Little is commonly known or understood about Endometriosis. What is known is that it can strike between 10 and 20 percent of American Women of childbearing age.
The name Endometriosis comes from the word “endometrium”, the tissue that lines the inside of the uterus. Normally, this tissue builds up and is shed each month and is discharged as menstrual flow. In case of Endometriosis, a small piece of this endometrial tissue is “misplaced” and is found outside the normal lining of the uterus. It may be located on ovaries, tubes, intestines, walls of abdomen and pelvis or the ligaments supporting the uterus.
Unlike menstrual fluid, which is discharged during menstruation, blood from the misplaced uterine lining causes the surrounding tissue to become inflamed or swollen. This may produce scar tissue (adhesions) in the area of endometriosis or can develop into what is commonly called “implants”, “lesions”, “nodules”, or “growths”.
We do not fully understand why endometrial tissue grows outside of the womb in some women, but not others. It probably has something to do with genetic factors, since endometriosis frequently runs in families. We do know that the female hormone estrogen makes the problem worse. Women have high levels of estrogen during their childbearing years. It is during these years (from 20s into their 40s), that women have endometriosis. Estrogen levels drop when menstrual periods stop (menopause) and then symptoms usually go away.
The Mystery of Endometriosis is that while some women have severe pain, others who have the condition have no symptoms at all!
Pain is the most common symptom of endometriosis. Some women have severe cramps during their periods. Women that have progressively more painful periods with age usually have endometriosis. Other women have pain during intercourse or during urination or bowel movements.
Infertility occurs in about 30-40 percent of women with endometriosis.
Ovarian cysts filled with endometriotic material (dark, chocolate colored substance) may be detected with ultrasound. However these are present in less than 20% of women with endometriosis.
Accurate Diagnosis – Requires Extensive Experience
Diagnosis of endometriosis remains a big problem. We can seldom diagnose this disease through the use of the present tools such as ultrasound, blood tests or doctor exams. The only accepted diagnosis can be made by visual examination of the lesions. This of course requires a surgical procedure, with laparoscopy (laser surgery) being the most precise.
There are more then 100 documented appearances of endometriosis. Because the appearance of these lesions can be highly variable, some surgeons may fail to make an accurate diagnosis. Unless a surgeon is experienced in working with this disease, a patient with severe pain or infertility may go incorrectly diagnosed even after undergoing a surgery.
Our goal is to avoid surgery whenever possible. However, laporoscopy offers the only definitive diagnosis of endometriosis. Furthermore, only laporoscopy with laser ablation or excision of endometriosis offers the best chances of restored fertility.
Treatment with medicines does not cure endometriosis. Medicines are also generally not recommended if infertility from endometriosis is your main problem. However, therapy can reduce pain and bleeding. Hormone therapy with birth control hormones, a gonadotropin-releasing hormone agonist (GnRH-a), progestin, or danazol can shrink endometriosis and reduce pain.
Birth control hormones and NSAID therapy are usually recommended first. Unlike other hormone therapies, they are least likely to cause serious side effects and can be used on long term basis.
Endometriosis can be diagnosed and treated at the same time with the laporoscopic approach. During laporoscopy, a camera is inserted through a small incision inside the belly button and a Carbon dioxide laser is used to ablate (zap) the lesions of endometriosis. If a patient has infertility her best chances of getting pregnant are in the six month folowing the procedure. Pain is usually controlled for years. In fact, after a laporoscopy when the pelvis is “clean” is usually an opportune time to begin hormonal therapy if the patient so wishes.Although hysterectomy with or without oopherectomies does result in treatment and potential “cure” for edometriosis in our center we seldom take this approach, In our center, we prefer the minimally invasive treatment and usually can control symptoms without removing any organs.
Our doctors have the highest skill level of surgically removing the Endometriosis using CO2 Laser.