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What is Endometriosis?

Endometriosis is common but also commonly misunderstood.  It affects one in 15 women, or 5 million Americans!  Four in 10 of them will be infertile as a result.  Endometriosis may be marked by severe cramping before and during menses, but some women will be asymptomatic.  Classically women are not affected until their 20s or 30s, but girls as young as 17 have been diagnosed.  The pain of endometriosis is not generally relieved by non-steroidal anti-inflammatory medications, as is the pain of routine menstrual cramps.

What causes endometriosis?  Simply put, some of the lining cells of the womb flow backward into the pelvis and implant on other tissues, such as the ovaries or fallopian tubes.  Being estrogen sensitive, these implants react cyclically: They can grow and cause pain, abnormal bleeding and tubal blockage.  There are many things we still don't understand about endometriosis: what causes it in some women and not others, why the symptoms are not necessarily related to the size or location of the implants, or how to prevent it.  There are also many other theories about what causes endometriosis.

Endometriosis is also difficult to diagnose conclusively without a surgical procedure called a laparoscopy. This allows your doctor to look into your abdomen and pelvis with a lit tube through a small incision beneath your belly button.   This is a major reason this procedure is recommended for women with unexplained infertility. Even mild endometriosis can cause infertility and early treatment can double a woman's chances of conceiving.  If necessary, the gynecologist can also use lasers to destroy some evident implants or other microsurgical techniques to remove tubal scarring.

There are effective medical treatments available for endometriosis as well, although there is no cure.  Treatment recommendations will be based upon the woman's age, her desire for preserving her fertility, the extent of her symptoms, and the extent of the endometriosis.  Sometimes, doctors simply recommend a trial of birth control pills.  Next, hormones called danazol or GnRH analogs and antagonists may be tried.  All of these medicines have side effects or limitations, so several options may need to be tried.  And, of course, each of these medications postpone pregnancy.

If you think you have endometriosis, talk to your doctor sooner rather than later.

Created: 8/14/2003  -  Donnica Moore, M.D.

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