Endometriosis is a condition in which there is a growth of tissues outside of the uterus that can either cause pelvic pain or infertility. It is without question one of the most baffling conditions that affect women. An estimated 10 million women in the US are affected by this disease, and it is one of the leading causes of infertility in women. Though there are many effective treatments, there is no known cure. The diagnosis is confirmed when uterine or endometrial cells are identified outside their usual location inside the uterus.
Endometriosis may be found on the outside of the uterus, inside and outside the ovaries, or implanted upon the fallopian tubes, bowel, urinary tract, and anywhere in the abdomen. When a woman gets her period the endometriosis often responds to the menstrual cycle’s hormonal signals. When the endometriosis bleeds, the woman may have sensations of deep pain or cramping. The body responds to the bleeding by surrounding it with inflammation often causing adhesions and leaving scar tissue. Endometriosis is estimated to be present in 15% of all reproductive age women, but as many as 30-40% of all infertile women. The exact ways that endometriosis affects infertility are not fully understood. Scar tissue and adhesions are known to interfere with the path the egg and sperm must travel to unite and become fertilized and implanted. In some women, endometriomas (a special type of ovarian cyst that contain endometrial cells that grow and bleed during menstruation) may form inside the ovaries causing enlargement of the ovaries, therefore interfering with normal ovarian functions such as ovulation. There also may be links between endometriosis and hormo
nal imbalances or immune system abnormalities that can also interfere with fertility. Some women with endometriosis experience severe pain during their menstrual cycle or during intercourse, excessive or irregular bleeding during menstruation, or urinary or bowel problems in conjunction with menstruation.
Other symptoms may include fatigue; painful bowel movements with periods; lower back pain with periods; diarrhea and/or constipation and other intestinal upset with periods. The amount of pain is not necessarily related to the extent or size of growths. Other women experience no symptoms, and their endometriosis goes undiagnosed until they seek medical help to explain their inability to conceive. Because endometriosis is progressive, the key to preserving fertility in women who have endometriosis is early diagnosis and treatment of the symptoms that interfere with conception and pregnancy.
Ultrasound scans may detect the presence of endometriomas in the ovaries, while laparoscopy is typically the definitive way endometriosis is diagnosed. Laparoscopy is typically performed as an outpatient surgical procedure in which a fiberoptic telescope is inserted into a female’s abdomen below the navel to look for endometriosis, scarring, and adhesions. While there is no known cure for this disease, effective treatment of the symptoms is available. In general, surgery and hormonal treatments may be helpful for the treatment of pain related to endometriosis. For infertility, there may be a need for other types of treatment following surgery to increase the number of eggs ovulated in a given month. In extreme cases, in which the endometriosis has caused extreme tubal damage, in vitro fertilization may be needed to bypass the scarred Fallopian tubes.
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