What you need to know about endometriosis

Endometriosis affects about 5.5 million women and girls -- between 2% and 10% of all females of reproductive age -- in the United States and Canada. It even affects women past menopause who are on hormone replacement therapy. It is estimated that up to 40% of the women with endometriosis experience infertility.

While there is no definitive cure for endometriosis, it can be treated. So it is important to understand this chronic disease, be aware of its warning signs, and know about the medical and surgical treatments available.

What is endometriosis?
The name comes from the tissue lining the uterus, which is known as the endometrium, and which in endometriosis travels outside the uterus and begins to grow in other locations. The most common sites are the ovaries, fallopian tubes, and ligaments that support the uterus; the lining of the pelvic cavity; and the outer surface of the uterus. But endometriosis can also affect the bladder, vagina, bowel, cervix and other areas.

What happens in endometriosis?
Endometrial tissue that travels to these other areas acts just like the tissue found in the uterus. It breaks down each month, according to a womanÕs menstrual cycle. When this occurs inside the uterus, this tissue is shed through the vagina as menstrual blood. But when it occurs outside the womb, the blood and tissue have nowhere to go and the result is inflammation and scar tissue. This can lead to pain, infertility and other problems.

What are the symptoms?
Symptoms may include severe menstrual cramps, pelvic pain, pain during sexual intercourse, heavy or abnormal menstrual bleeding, infertility and painful bowel movements or other stomach problems.

How is it diagnosed?
A gynecologist inserts a long, thin instrument called a laparoscope into the vagina or abdomen. A lens at the end of the instrument magnifies and illuminates the organs allowing the doctor to look for endometrial growth and examine them for size and severity.

There are four levels of endometriosis, depending on how bad the disease is:
· Minimal (Stage I)
· Mild (Stage II)
· Moderate (Stage III)
· Severe (Stage IV)

 How does endometriosis affect fertility?
Endometrial growths may cause scar tissue to form in the ovaries and fallopian tubes and may hormonally affect egg pickup or affect tubal transportation of the embryo.  It is estimated that up to 40% of women with endometriosis experience infertility.

What medications are available?
Drugs can be used to stop ovulation for as long as possible, so that there is no monthly buildup and breakdown of endometrial tissue. Oral contraceptives are usually given first, often without the usual hormone-free week. As a result, the woman not only stops ovulating but also stops menstruating. Other pharmaceutical agents include danazol, which comes from testosterone, and gonadotropin-releasing hormone agonists. These medications induce the conditions of menopause. However, endometriosis often returns after drug treatment is stopped.

What kind of surgery is available?
The least invasive approach is through a laparoscope. In this procedure, the doctor removes endometrial growths and reconstructs damaged pelvic organs, often relieving pain and correcting infertility. In more severe cases, a more extensive procedure may be necessary, most likely involving a full abdominal incision. This usually requires a 5-day hospital stay followed by 3-5 weeks of recuperation. Radical hysterectomy may be performed in the most severe cases to remove the uterus, ovaries and all endometrial growths. Although this usually eliminates the disease, sometimes endometriosis will come back.

Who can treat endometriosis?
At Florida Fertility Experts we are skilled at treating endometriosis. If pregnancy is your goal, we can help. Additionally, if relief of the symptoms of your endometriosis is your goal, we can also help you become pain free. Feel free to contact us with questions or to schedule an appointment.

Where can I find out more?
Useful information is available from the Endometriosis Association at (800) 992-3636 or its website www.endometriosisassn.org.

Click here for additional information on Endometriosis or contact us.
 
DO YOU HAVE ENDOMETRIOSIS?
A SELF-TEST

For at least 6 months have you had:

1.  Pelvic pain?  The pain may have a monthly pattern.  For example, it may
     be worst during your period and/or midcycle.  Some women have
     constant pain.                              
2.  Fatigue, exhaustion, low energy?
3.  Diarrhea, painful bowel movements, or other stomach upset at the time
     of your period?                                                                    
4.  Stomach bloating and swelling?
5.  Heavy or irregular periods?

Score 10 points is you answered "yes" to question #1, and 5 points for each "yes" to questions #2 through #5.  If you score 10 points or more, you clearly have risk factors for endometriosis. However, if you said yes to any question, regardless of your score, you should tell your doctor about your symptoms.

Self-test reproduced from the Endometriosis Association Web site.