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Q: What's endometriosis?

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A: Endometriosis is a chronic, benign disorder in which endometrial tissue, responding to ovarian hormonal stimulation, is implanted outside the uterus, causing pain and sometimes infertility.


The exact cause of endometriosis is unknown, but the most common theory is retrograde menstruation, in which menstrual flow backs up into the fallopian tubes, pelvis, or abdominal cavity. Transplantation of endometrial tissue can also occur during surgery, and tissue can be spread via the lymphatic and venous systems as well. Adhesions can block the fallopian tubes and interfere with ovulation. They can also block the uterine tubes, preventing the spontaneous movement of ovum to the uterus.


Any woman of reproductive age is at risk for endometriosis. The risk is greater for women who have children later in life, and the average age at diagnosis is 25 to 35 years. Endometriosis also seems to run in families.


Symptoms range from nonexistent to incapacitating. They may occur at any time during the menstrual cycle, but usually increase during menstruation because swelling and inflammation cause the implants to bleed. Many women remain asymptomatic, but those with symptoms commonly experience chronic pain located mostly in the lower abdomen, lower back (possibly radiating down the legs), and pelvic area. Other symptoms include dysmenorrhea, menorrhagia, dyspareunia, diarrhea, painful bowel movements, painful urination, intestinal pain, abdominal tenderness, and pelvic pain with exercise or upon pelvic examination.


Endometriosis may be diagnosed in the office based on palpation of endometrial implants via rectovaginal exam. Laparo-scopy is used to confirm the diagnosis and stage the disease. In stage 1, the patient has superficial or minimal lesions; stage 2, mild involvement; stage 3, moderate involvement; and stage 4, extensive involvement and adhesions with obliteration of the cul-de-sac (area behind the uterus and in front of the rectum). Ultrasound may be done to rule out other pelvic diseases, and a CA-125 antigen blood test may be ordered.


Treatment, which depends on symptom severity and extent of disease, may include the following:


[black small square] nonsteroidal anti-inflammatory drugs


[black small square] oral contraceptives to reduce endometrial tissue when implants are small


[black small square] gonadotropin-releasing hormone agonists, such as leuprolide (Lupron) and nafarelin (Synarel), which create drug-induced menopause that reduces endometrial lesions


[black small square] short-term hormone therapy, such as the androgen derivative danazol (Danocrine), which causes regression of endometrial tissue by decreasing estrogen and progesterone levels.



Many patients respond to a combination of therapies. With treatment, symptoms diminish for more than 80% of patients with mild to moderate endometriosis; pregnancy also alleviates symptoms due to menstruation cessation.


Surgical intervention to remove the implants may be considered for a woman with severe, acute, or incapacitating symptoms based on her age, desire for children, and location of the implants. Laser removal of endometrial tissue while retaining ovarian function is also an option.


With your care and support, your patient with endometriosis has a strong chance of recovery and successful pregnancy.


Learn more about it


eMedicineHealth. Endometriosis. Accessed March 14, 2007. Treatments for endometriosis. Accessed March 14, 2007.