Endometriosis

What is Endometriosis?

Endometriosis is a disease in which cells similar to those that line the inside of the uterus (endometrium) grow outside the uterus. The severity of endometriosis can range from mild to severe. It can affect any areas of the abdomen and pelvis, such as the ovaries, uterus, bowel, bladder, liver, diaphragm, and abdominal wall. There are also cases of endometriosis involving areas such as the lungs. In severe cases, extensive scarring and distortion of normal anatomy may occur. Symptoms may include pelvic pain, painful periods, painful intercourse, heavy or irregular periods, infertility, gastrointestinal symptoms including constipation, diarrhea, nausea, bloating, painful bowel movements, urinary symptoms including painful urination and urinary frequency and burning, and general fatigue/malaise. Infertility can also be a concern.

Causes of Endometriosis

The exact cause for the endometriosis is not known. There are several theories but likely the cause is multifactorial. Endometriosis may be inherited genes that run in families.

Diagnosis of Endometriosis

Your gynecologist will ask you about general health and symptoms, as well as perform a pelvic examination. An ultrasound scan or MRI may also be performed.

Management and Treatment of Endometriosis

There are several management and treatment options available:

Pain Medication

Over the counter non-sterioidal anti-inflammatory drugs (NSAIDs), such ibuprofen or naproxen, may be helpful for mild pain. Stronger nonsteroidal anti-inflammatory medications will be prescribed by your doctor in cases of severe pain.

Hormone Treatment

Hormonal preparations can be used in the form of pills, injections, or progesterone-containing intrauterine device (IUD).

Surgery

Surgery may be recommended for some women in cases of pain despite hormonal management, infertility, pelvic masses, or severe adhesions. See Excision of Endometriosis.

Laparoscopy/Robotics: During this surgery, endometriosis lesions and scar tissue are removed. This is typically done using a minimally invasive technique. With early stage disease, difficulty identifying disease can often be a concern. Three-dimensional visualization and the ability to magnify tissue up to 10-15 times can, therefore, be very beneficial in identifying endometriosis and removing it accordingly.

Hysterectomy: It is a surgery that involves removal of the uterus. This procedure is done when there is severe damage or scarring involving the uterus, the presence of uterine disease, and only if the patient no longer desires future fertility.