What Is Endometriosis?
Endometriosis is aberrant growth of endometrium outside the uterus, particularly in the dependent parts of the pelvis and in the ovaries. Endometriosis is a common cause of abnormal bleeding and secondary dysmenorrhea.
Endometriosis is a common, yet poorly understood disease. It can strike women of any socioeconomic class, age or race. It is estimated that between 10 and 20 percent of American women of childbearing age have endometriosis. While some women with endometriosis may have severe pelvic pain, others who have the condition have no symptoms. Nothing about endometriosis is simple, and there are no absolute cures. The disease can affect a woman’s whole existence – her ability to work, her ability to reproduce, and her relationships with her mate, her child, and everyone around her.
The name endometriosis comes from the word “endometrium,” the tissue that lines the inside of the uterus. If a woman is not pregnant this tissue builds up and is shed each month. It is discharged as menstrual flow at the end of each cycle. In endometriosis, tissue that looks and acts like endometrial tissue is found outside the uterus, usually inside the abdominal cavity.
Endometrial tissue residing outside the uterus responds to the menstrual cycle in a way that is similar to the way endometrium usually responds in the uterus. At the end of every cycle, when hormones cause the uterus to shed its endometrial lining, endometrial tissue growing outside the uterus will break apart and bleed. However, unlike menstrual fluid from the uterus, which is discharged from the body during menstruation, blood from the misplaced tissue has no place to go. Tissues surrounding the area of endometriosis may become inflamed or swollen. The inflammation may produce scar tissue around the area of endometriosis. The endometrial tissue sites may develop into what are called “lesions,” “implants,” “nodules,” or “growths.”
Endometriosis is most often found in the ovaries, on the fallopian tubes, and the ligaments supporting the uterus, in the internal area between the vagina and rectum, on the outer surface of the uterus, and on the lining of the pelvic cavity. Very rarely have endometrial growths been found outside the abdomen, in the thigh, arm or lung.
Most common symptoms of endometriosis start years after menstrual periods begin. Over the years, symptoms tend to gradually increase as the endometriosis area increases in size. After menopause, the abnormal implants shrink away and the symptoms subside. The most common symptom is pain, especially excessive menstrual cramps, which may be felt in the abdomen or lower back during or after sexual activity. The cause of endometriosis is still unknown. One theory is that during menstruation some of the menstrual tissue backs up through the fallopian tubes into the abdomen, where it implants and grows. Whatever the cause of endometriosis, its progression is influenced by various stimulating factors such as hormones or growth factors.
Diagnosis of endometriosis begins with a gynecologist's evaluation of the patient’s medical history. A complete physical examination, including pelvic examination, is also necessary. However, diagnosis of endometriosis is only complete when proven by a laparoscopy, a minor surgical procedure in which a laparoscope (a tube with a light in it) is inserted into a small incision in the abdomen. The laparoscopy will show the locations, extent, and size of the growths and will help the patient and her doctor make a better-informed decision about treatment.