Overview

What is Endometriosis.
Endometriosis is a disease affecting women and is characterized by the growth of the uterine lining (endometrium) outside of the uterus. The uterine endometrium during the first half of the menstrual cycle increases in thickness and during the second half, acquires a spongy-like consistency to facilitate embryo implantation. If there is no pregnancy, the uterine endometrium sheds along with the menstrual blood during the menstrual period. The same cyclic changes also occur in the endometrium of endometriosis which causes bleeding into the abdomen or other organs, inflammatory reaction, development of adhesions (scar tissue), or appearance of cysts filled with blood which, over time, acquire a consistency of liquid chocolate (chocolate cysts).

Symptoms - Their frequency and Intensity.

Endometriosis – common sites

Cyclic changes in endometriotic lesions (described above) are responsible for symptoms of the disease such as:

Painful menstrual periods
Pain during or after urination
Pelvic pain unrelated to menstruation
Heavy, prolonged menstrual periods
Pain during and after sexual intercourse
Infertility
Pain during or after bowel movements

Typical lesions
in the cul-de-sac

The frequency and intensity of these symptoms varies and there is no direct relationship between symptoms and severity of endometriosis. Some women have advanced endometriosis and few, if any, symptoms; others have severe symptoms with minimal disease. The intensity of symptoms is most likely related to the local inflammatory reaction and production of substances, such as prostaglandins and cytokines, by the endometriotic cells and cells of the immune system.

Non-pigmented endometriosis

Endometriotic lesions, although benign, may spread like cancer from the reproductive system to other organs and sometimes even to distant locations away from the pelvis. We have seen women with endometriosis of the bladder, bowel, liver, lungs, arms, thighs, and even brain. If endometriosis spreads outside of the pelvis, it can cause generalized symptoms and/or symptoms of pain or bleeding in other organs. In general, any symptom or change in the body that undergoes cyclic changes coincidental with the menstrual cycle, should be suspect of being endometriotic in origin.

Changes in the Immune System.

Laparoscopy for endometriosis

For more than 30 years, staff of the Institute for the Study and Treatment of Endometriosis (Endometriosis Institute), which is affiliated with the OBFC, has been in the forefront of endometriosis research. Our studies indicate that during the menstrual period, blood and fragments of shed endometrial tissues are transported through fallopian tubes into the abdomen in all women. In healthy women, these misplaced cells are programmed to die (undergo apoptosis) and are removed by the cells of the immune system (macrophages). In about 10% of women, apoptosis and the ability of macrophages to remove misplaced endometrial cells is impaired. The misplaced cells are allowed to survive and implant. Typically they implant on the peritoneal surfaces (lining of the abdomen), in the anterior and posterior cul-de-sacs (anterior is between the uterus and urinary bladder — posterior is between the uterus and rectum), on the ovaries, and on other abdominal organs. Following implantation, endometrial cells divide, multiply, and form typical endometriotic lesions. Changes in endometrial apoptosis and in the immune system that lead to the development of endometriosis may be transmitted genetically from mother-to-daughter or may be acquired as a result of the environmental effect on the immune system.

Diagnosis.

Severe pelvic endometriosis

Endometriosis can be suspected based on characteristic symptoms, physical examination findings, and/or changes on pelvic ultrasound, CT scans, or x-rays. However, other diseases may give similar findings and the only way to diagnose endometriosis is through a surgical procedure called a laparoscopy or laparotomy. The diagnosis needs to be confirmed by microscopic examination of the tissue. Not every lesion having a visual appearance of endometriosis is actually endometriotic and sometimes atypical lesions may be endometriotic in nature. Your laparoscopic surgeon should take a biopsy to confirm his visual diagnosis. He should also be able to assign a score for the size, depth, and location of endometriotic lesions which is the basis for classifying endometriosis as Stage I, II, III, or IV — with Stage I being the minimal and Stage IV the most advanced. Endometriosis is a progressive disease which impairs fertility, tends to come back after treatments, and lasts as long as there is ovarian function, that is, until menopause. Therefore, prompt definitive diagnosis and staging are extremely important for lifelong treatment, recurrence prevention, and family planning.

Treatment.

Bowel endometriosis

Laparoscopy is a minor surgical procedure performed under anesthesia on an outpatient basis. An experienced laparoscopic surgeon should be able to resect or destroy endometriotic lesions with electrical current or laser at the time of laparoscopy. Alternative treatments include various types of hormonal medications, the purpose of which is to suppress ovarian function and stop menstrual cycles. Without menstrual bleeding, endometriotic lesions heal and gradually disappear. Large chocolate cysts and adhesions may need to be removed surgically.

Endometriosis of the diaphragm

The choice of treatment in endometriosis depends on several factors such as:

Woman’s age
Severity of symptoms
Fertility status
Stage of the disease
Prior treatments (if any) and treatment response and side effects (if any)

These factors as well as patient-specific indications and contraindications, advantages and disadvantages, and risks and benefits of different treatment options need to be thoroughly discussed and considered prior to treatment selection.

Our Approach.

Ovarian endometrioma

At the Endometriosis Institute, our objective is to help you select the treatment option that is most appropriate in your case. Our overall goal is to remove or suppress endometriosis, to delay its recurrence, control its progression, and to take care of its symptoms without adversely affecting your fertility and without exposing you to undesirable side effects of treatments. We recognize that different women may respond differently to the same treatment, both in terms of the effectiveness and side effects, and that there is no one treatment that would be effective in all women. Our Endometriosis Institute at all times has several ongoing clinical research projects and we frequently have new medications for clinical trials before they become generally available. Such clinical studies, including medications, may be at no charge to you. For more information, please call 630-954-0054, ext. 4.