Endometriosis

Endometriosis is a common cause of abdominal pain, pelvic pain, and infertility in women. Pain can increase during menses, urination, bowel movements and intercourse. Some women have endometriosis causing infertility with no associated pain. The term "endometriosis" comes from the name of the type of cells causing the disease, "endometrial cells."

Endometrial cells line the inner layer of the uterus and nourish a developing fetus. These cells are able to provide nutrients because they have the capacity to divide rapidly and increase in vascularity (more blood flow) under the influence of estrogen and progesterone.

During the monthly ovulatory cycle, levels of estrogen and progesterone increase leading to thickening of the uterine lining. If conception occurs, the corpus luteum (follicular structure that remains after ovulation) produces progesterone to further support the endometrium in sustaining a developing embryo. If conception does not occur, the vascular endometrial tissue is expelled during menstruation.

Endometriosis occurs when endometrial cells enter the body cavity or bloodstream and attach to organs or other structures. Once the endometrial cells attach, they retain their capacity to grow rapidly under the influence of estrogen. Endometrial cells can enter the bloodstream and have been found in virtually all parts of the body including the lungs, the bowel, attached to the fallopian tubes, the ovaries, etc. Their growth can damage, and in some cases, penetrate the host organ.

There are many theories as to the cause of endometriosis but the most popular states that endometrial cells enter the pelvic cavity as a "backflow" of blood during the menstrual cycle. It is also postulated that some women's immune systems do not immediately identify and destroy the endometrial tissue. This helps to explain why there is a genetic link with daughters of women with endometriosis more likely to have the disease.

Since endometrial cells depend upon estrogen, medical treatments for the disease seek to lower estrogen levels. Lupron is a common first line drug that blocks the production of FSH and LH leading to reduced estrogen production. Lupron is also used in assisted reproductive technology cycles (IVF) to control ovulation timing.

Many times endometriosis must be surgically removed using the laparoscope. The laparoscopy for fertility conditions, such as endometrial tissue removal, should be performed by a reproductive surgeon whenever possible. These specialists have extensive advanced microsurgical training and can keep the formation of scarring or adhesions to a minimum.

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