What It Is
Endometriosis, a non-cancerous condition, is a chronic gynecological disease in which cells from the endometrium (the lining of the uterus) grow in the wrong spot. Instead of just growing inside the uterus, they grow outside of it – usually in a woman's pelvic area instead. While endometriosis can affect almost any part of the body, in most cases the tissue adheres to other pelvic structures, including the ovaries and fallopian tubes. Less commonly, lesions can also occur on the bladder, bowels, and rectum. In rare cases, endometriosis has even been found in cesarean section and laparoscopy scars, and in the lungs, spine, and brain.
Who Gets It
An estimated 10 to 15 percent of reproductive age women are affected. The disease often runs in families.
Endometriosis can be completely silent, but the most common symptom is pelvic area pain during menstruation. The pain may be mild or severe, and it can occur in unexpected areas depending on which organs are involved. Symptoms may include heavy, painful periods, pain during or after sexual intercourse, painful bowel movements or diarrhea, pain in the legs, severe cramping (either with menstruation or otherwise), backaches, tenderness or discomfort in the abdominal area, blood in the urine, fatigue or sleeplessness (often due to pain).
How It's Diagnosed/Detected
When endometriosis is suspected, physicians confirm the diagnosis by laparoscopy, a surgical procedure in which a lighted tube is passed into the abdomen so the doctor can look for the telltale “chocolate cysts” (bits of misplaced endometrial tissue) that indicate the disease. The disease can actually be treated during the laparoscopy, too (see below). Scientists are working to develop new tests that will allow doctors to diagnose the disease without surgery.
How It Affects Fertility (And Pregnancy)
More than half of women with endometriosis will have no trouble conceiving. But studies by the American College of Obstetricians and Gynecologists have found that 20 to 50 percent of women having fertility problems suffer from the disease, making it a leading cause of female infertility. How and where the endometrial tissue lands in the body seems to determine how conception is affected. Endometrial scarring can obstruct the fallopian tubes and block the egg’s travel to the womb. The uterus may also be less receptive to implantation. Endometriosis may also interfere with egg development, due to increased fluid, inflammation, and antibodies.
Treatment for endometriosis generally involves surgical removal (usually via laparoscopy) of the abnormally sited endometrial cells. The excess tissue can be cut out or ablated (burned) to clean the area and make pregnancy more likely. Some studies show that simply having this procedure can double the chances of getting pregnant among women with mild endometriosis.
Endometriosis may also be treated with drugs or hormones; however, since the most common hormonal treatments are the birth control pill or other conception-blocking hormones, this is clearly not the treatment of choice for a woman who is trying to become pregnant.
If you have endometriosis, consult your physician for advice before you and your husband start trying. Depending on your age, the severity of your endometriosis, and other factors, your doctor may want you to start trying on your own for a certain amount of time before recommending any further treatment.
Roughly 60 to 70 percent of women with endometriosis have no problem conceiving, according to experts at the National Institutes of Health (NIH). Fortunately, treatment for endometriosis-related infertility has a high success rate. But since endometriosis often recurs, doctors generally urge women to try getting pregnant soon after the surgery.
If pregnancy hasn’t occurred in several months, many patients are referred to ovulation induction and artificial insemination. If the passage between the ovary and fallopian tube is blocked, or if the endometriosis is severe, in vitro fertilization (IVF) may be recommended.
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