgery is being performed for other reasons. The pain from endometriosis can range from mild to severe and is not necessarily related to the amount of endometriosis inside the pelvis and thus not related to the severity of your condition. Pelvic pain resulting from endometriosis may occur with sex (dyspareunia), just before or during your menstrual cycle (dysmenorrhea), during bowel movements (dyschezia) or urination (dysuria). These symptoms worsen with the menstrual cycle.
The pain can also radiate to the back and down the legs. Over time and with each successive menstrual cycle, the scarring (adhesions) caused from endometriosis can cause chronic pelvic pain.
Endometriosis can also lead to infertility although the exact mechanism of this association is still not completely understood. Therefore, the probability of endometriosis is infertile women is much higher than in the general population.
One particular condition resulting from endometriosis is called endometrioma. Endometriomas are cysts that develop in areas where endometriosic tissue is found abundantly enough so it grows to form a mass or a cyst, typically called chocolate cysts due to the appearance of old blood that resembles chocolate syrup. They are found most commonly in the ovaries.
What are the possible causes of endometriosis?
The exact cause of endometriosis is not known, but there are a number of theories that have been suggested and still under investigation. Genetic factors may also play a role since 7% of women with family history of endometriosis will develop the condition.
How do we diagnose endometriosis?
The diagnosis of endometriosis can be strongly suspected after obtaining a good history and performing a thorough physical and pelvic examination. However, since most of the signs and symptoms of endometriosis are present in a variety of other conditions, the only way to confirm the diagnosis is by visualizing the areas of endometriosis by performing surgery, whether open surgery (laparotomy) or laparoscopy. Both surgeries require that you will be under general anesthesia. During the surgery, your physician will be able to assess the location, size, and extent of the endometriosis if present, and a small sample (biopsy) of the lesions is usually performed and sent to pathology in order to confirm the diagnosis.
There are no blood tests or imaging tests that can be performed to diagnose endometriosis since the areas of endometriosis are often too small to be seen by these tests, therefore normal results do not mean you don’t have the condition.
What are treatment options for endometriosis?
Please refer to Treatment Options for Endometriosis.