Endometriosis is endometrial glands, tissue we see on a pad during a period, transported and growing on the organs outside of the uterus. We don’t know for certain how this happens but have many theories. Suffice it to say that once the endometrial tissue gets to the inside of the abdomen it can quickly attach and grow on the ovaries, bowel, fallopian tubes, and any other pelvic and abdominal organ. Endometriosis is fed by hormones secreted from the ovaries, therefore, puberty is thought to be the start of the spread of the implants. Estimates are that 15% of women may have endometriosis.
As a woman sheds the endometrial lining during menstruation, the endometriosis implants also grow and bleed inside the abdomen. Blood and inflammation from endometriosis result in pain and damage to pelvic organs. Pain with time worsens and can become debilitating. Damage to organs in the pelvic area may result in infertility. Some of the most common signs of endometriosis are chronic pain with menstruation, infertility, pain on intercourse, and bloody ovarian cysts.
The most common age of presentation for evaluation is in the mid to late 20’s. By this time endometriosis has grown for many years and symptoms become noticeable. In most cases, however, the degree of the disease does not correlate with the degree of pain. 80%.of women with difficulty achieving pregnancy with no identifiable cause for infertility have been found to have endometriosis.
The diagnosis of endometriosis may be made by history of progressive pain and a suspicious pelvic exam or finding of a bloody cyst on ultrasound. The definitive diagnosis, however, is made through a minimally invasive operation called laparoscopy. The operation is conducted through a 5mm incision in the umbilicus and lesions consistent with endometriosis are identified and biopsied. Endometriosis can also be treated during the diagnostic laparoscopy.
Surgical treatment through laparoscopy is an outpatient procedure. The goal is to remove as much of the endometriosis implants as safely as possible. Treatment can also be in the form of medical therapy. Numerous treatment options for the alleviation of pain and other side effects from endometriosis are available now. Early, individualized, and aggressive treatment of endometriosis improves the quality of a woman’s life and reduces the risks of future complications associated with endometriosis such as infertility.
Dr. Tahery is a member of the Cedars Sinai Center of Excellence in Minimally Invasive Surgery and is an expert in the treatment of endometriosis.