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Endometriosis
Endometriosis is a disorder of the female reproductive system in which endometrial tissue (the normal lining of the uterus) is found outside the uterine cavity. An estimated three to five million American women of reproductive age suffer from endometriosis. This disease is prevalent in women 30-40 years of age, though it can begin in the late teens and early twenties. About 40% of patients with endometriosis will experience some degree of infertility.
The relationship between endometriosis and infertility is not completely understood. The primary cause of infertility resulting from endometriosis appears to be a blockage caused by scarring and adhesions in the tubes. These adhesions can prevent the egg and sperm from meeting or prevent the fertilized egg from moving down the tube normally (resulting in an ectopic pregnancy).
Some researchers feel that endometriosis can cause a luteal phase defect, which results from low levels of the hormone progesterone or a poor build-up of the uterine lining after ovulation. A luteal phase defect makes it difficult for the fertilized egg to implant. Some studies report as high as a 36% spontaneous abortion (miscarriage) rate in women with endometriosis versus 15% in the normal population. Other areas being studied are the effect of endometriosis on normal ovarian function and the role of prolactin in endometriosis.
Symptoms
Women with endometriosis often, but not always, have one or more of the following symptoms:
- dysmenorrhea (painful cramps during menstruation)
- dyspareunia (painful intercourse)
- dysfunctional uterine bleeding, including heavy periods or unusual spotting
- In about 30% of women, there are no symptoms except infertility.
Diagnosis
Diagnosis of endometriosis is made by a combination of tests, including:
- a careful history of the symptoms and menstrual cycle of the patient
- a thorough pelvic examination
- a laparoscopy, during which the abdominal cavity, the ovaries, and other structures can be seen.
Treatment
For a woman who wishes to attempt pregnancy, treatment will have two goals:
- Unblocking tubes and removing any adhesions that may affect conception, fertilization, and movement of fertilized eggs down the fallopian tubes
- Keeping the disease process in check by decreasing hormonal stimulation to these implants so that they do not grow and slough off, resulting in more damage to surrounding tissues.