Endometriosis

Description

# The endometrium is the tissue that lines the inside of the uterine cavity. Endometriosis is a disease in which some of this tissue spreads, i.e., into the ovaries or elsewhere in the abdominal cavity.
# Endometriosis can cause pain and infertility.
# Thirty to 40% of infertile women have endometriosis.
# Common sites for endometriosis are around the ovaries, fallopian tubes, colon, and rectum. Since this tissue fluctuates in size and structure in relation to hormones released during the menstrual cycle, women with endometriosis will notice a pattern of pain or bleeding that correlates with their menstrual cycle. For example, if endometriosis occurs in the colon (bowels), during the end of the menstrual period, this tissue will enlarge and 'squeeze' down on the colon and cause pain in the colon or constipation.

Symptoms

Some or all may occur:
# Aching pain that usually begins 2-7 days before menstrual period starts and increases until menstrual flow starts to decrease. Pain types include:
1. Uterine pain
2. Abdominal pain
3. Rectal pain
# Vaginal bleeding
# Rectal bleeding
# Infertility (inability to become pregnant)



Diagnosis

# Examination
# Possibly no findings
# Nodules may be felt on examination.
# Testing
# Ultrasound-limited value
# MRI-most helpful noninvasive test
# Barium enema if rectal involvement is suspected
# Laparoscopy: A small incision is made in the belly button and a scope is inserted.
# Laparotomy: open surgical exploration, if the laparoscopy is not possible or inconclusive



Similar conditions

# Ovarian cancer
# Uterine tumors
# Pelvic inflammatory disease
# Colorectal cancer



Treatment

# Medicine
# Goal is to suppress ovulation (and thereby the female hormones), therefore the following treatments can be used to manipulate female hormones:
# Nafarelin nasal spray
# Leuprolide acetate injection
# Danazol: An androgen ('male-like) drug. Bothersome side effects include acne, excess facial hair growth, weight gain, and decreased breast size.
# Oral birth control pills
# Medro-xyprogesterone acetate and oral estrogen
# Anti-inflammatory medications, especially Anaprox or Motrin
# Narcotic pain medications, e.g., Tylenol with codeine
# Surgical Treatment
# The endometrial tissue that is located in abnormal places is removed. Surgery is usually performed if there is extensive endometriosis, infertility, or severe pain that is not responsive to medications.
# If future pregnancy is not desired, removal of the ovaries can be performed. This is usually curative since the female hormone levels are substantially reduced.