What is Endometriosis? Endometriosis is a very common condition in which tissue resembling the interior of the uterus grows on other parts of the body. It has been estimated that 4 to 6 million women of child-bearing age suffer from endometriosis. How Does Endometriosis develop? The lining of the uterus, where a fertilized egg grows into a baby, is called the endometrium. Every month, female sex hormones cause this lining to thicken in preparation to receive a fertilized egg. If a fertilized egg doesn't arrive, however, the lining is shed and leaves the body as menstrual flow. Sometimes, tissue resembling the endometrial lining grows outside of the uterus. It can appear on almost any organ in a woman's body-even on the digestive or excretory organs-but most commonly endometrial tissue affects the reproductive organs including the ovaries, the fallopian tubes, the outside of the uterus and the ligaments behind it. This tissue is not shed with the menstrual period. Instead, it grows into an "implant" and bleeds each month in response to the same female sex hormones that stimulate the uterus to prepare for the arrival of a fertilized egg, or cause the uterus lining to shed if conception does not occur. What Causes Endometriosis? One widespead theory is that endometriosis is a result of retrograde menstruation, a process in which parts of the endometrial lining are carried backwards during the menstrual period into the fallopian tubes and abdomen. Most women regularly experience some retrograde menstrual flow but not everyone develops endometriosis. In those who do, the tissue carried backwards by retrograde flow becomes attached and begins to grow. A second theory is that cells found in places other than the uterus are transformed into endometrial cells after a young woman begins to menstruate. What Are The Symptoms Of Endometriosis? The three main symptoms of endometriosis are : severe pain around the time of your period; pain during sexual intercourse; and difficulty getting pregnant after many months of trying. In fact, endometriosis causes infertility in as many as 40% of those who have the condition. Other symptoms include backaches, generalized pelvic pain, unusually heavy bleeding during the menstrual period, or spotting between periods. In many women, the pain associated with endometriosis gets worse with time and can become so severe that bedrest is required. Yet some women with severe endometriosis don't experience any pain at all. How Does Endometriosis Affect The Ability to Conceive? Endometrial adhesions can block the fallopian tubes or ovaries. This can interfere with the release of the egg during ovulation or block the egg in its passage through the fallopian tubes to the uterus. How Is Endometriosis Diagnosed? A physician can assess the extent of endometriosis by performing a fairly simple surgical technique known as laparoscopy. In this procedure, a small incision is made in the abdomen and a tube with a lens attached is inserted. Through this tube the doctor can actually see where the endometrial implants are located and how severe the condition is. Undergoing laparoscopy is fairly painless, but it is a surgical procedure. Most women have the procedure done in the hospital or their doctor's office early in the morning and are home in the afternoon. How Is Endometriosis Treated? Once it is known whether the endometriosis is minimal, mild, moderate, or severe, treatment can begin. If the condition is minimal or mild, no treatment may be needed other than an over-the-counter painkiller. This works for some women until they reach menopause, when they stop menstruating and endometriosis stops being a problem. If the condition is painful, however, the patient has two options: treatment with drugs or surgery. Medications especially designed to stop endometriosis are currently available. If drug treatment isn't successful or the endometriosis is very severe and widespead, surgery may be recommended. Sometimes the endometrial implants can be removed during the dame laparoscopy that is performed to determine the extent of the condition. Or, the doctor may decide that a second operation is necessary. The most common type of operation used to treat endometriosis is classified as conservative surgery, since it removes endometrial implants while preserving a woman's fertility. Laser surgery has allowed doctors to operate more accurately and with less risk of infection. Sometimes, however, it's not possible to protect reproductive organs and they must be removed in order to stop endometriosis from recurring; a total hysterectomy (meaning removal of the uterus) may be performed. Removal of the ovaries and fallopian tubes is sometimes done in addition to a hysterectomy. Can The Risk Of Endometriosis Be Minimized? In addition to the medical and surgical approaches described above, some physicians believe that certain measure may help minimize the development of retrograde menstruation which can lead to endometriosis. Your physician may suggest the following: do not use tampons, diaphragms, and cervical caps; avoid sexual intercourse during your period; exercise regularly; this results in lighter periods. Avoid gynecologic procedures and examinations which involve manipulation of the genital tract during or around the time of your menstrual period or soon after cervical dilation or curretage (destruction of tissue by means of extreme cold) and vigorous pelvic examination. Consult the following sources for more information: The Endometriosis Association 8585 North 76th Place Milwaukee, Wisconsin 53223 414-355-2200 800-992-ENDO Breitkopf LJ, Bakoulis MG: Coping with Endometriosis. New York: Prentice Hall Press, 1988 Weinstein K: Living with Endometrioisis: How to Cope with the Physical and Emotional Challenges. Reading, MA: Addison-Wesley Publishing Company, Inc., 1987 Stewart F, Guest F, Stewart G, Hatcher R: Understanding Your Body: Every Woman's Guide to Gynecology and Health. New York: Bantam Books, 1987

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