Endometriosis is a painful, chronic disease that affects 5.5 million women and girls in the USA and Canada, and millions more worldwide. It occurs when tissue like that which lines the uterus (tissue called the endometrium) is found outside the uterus — usually in the abdomen on the ovaries, fallopian tubes, and ligaments that support the uterus; the area between the vagina and rectum; the outer surface of the uterus; and the lining of the pelvic cavity. Other sites for these endometrial growths may include the bladder, bowel, vagina, cervix, vulva, and in abdominal surgical scars. Less commonly they are found in the lung, arm, thigh, and other locations.

This misplaced tissue develops into growths or lesions, which respond to the menstrual cycle in the same way that the tissue of the uterine lining does: each month the tissue builds up, breaks down, and sheds. Menstrual blood flows from the uterus and out of the body through the vagina, but the blood and tissue shed from endometrial growths has no way of leaving the body. This results in internal bleeding, breakdown of the blood and tissue from the lesions, and inflammation — and can cause pain, infertility, scar tissue formation, adhesions, and bowel problems.

The most common symptoms of endometriosis are:

• Pain before and during periods
• Pain with sex
• Infertility
• Fatigue
• Painful urination during periods
• Painful bowel movements
• Other gastrointestinal upsets such as diarrhea, constipation, nausea

Diagnosis is considered uncertain until proven by laparoscopy, a minor surgical procedure done under anesthesia. A laparoscopy usually shows the location, size, and extent of the growths. This helps the doctor and patient make better treatment choices.

The cause of endometriosis is unknown. The retrograde menstruation theory suggests that during menstruation some of the menstrual tissue backs up through the fallopian tubes, implants in the abdomen, and grows. Some experts believe that all women experience some menstrual tissue backup and that an immune system problem or a hormonal problem allows this tissue to grow in the women who develop endometriosis.

Another theory suggests that endometrial tissue is distributed from the uterus to other parts of the body through the lymph system or through the blood system. A genetic theory suggests that it may be carried in the genes in certain families or that some families may have predisposing factors to endometriosis.

Surgical transplantation has also been cited in many cases where endometriosis is found in abdominal scars.

Another theory suggests that remnants of tissue from when the woman was an embryo may later develop into endometriosis, or that some adult tissues retain the ability they had in the embryo stage to transform reproductive tissue in certain circumstances.

Although there is no cure for endometriosis, a variety of treatment options exist. Goals may include: relieving/reducing pain symptoms, shrinking or slowing endometrial growths, preserving or restoring fertility, and preventing/delaying recurrence of the disease.

• PAIN MEDICATION: Over-the-counter pain relievers may include aspirin and Tylenol, as well prostaglandin inhibitors such as ibuprofen, naproxen sodium and indomethacin. In some cases, prescription drugs may be required.
• HORMONAL THERAPY: Hormonal treatment aims to stop ovulation for as long as possible and may include: oral contraceptives, progesterone drugs, a testosterone derivative (danazol), and GnRH agonists (gonadotropin releasing hormone drugs like Lupron).
• SURGERY: Conservative surgery seeks to remove or destroy the endometriosis, relieve pain, and often allows pregnancy to occur. Conservative surgery can involve laparoscopy (minor procedure with a tiny abdominal incision) or laparotomy (more extensive procedure, full incision, longer recovery period). Hormonal therapy may be prescribed along with conservative surgery. Extensive surgery, which may be necessary in severe cases, involves hysterectomy, removal of all growths, and removal of the tubes and ovaries.
• FDA Trials and Protocols: The physicians at Florida Fertility Institute are in the unique position to be able to offer patients with refractory endometriosis non-standard treatment. This may include FDA regulated clinical trials and protocols. Visit Women’s Medical Research for more information.

We are experts at treating endometriosis and are considered Tampa Bay’s preeminent physicians for treating the disease. If pregnancy is your goal, we can help. Additionally, if relief of the symptoms of your endometriosis is your goal, we can assist you to become pain free. Feel free to contact us with questions or to schedule an appointment.