Endometriosis

Endometriosis is a condition in which tissue from the endometrial lining of the uterus becomes detached and grows in the abdominal cavity outside the uterus. It occurs only in women of childbearing age, especially in women between the ages of 30 and 40 years.

Cause

During each menstrual cycle, the endometrium normally thickens and swells in preparation for possible pregnancy. If no pregnancy occurs, portions of endometrial tissue break down and pass out of the uterus as part of the menstrual flow. When endometriosis develops, displaced endometrial tissue continues to swell and bleed each month in an abnormal location, but the blood has no outlet. The body responds to the presence of this accumulated blood by surrounding it with scar tissue, which builds up month after month, until blood-filled pockets, or cysts, are formed on the affected organs.

The exact cause of endometriosis is not known, but several conditions are thought to lead to its development: Menstrual blood may flow backward through the fallopian tubes and into the abdominal cavity; the cervix or vagina may be blocked, so that the menstrual blood cannot flow out normally; or surgery or another condition may lead to the displacement of some tissue from the uterus.

Symptoms

The symptoms of endometriosis are pain immediately before, during, or immediately after the menstrual period; pain during intercourse; discomfort in the lower urinary tract or intestine; irregular or excessively heavy menstrual flow; bleeding from the rectum; blood in the urine; and infertility. Some women may experience all of these symptoms, while others may experience only one or two.

Diagnosis

Diagnostic evaluation begins with a complete medical and menstrual history. A pelvic examination may be performed -- once during menstruation and once between periods -- to investigate the changes in the reproductive organs during the cycle. The doctor may also perform a laparoscopy, in which a lighted, tubelike instrument is inserted into the lower abdomen through a tiny incision, which will allow a view of displaced tissues.

Treatment

Treatment of this disorder consists of halting the condition, reducing the pain, and restoring normal menstruation and fertility. The best way to halt endometriosis is to modify the body's natural hormonal secretions with drugs in order to stop menstruation and ovulation for some time, thus allowing the endometrial tissue to shrink. Naturally, the patient will be unable to become pregnant during this type of drug therapy, but since endometriosis often causes infertility, many patients are already unable to conceive.

Three types of drugs are usually used in this treatment. Birth control pills, as well as several other medications that modify female hormonal secretions, are sometimes prescribed in doses high enough to stop menstruation and ovulation. However, an excessive dosage often brings with it undesirable side effects, such as nausea, fluid retention, and blood clotting.

A synthetic hormone called danazol creates a condition similar to menopause, causing menstruation and ovulation to stop and the endometrial tissue to shrink almost immediately. Danazol does not have some of the side effects associated with other hormonal drugs. However, it is relatively expensive and is not effective in all cases.

The newest form of treatment is a nasal spray that causes the brain to stop producing hormones that cause ovulation and menstruation. As with the use of danazol, the nasal spray causes endometrial tissue to shrink almost immediately.

If drug therapy is unsuccessful, surgery may be necessary, involving either the removal of scar tissue and endometrial tissue or, in advanced cases, the removal of the uterus and ovaries, rendering the patient sterile. Endometriosis may be destroyed by using very precise medical lasers. This form of therapy has been used to dissolve areas of endometriosis while leaving surrounding normal tissue unharmed.