Definition    

     Endometriosis is a condition in which the tissue that normally lines the uterus (endometrium) grows in other areas of the body, causing pain, irregular bleeding, and possible infertility.

     The tissue growth (implant) typically occurs in the pelvic area, outside of the uterus, on the ovaries, bowel, rectum, bladder, and the delicate lining of the pelvis. However, the implants can occur in other areas of the body, too.

Cause

     The cause of endometriosis is unknown. However, there are a number of theories. One suggests that the endometrial cells (loosened during menstruation) may "back up" through the fallopian tubes into the pelvis, where they implant and grow in the pelvic or abdominal cavities. This is called retrograde-menstruation.

Symptoms

• Vaginal bleeding

• Rectal bleeding

• Infertility (inability to become pregnant)

Screening and Diagnostics

1. Ultrasound -- limited value

2. MRI -- most helpful noninvasive test

3. Barium Enema if rectal involvement suspected

4. Laparoscopy -- small incision in the belly button is made for a scope to pass through.

5. Laparotomy (open surgical exploration) is only done if laproscopy is not possible or not conclusive.

Treatment

1. Nafarelin nasal spray a gonadotropin-releasing hormone agonist (GnRH).

2. Leuprolide acetate (GnRH agonist) injection

3. Zoladex (GnRH agonist) implant.

4. Danazol -- an androgen (male-like) drug.  Side effects that can be bothersome include acne, excess facial hair growth, weight gain, and decreased breast size.

5. Oral birth control pills

6. Medroxy-Progesterone acetate and oral estrogen

• Anti-inflammatory medications-especially Anaprox or Motrin

• Narcotic pain medications, e.g., Tylenol with codeine

• Calcium supplementation is recommended when using GnRH therapy

1. The endometrial tissue located in abnormal places is removed.  Surgery is usually performed if there is extensive endometriosis, infertility (problems getting pregnant), or severe pain that is not very responsive to medications.

2. If future pregnancy is not desired, removal of the ovaries can be performed.  This is usually curative since the female hormone levels are substantially reduced.
    

Prognosis

     How well surgery helps improve fertility depends on the severity of the endometriosis. Pregnancy rates after surgery in women previously considered to be infertile are approximately 75% for mild endometriosis, 50-60% for moderate cases, and 30-40% for severe cases.

Complications 

     Infertility may result from endometriosis, but not in every patient -- especially if the endometriosis is mild. Endometriosis has been known to come back even after a hysterectomy. Other complications are rare. In a few cases endometriosis implants may cause blockages of the gastrointestinal or urinary tracts.

Prevention

     There is no proven prevention for endometriosis. Women with a strong family history of endometriosis may consider taking oral contraceptive pills, as this treatment may help to prevent or slow down the development of the disease.