Endometriosis is a confusing disease which may affect as many as one in ten women during their childbearing years. It is especially common in women who have difficulty achieving pregnancy, and in women who experience pelvic pain.
It is a condition in which endometrial cells, which normally line the inside of the uterine cavity (womb), grow outside of the uterus. It usually presents as small spots or clusters in the pelvis – typically on the ovaries, fallopian tubes, bladder, pelvic side walls and rectum. Endometriosis can also cause cysts on the ovaries. These cysts contain some dark brown fluid – and are sometimes called chocolate cysts. In rare circumstances endometriosis may be found in other parts of the body such as the lungs, liver and kidneys. For the most part it is a benign disease that does not lead to cancer.
There are a number of theories which have been suggested to explain how endometriosis occurs. One of the most common is that during menstruation there is backflow of blood and cells through the fallopian tubes into the pelvis. The theory is then that some of these cells, which are still viable, grow inside the pelvis. As these deposits grow, they respond to the hormones produced by the ovaries, and release chemicals which cause local inflammation and pain. It has also been suggested that it is a faulty immune system which allows these endometrial cells to grow where they should not be growing. It has also been suggested that the disease may start before birth when a baby girl is developing in the womb. Endometrial cells from the uterus may stray out of the womb into the pelvis – and lie quietly there until the teenage years when the ovaries start producing estrogen – which may stimulate them to grow and cause inflammatory changes in the pelvis. Another theory is that endometrial cells may travel in the bloodstream, and deposit themselves in vulnerable areas.
Although there may be no symptoms at all, common symptoms include the following:
Like any chronic illness, women may find it difficult to live with endometriosis. It may not only affect them, but their partners, children, friends and family. Family life and careers may suffer. Relationships are particularly vulnerable, because in many cases women find sexual intercourse painful and unrewarding – and therefore prefer to avoid it. The pain associated with menstruation can cause significant mood disturbances.
The symptoms described above should alert you and your physician that you may have endometriosis. Sometimes on clinical examination, a nodularity can be felt behind the uterus during a vaginal examination. This is very typical of endometriosis. Ultrasound may sometimes be helpful – particularly if there are cysts on the ovaries.
There is a blood test called CA-125 which can also be used as a marker for both endometriosis and ovarian cancer. The most definitive test for evaluating the pelvis and diagnosing endometriosis is a procedure called a laparoscopy. This involves a general anesthetic, and passing a small telescope through the bellybutton into the pelvic cavity.
There are a number of different options which are available. These may be either medical or surgical:
It is important that you have a good relationship with your physician – in order that you understand the disease, the extent of it, and the different options for treatment.