Endometriosis is a condition in which the endometrial tissue normally found in the uterus grows in other areas.
The endometrium, a type of tissue that nourishes fertilized eggs, normally grows each month within the uterus and, if no egg is implanted, is shed through menstruation. Endometriosis occurs at menstruation when normal endometrial tissue backs up with menstrual blood through the fallopian tubes and then implants and grows in other places such as:
- Fallopian tubes
- Outer surface of the uterus
- Outer surfaces of the bowel
- Other pelvic structures
- Other body tissues located anywhere in the abdomen
These tissues respond to the cycle of changes brought on by the female hormones just as the endometrium normally responds in the uterus. Thus, at the end of every cycle, when the hormones cause the uterus to shed its endometrial lining, endometrial tissue growing outside the uterus will break apart and bleed. Unlike menstrual fluid from the uterus, which is discharged freely out of the body during menstruation, blood from the abnormal tissue has no place to go. Body tissues respond to this menstrual-type bleeding by:
- Surrounding it with inflammation (tissue that becomes red, swollen, and painful around the area)
- Trying to absorb it back into the circulatory (blood) system
This monthly inflammation subsides when the bleeding ends (at the same time normal menstrual bleeding ends), and scar tissue is produced around the area. This pattern occurs in the same cycle as the menstrual cycle, occurring month after month, ultimately creating scar tissue and sometimes adhesions - abnormal tissue growth that bind organs together. Sometimes a patch of endometriosis is surrounded by enough scar tissue to cut off its blood supply and the tissue can no longer respond completely to the hormones. Other patches may rupture, or burst, during menstruation and spread their contents to other pelvic areas, causing new spots of endometriosis to develop. Thus, the condition may become gradually worse with time, although symptoms may come and go.
The cause of endometriosis is still unknown. One theory is that during menstruation some of the menstrual tissue backs up through the fallopian tubes into the abdomen, where it implants and grows. Another theory suggests that endometriosis may be a genetic process or that certain families may have predisposing factors.
The symptoms of endometriosis are:
- Pain before and during menstrual periods
- Pain during or after sexual activity
- Heavy or irregular bleeding
- Pain with bowel movements at the time of the period
Diagnosis of endometriosis requires confirmation by a laparoscopy. This is a relatively minor surgical procedure done under anesthesia. A laparoscope (a thin tube with a light in it) is inserted into an incision made in the patient's abdomen. The laparoscope is moved around the abdomen, which has been distended with carbon dioxide gas to make the organs easier to see. The surgeon can then check the condition of the abdominal organs and see the location, extent and size of the endometrial growths.
There is no certain cure for endometriosis. The goal of the treatment is to keep the disease and its symptoms in check. Based on the disease stage, the severity of symptoms, and the patient's age, desire to have children, circumstances and preferences, the doctor will recommend one of three approaches - pharmaceutical intervention (medication), surgery or a combination of the two.