Endometriosis is the implantation of the endometrial tissue in the pelvis or the abdomen. Endometrial tissue is what you see on your pad during menses. We think it finds its way to the inside of the abdomen through the fallopian tubes, tubes attaching the inside of the uterus to the inside of the abdomen. In most people the bodies immune system cleans these implants, but in 6-10% of women it does not. These implants attach to the organs in the pelvis and abdomen and grow each month causing inflammation during menses.
The pain becomes worse and worse with time and eventually no longer restricted to menses. Pain can appear randomly, with bowel movement, intercourse, cause frequent urination, bloatedness and many other symptoms. The usual age of diagnosis is late 20’s when the pain gets intolerable or if a couple has difficulty getting pregnant. The major issues reported are pain and infertility. Women with strong family history of endometriosis are at higher risk for the disease. Puberty hormones stimulate the growth of the endometriosis and menopausal hormone withdrawal marks the end of endometriosis. Endometriosis have been found in girls as young as 8 year of age.
Diagnosis of endometriosis is surgical. Diagnosis is performed through a small umbilical incision of 5mm by inserting a camera called a laparoscope inside the abdomen. This operation is usually recommended once a patient reports unbearable progressive menstrual pains, or unexplained fertility. Other times finding of a blood filled ovarian cyst also called endometrioma prompts a surgical evaluation and leads to diagnosis. Endometriosis is staged based on the spread of the disease identified during surgery. Severity of symptoms do not correlate with the extent of the disease.
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Treatment options are surgical and hormonal suppression. During a diagnostic laparoscopy endometriosis lesions can be eliminated using excision or lasers. Treatment can also be in the form of hormonal suppression such as birth control pills. Many women who are unable or unwilling to use birth control pills may use bio-identical hormones to suppress the growth of the endometriosis and control pain. The ideal treatment is a combination of the surgical and hormonal suppression. Surgically the extent of the disease can be determined and the visible lesions can be excised which reduces pains and improve fertility. Hormonal suppression is also used to reduce the disease progression or recurrence.
Early diagnosis and treatment is crucial since endometriosis expands with time. In my practice women diagnosed early usually have the best outcome. Do not ignore persistent signs and symptoms. If you suspect endometriosis in yourself or a friend and would like to be evaluated please give us a call or pay us a visit in Glendale or West Los Angeles.