Endometriosis
| Endometriosis
is a common disease affecting women in their reproductive
years. The name comes from the word "endometrium",
the tissue that lines the cavity of the uterus, builds
up, and sheds each month in the menstrual cycle. In endometriosis,
tissue similar to the endometrium occurs outside the uterus
in other areas of the body. These tissue growths, called
"implants", can cause pain, infertility, and
other problems. |
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The most common locations for endometriosis implants are the
pelvic area - involving the ovaries, fallopian tubes, the
ligaments supporting the uterus, and the area between the
vagina and the rectum (called the "cul de sac"),
the outer surface of the uterus and the lining of the pelvic
cavity. These endometrial growths usually respond to the hormones
of the menstrual cycle, so they build up tissue each month,
break down and then cause bleeding. This process results in
inflammation of the surrounding areas and the formation of
scar tissue. The scar tissue can eventually distort the normal
anatomy of the pelvis and interfere with normal reproductive
functions. Endometriosis may affect egg and embryo development
and sperm/egg transport.
Symptoms
of Endometriosis
The most common symptoms of endometriosis are pelvic pain before
and during periods (usually worse than "normal" menstrual
cramps), pain during or after sexual activity, infertility and
heavy or irregular bleeding. Other symptoms may include fatigue,
painful bowel movements during periods, lower back pain during
periods, diarrhea and/or constipation and other intestinal upset
during periods. Some women with endometriosis have no symptoms.
The amount of pain is not necessarily related to the extent
or size of the implants. Infertility commonly affects about
30% of women with endometriosis.
Theories About the Cause of
Endometriosis
The cause of endometriosis is not known. A number of theories
have been advanced, but no single theory seems to account
for all cases. Theories include "retrograde menstruation",
or backflow of menstrual blood through the tubes, genetic
causes, immune causes, or transport through the bloodstream.
Diagnosis
of Endometriosis
Diagnosis of endometriosis is generally considered uncertain
until proven by laparoscopy. Laparoscopy is a minimally-invasive
surgical procedure done under anesthesia. The patient's abdomen
is distended with carbon dioxide gas. A laparoscope (a thin
telescope with a light on the end of it) is inserted into
a tiny incision through the "belly button". By looking
through the laparoscope the surgeon can check the condition
of the abdominal organs and see the endometrial implants.
The surgeon can then take samples of these implants for analysis
and treat these areas with an UltraPulse or KPT laser to remove
them. Endometriosis is categorized as "minimal",
"mild", "moderate", or "severe"
based on the extent of implants.
Surgical
Endometriosis Treatment
It is now possible to eliminate endometriosis
at the same time that the diagnosis is made laparoscopically.
The UltraPulse 5000L carbon dioxide laser allows the surgeon
to completely vaporize implants of endometriosis while sparing
normal tissue. Only rarely is more radical surgery involving
the removal of pelvic structures necessary.
Medical Treatment of Endometriosis
Hormonal treatments offer suppression of endometriosis with
few side effects. Sometimes these hormones are used in conjunction
with laser laparoscopy. Drugs known as gonadotropin releasing
hormone (GnRH) analogues can be administered on a monthly
basis to treat endometriosis. The drugs create an artificial
"menopause", which is temporary and reversible once
the drug has worn off. This "menopause" significantly
decreases estrogen levels; estrogen is known to stimulate
the growth of endometriosis. These medications are known by
the names "Lupron", "Zoladex", and "Synarel",
which are available by prescription. Three to six months of
treatment with these drugs produce an excellent result.
An older, but effective, drug is known as Danocrine. It is
a weakened relative of testosterone, a potent male hormone.
This medication also produces excellent results when taken
by mouth. It does, however, have some side effects relating
to its male hormone effect, such as acne, oily skin and additional
growth of bodily hair, which some women may find undesirable.
For this reason, it is less commonly used.
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