Endometriosis occurs when cells that normally line the uterus (endometrial cells) grow in other areas of the body, such as the ovaries or the pelvis.
Endometriosis is present in approximately 40 percent of infertile women and is a common cause of pelvic pain. Women with endometriosis often experience severe pain during menses, when urinating, with bowel movements, and during intercourse. However, significant endometriosis can be present and produce no symptoms.
There are several theories as to the cause of endometriosis but most authorities believe that it is caused by a “back flow” of menstrual blood into the pelvic cavity during menstruation. Menstrual blood is rich in endometrial cells since it is formed from the breakdown of the uterine lining (endometrium).
There also appears to be a genetic component since daughters of women with endometriosis have a higher incidence of the disease.
Because endometriosis symptoms do not always appear, or may be caused by other conditions, a diagnosis cannot be based on symptoms alone. Laparoscopy is the only definitive method for diagnosing endometriosis. However, a trial using a hormonal drug may be used to confirm or rule out endometriosis.
In “mild” cases, medical intervention with medications such as Lupron may be effective, however, laparoscopic surgery is usually the best treatment option.
Endometrial cells depend upon the hormone estrogen for growth. Reducing the amount of estrogen inhibits endometrial cell growth so drugs such as Lupron are effective in treating the disease. Lupron suppresses the production of follicle stimulating hormone (FSH) and leutinizing hormone (LH) which ultimately leads to lower estrogen levels.
Endometriosis is often removed surgically by laparoscopy, especially in infertility patients. If a laparoscopy is performed, it is very important that all endometriosis be removed as some authorities believe that small amounts can create an inflammatory environment in the pelvis.
Many specialists prefer to move into aggressive infertility treatment such as ovarian stimulation with intrauterine insemination (IUI) or in vitro fertilization (IVF) rather than proceed to surgery. IVF success rates in patients with endometriosis are excellent.