Endometriosis is a leading cause of infertility. It is a condition in which the uterine lining, the endometrium, grows outside the uterus on abdominal organs such as the ovaries, fallopian tubes, bowels and bladder. It is a progressive disease that tends to advance over time and can reoccur even after multiple treatments. The symptoms include pain during the menstrual period, pain during sexual intercourse and pain during bowel movements or urination.
The endometrial implants respond to hormonal stimulation throughout the menstrual cycle in the same fashion as the uterine lining. The lesions thicken during the menstrual cycle and shed like the normal lining inside the uterus causing bleeding within the abdomen. Consequently, since this cannot be discharged like the menstrual flow, it causes an immune reaction which eventually produces scar tissue. That scar tissue can modify the anatomical landmarks in the abdomen causing the fallopian tubes to be in an abnormal location, blocked or not in sync with the ovaries. The blood can also collect inside the ovary, causing an ovarian cyst, or “endometrioma” which can grow very large in size (4-5 inches or more). A byproduct of blood fills the endometrioma. It is brownish in appearance thus termed chocolate cyst fluid. Many times the ovarian cysts can interfere with ovulation or with the appropriate relationship with the tube.
- Medical – The medical treatment for endometriosis includes GnRH agonist (Lupron), Danazol and continous oral contraceptive.
- Surgery -Laparoscopy with either laser or electro-coagulation has been found to be very successful in women with endometriosis. The treatment not only decreases the number of implants and reduces the presence of scar tissue but also is successful especially in cases where endometriomas (cyst in the ovary composed of a breakdown of blood product) are present. This procedure can restore the normal anatomy of the pelvis and consequently result in pregnancy.
Adenomyosis is endometriosis inside the muscle of the uterus itself (adeno means gland and myosis means muscle). The presence of the endometrial lining inside the wall of the uterus (internal endometriosis) can have a major impact on the size of the uterus, the ability to get pregnant and to maintain the pregnancy, and on abnormal menstrual bleeding and chronic pelvic pain.
To schedule a consultation to discuss the work-up, diagnosis and treatment of endometriosis please call the office at (610) 447-2727.