Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity and musculature of the uterus. Endometrial tissue lines the cavity of the uterus and is constantly changing to accommodate a fertilized egg on a cyclic basis. In endometriosis it is typically found on dependent surfaces in the pelvis and most often the ovaries and areas behind the uterus are involved.
It can affect other areas including the abdominal organs, urinary tract and rarely the lungs and brain.
It is common and affects up to 32% of women undergoing laparoscopy for pelvic pain.
The exact cause is unknown.
– pelvic tenderness and thickening found on exam
– pain with uterine movement
– fixation of the uterus with decreased mobility
– ovarian enlargement with tenderness
– painful periods
– pain with intercourse
– some women even with advanced disease are asymptomatic
The diagnosis can be substantiated only by laparoscopy.
Pelvic ultrasound can be helpful to aid in the diagnosis in certain situations.
Treatment of patients with endometriosis is based on the extent of the disease, the severity of the disease, infertility needs, the patient’s age and other related medical and surgical factors.
Medical therapy usually involves treatment to suppress ovulation and therefore ovarian hormone production.
Medical treatment has no benefit over surgery alone in treatment of patients with endometriosis associated pain or infertility. The progesterone releasing IUD (Mirena) has shown promise as an alternative for the treatment of endometriosis. Occasionally hysterectomy after completion of childbearing is indicated. Removal of one or both ovaries is individualized. If both ovaries are removed estrogen therapy can be initiated immediately after surgery.