Endometriosis is when the glands and tissue from the endometrial lining grows outside the uterus. This tissue usually grows in the pelvic area, on the ovaries, bowel, fallopian tubes, and other pelvic organs. Endometriosis starts growing after puberty once the ovaries start hormone production and expands with age. Estimates are that 15% of women may have endometriosis.
As a woman sheds the endometrial lining during menstruation, the endometriotic tissue also engorges and bleeds during menstruation inside the abdomen and may cause scarring that cause infertility, pain on intercourse, and bloody ovarian cysts.
The usual presentation is pain with menstruation that progressively gets worse with time. The most common age of presentation is in the mid to late 20’s. Extent of the pain however does not correlate with the degree of pain. Patients with fertility issues and no other identifiable cause may have endometriosis in up to 80% of the cases.
The diagnosis may be made by a classic history and a suspicious pelvic exam or finding of a chocolate cyst on ultrasound. But the definitive diagnosis is made by 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. These lesions can also be removed during the same procedure.
Treatment can also be in the form of hormonal therapy for suppression. Significant treatment options for alleviation of pain and side effects from endometriosis are available now. Careful and optimal treatment helps avoid future consequences from endometriosis.
Dr. Tahery is a member of the Cedars Sinai Center of Excellence in Minimally Invasive Surgery and is an expert in treatment of endometriosis.