Endometriosis is a female health disorder that is the abnormal growth of cells (endometrial cells) in a location outside of the uterus. Endometrial cells are cells that are shed each month during menstruation. The cells of endometriosis attach themselves to tissue outside the uterus and are called endometriosis implants. These implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They can also be found in the vagina, cervix, bladder and pelvis. Rarely, endometriosis implants can occur outside the pelvis, on the liver, in old surgery scars, and even in or around the lung or brain. Endometrial implants, while they can cause problems, are benign (not cancerous). Endometriosis disorder can lead to pain, irregular bleeding, and problems getting pregnant (infertility).
Endometriosis Causes and Risk Factors
The cause of endometriosis is unknown. One theory is that the endometrial cells shed when you get your period travel backwards through the fallopian tubes into the pelvis, where they implant and grow. This is called retrograde menstruation. This backward menstrual flow occurs in many women, but researchers think the immune system may be different in women with endometriosis.
Endometriosis is common. Sometimes, it may run in the family. Although endometriosis is typically diagnosed between ages 25 – 35, the condition probably begins about the time that regular menstruation begins.
A woman who has a mother or sister with endometriosis is much more likely to develop endometriosis than other women. You are more likely to develop endometriosis if you:
Started your period at a young age
Never had children
Have frequent periods or they last 7 or more days
Closed hymen, which blocks the flow of menstrual blood during the period
Pain is the main symptom of endometriosis. A woman with endometriosis may have:
Pain in the lower abdomen before and during menstruation
Cramps for a week or two before menstruation and during menstruation; cramps may be steady and range from dull to severe)
Pain during or following sexual intercourse
Pain with bowel movements
Pelvic or low back pain that may occur at any time during the menstrual cycle
Note: There may be no symptoms. Some women with a large number of tissue implants in their pelvis have no pain at all, while some women with milder disease have severe pain.
Endometriosis can be suspected based on characteristic symptoms, physical examination findings, and/or changes on pelvic ultrasound, CT scans, or x-rays. However, other diseases may give similar findings and the only way to diagnose endometriosis is through a surgical procedure called a laparoscopy or laparotomy.
During laparoscopy, a laparoscope is passed through a small incision in the abdomen. A second incision may be made on the lower abdomen to provide an additional opening for surgical instruments. Using the laparoscope, your doctor can look directly at the outside of the uterus, ovaries, fallopian tubes, and nearby organs. The laparoscope can also be fitted with surgical devices for taking tissue samples or removing scar tissue.
Laparoscopic Endometriosis Surgery
Endometriosis can be treated at the time of diagnosis. Endometriosis is diagnosed using a surgical procedure called laparoscopy. Endometriosis implants can be cut away (excised) or burned away using a high-energy heat source, such as a laser. Treatment with laparoscopy is more difficult with advanced disease that involves large areas of the rectum or larger lesions.
Advanced laparoscopic surgery for chronic pelvic pains and suspected endometriosis should be performed by a surgeon with the necessary skills and expertise in the resection of such lesions and in an operating room equipped for such a surgery. Care should be taken to perform endometriotic implants as complete as possible resection of deep infiltrating endometriotic nodules which are usually the cause of pelvic pains. To reduce pain transmission, nerve interruption procedures should be considered. Adhesions (scar tissues) should be completely resected and measures preventing their reformation should be applied. The surgeon should also be prepared to resect endometriotic lesions that may involve other organs such as the bowel or bladder. Appendectomy should also be performed if endometriosis involves the appendix.