Endometriosis

The lining of the uterus is called the endometrium and it is shed monthly if pregnancy does not occur. The endometrial tissue passes through the uterus and outside the body in the form of menstrual bleeding. Endometriosis results when endometrial-like tissue grows outside the uterus in areas such as the ovaries, fallopian tubes and abdominal cavity. Distortion of the anatomy due to endometriosis can block the fallopian tubes and prevent the sperm from reaching and fertilizing the egg.

Symptoms

Painful intercourse and painful, heavy menstrual periods may be symptoms of endometriosis. However, some cases of endometriosis are totally without symptoms. A surgical procedure called a laparoscopy can confirm the diagnosis of endometriosis.

Cause

The cause of endometriosis is not clear. One theory is retrograde menstruation. This backward flow of menstrual bleeding through the tubes and into the pelvis might cause the endometrial cells to implant on the ovaries, uterus and other non-reproductive abdominal organs. Researchers also think that it could be genetic, since female family members sometimes share the condition. An abnormal immune response may also contribute to the development of endometriosis.

Treatment

Endometriosis can be treated in several ways, depending on the severity of the condition and your personal goals:

Drug treatment: If the endometriosis is causing you pain, your physician may recommend managing it with over-the-counter pain relievers. Depending on your case and goals of care, your physician may prescribe one of the following hormone therapies (most of which will also prevent pregnancy) to help manage the condition:
• Contraceptives (i.e. birth control pills, patches or vaginal rings) help regulate the hormones responsible for building the endometrial lining each month, and have been shown to have potential beneficial effects on endometriosis.
• GnRH analogues work by inhibiting output of gonadotropins (LH and FSH) from the pituitary and decreasing estrogen levels. This achieves a menopause-like state, which results in an atrophy of the endometrial tissue in the uterus and fallopian tubes. Typically, menstruation will stop while on this type of medication.
• Synthetic progesterones (called progestins) act by a number of mechanisms, including inhibiting gonadotropin production which causes the atrophy of the endometrial implants.

Surgical treatment: Procedures such as laparoscopy or laparotomy can surgically remove endometrial implants or adhesions (scarring) that result from endometriosis. After surgery the healthcare provider may suggest intrauterine insemination (IUI) or in vitro fertilication (IVF) to increase the chances of conception.
Assisted reproductive technology: In vitro fertilization (IVF) is recommended for moderate to severe endometriosis if surgery fails to restore fertility. However, the more severe the endometriosis is, the lower the chance of conception.