The most common locations for endometriosis implants are the pelvic area - involving the ovaries, fallopian tubes, the ligaments supporting the uterus, and the area between the vagina and the rectum (the "cul de sac"), the outer surface of the uterus, and the lining of the pelvic cavity. These endometrial growths usually respond to the hormones of the menstrual cycle, so they build up tissue each month, break down, and then cause bleeding. This process results in inflammation of the surrounding areas and the formation of scar tissue. The scar tissue can eventually distort the anatomy of the pelvis and interfere with normal reproductive functions. Endometriosis may affect egg and embryo development and hamper the movement of egg or sperm.
Symptoms of Endometriosis
The most common symptoms of endometriosis are pelvic pain before and during periods (usually worse than "normal" menstrual cramps), pain during or after sexual activity, infertility and heavy or irregular bleeding. Other symptoms, particularly during periods, may include fatigue, painful bowel movements, lower back pain, diarrhea and/or constipation and other intestinal upsets. Some women have no symptoms. The degree of pain is not necessarily related to the extent or size of the implants. About 30 percent of women with endometriosis experience infertility.
Theories About the Cause of Endometriosis
The cause of endometriosis is not known. A number of theories have been advanced, but no single one seems to account for all cases. Theories include backflow of menstrual blood through the tubes (retrograde menstruation), genetic or immune causes, or transport through the bloodstream.
Diagnosis of Endometriosis
Diagnosis of endometriosis is usually uncertain until proven by laparoscopy. Laparoscopy is a minimally-invasive surgical procedure done under anesthesia. The patient's abdomen is distended with carbon dioxide gas. A laparoscope (a thin telescope that includes a fiber-optic light) is inserted through a tiny incision in the navel. This way the surgeon can check the condition of the abdominal organs and see the endometrial implants; if necessary the surgeon is able to take samples to confirm the diagnosis. Endometriosis may be described as minimal, mild, moderate, or severe depending on its extent.
Surgical Endometriosis Treatment
At the Advanced Fertility Institute an UltraPulse or KTP laser is used. This vaporizes implants of endometriosis with reduced scarring and minimal disruption to the surrounding tissue. Only rarely is more radical surgery necessary.
Medical Treatment of Endometriosis
Hormonal treatments offer suppression of endometriosis with few side effects. Sometimes these hormones are used in conjunction with laser laparoscopy. Drugs known as gonadotropin releasing hormone analogues (GnRHa) can be administered on a monthly basis to treat endometriosis. The drugs create an artificial menopause, which is temporary and reversible once the patient stops taking the drug. This "menopause" significantly decreases estrogen levels. Estrogen is known to stimulate the growth of endometriosis. These prescription medications are Lupron, Zoladex, and Synarel. Excellent results come from three to six months of treatment with these drugs.
An older, but also effective drug is Danocrine. It is a weakened relative of testosterone, a potent male hormone. This medication produces excellent results when taken by mouth. It does, however, have some side effects relating to its male hormone effect, such as acne, oily skin and additional growth of bodily hair. For this reason, it is less commonly used.
In most cases pelvic pain can be treated successfully. This includes pain associated with menstrual periods, ovulation, bladder and bowel function and with intercourse.
Common causes of pain include endometriosis, adenomyosis (endometriosis within the muscle wall of the uterus), pelvic infection, adhesions (scar tissue), ovarian cysts or tumors, and tumors or growths in the uterus. Sometimes conditions of the bowel tract may cause pain, such as irritable bowel syndrome, colitis or inflammatory bowel disease, chronic appendicitis, gallbladder disease or diverticulitis. Urinary tract infection, stones of the urinary tract and interstitial cystitis may cause abdominal pain. Back or muscle disorders may also excite pain-sensing nerves around the abdomen and pelvis.
At the Advanced Fertility Institute, we specialize in accurately defining the cause of pelvic pain and applying the most effective treatments. We use minimally invasive techniques, including laser laparoscopy and hysteroscopy, to cure the problem without damaging any normal tissue.
The Advanced Fertility Institute will provide the latest information about the diagnosis and treatment of endometriosis, pelvic pain and infertility. We offer the most advanced surgical and medical treatments for these conditions. We have extensive experience and specialized training in the treatment of endometriosis by laser laparoscopy (carbon dioxide laser and KTP-532 laser) and by electrosurgery. In many cases, minimally-invasive laparoscopy can restore the normal pelvic anatomy and alleviate pain and infertility.
Our physicians and staff members are sensitive and understand your individual medical needs. We recognize there can be significant suffering from endometriosis and pelvic pain, and we can provide the support you need.