What is Endometriosis?
Endometriosis occurs when normal tissue from the uterine lining, the endometrium,
attaches to organs in the pelvis and begins to grow. This displaced endometrial
tissue causes irritation in the pelvis that may lead to pain and infertility. Adendomyosis
is a form of endometriosis where the endometrial cells grow into the muscular wall of
the uterus causing abnormal bleeding and pain with menstruation. We do not know why
some women develop endometriosis. There are many theories about why endometriosis
forms and why some women get it and others don't. However as yet there is no proven
cause of endometriosis.

Early endometriosis implants look like small, flat patches, blebs or flecks
sprinkled on the pelvic surface. The flecks can be clear, white, brown, red, black
or blue. The severity and course of endometriosis is highly unpredictable. Some
women may have a few endometriosis implants on the surface of the pelvis, the
peritoneum, or pelvic organs, or it may invade the peritoneum and grow as
nodules. Endometriosis may grow on the surface of the ovary as implants or
invade inside the ovary and develop a blood filled cyst called an endometrioma,
or a “chocolate cyst.” Chocolate cysts are so named because over time the blood
they contain darkens to a deep reddish brown color. These cysts may be as small
as a pea or grow to be larger than a grapefruit. Endometriosis may irritate
surrounding tissue and produce internal scar tissue called adhesions. These
adhesions can bind the pelvic organs together, cover them entirely, or involve
nearby intestines. The adhesions may keep the fallopian tube from picking up
the egg from the ovary during ovulation. Endometriosis may also grow into the
walls of the intestine or into the tissue between the vagina and the rectum or into the
bladder.

Up to 10% of all women may have endometriosis. Many women who have
endometriosis experience few or no symptoms. Some women experience severe
menstrual cramps, chronic pelvic pain, or painful intercourse. In others,
infertility may be the only symptom of endometriosis. Often, endometriosis is
daignosed when a woman has pelvic surgery because of a persistent ovarian cyst
or other reasons. Endometriosis can affect women of all ages from early teens to senior
citizens. Endometriosis may be found in 24% to 50% of women who
experience infertility, and in more than 20% who have chronic pelvic pain.
Endometriosis is classified into one of four stages depending on the location, extent,
and depth of endometriosis implants, the presence and severity of adhesions, and
presenceand size of ovarian endometriomas. Most women have minimal or mild
endometriosis, which is characterized by superficial implants and mild
adhesions. Nevertheless, this degree of endometriosis is strongly associated with
infertility, dysmenorrhea, and chronic pelvic pain. Moderate and severe
endometriosis is characterized by chocolate cysts and more severe adhesions.

Symptoms of Endometriosis

Menstrual Cramps
Many women experience mild menstrual cramps, which are considered normal.
When cramping is more severe it is called dysmenorrhea, and may be a
symptom of endometriosis or other types of pelvic pathology such as uterine
fibroids or adenomyosis. Cramping severe enough to interfere with work or school is
very likely caused by endometriosis.

Painful Intercourse
Endometriosis can cause pain during or after intercourse, a condition known as
dyspareunia. The pain tens to be more severe just before of after the onset of the
menstrual period.

Painful Urination and Defecation
Pain with urination (dysuria) and pain with defecation (dyschezia) during the menses is
frequently associated with endometriosis.

Infertility
There is a large body of evidence that demonstrates an association between
endometriosis and infertility. Endometriosis can be found in up to 50% of
infertile women. Infertility patients with untreated mild endometriosis conceive
on their own at a rate of 2% to 4.5% per month, compared to a 15% to 20%
monthly fertility rate in normal couples. Infertility patients with moderate and
severe endometriosis have monthly pregancy rates of less than 2%. Even though
endometriosis is strongly associated with infertility, not all women who have
endometriosis are infertile.

HOW IS ENDOMETRIOSIS DIAGNOSED?
Endometriosis cannot be diagnosed by symptoms alone. Your physician may
suspect endometriosis if you are having fertility problems, severe menstrual
cramps, pain during intercourse, or chronic pelvic pain. It may also be suspected
when there is a persistent ovarian cyst.
Pelvic Exam
Certain findings of a pelvic examination may lead your physician to suspect
endometriosis. The doctor may feel a tender nodule behind the cervix during a
combined vaginal and rectal exam, or the uterus may be immobile. One or both ovaries
may be enlarged or fixed in position. Occasionally, endometriosis implants may be
visible in the vagina or the cervix.
Laparoscopy
Although your physician may suspect endometriosis, based on your history and the
results of a pelvic exam,
laparoscopy is needed to confirm endometriosis.
Endometriosis may be coagulated, vaporized, burned or excised,
and scar tissue or ovarian cysts may be removed. During laparoscopy, your
doctor can determine if your fallopian tubes are open by injecting dye through
the cervix into the uterus. The extent of endometriosis is evaluated during laparoscopy.
A clinicalstaging system is used to describe the extent of endometriosis, adhesions, and
endometrioma cysts in the ovary. Your physician may decide to treat your
endometriosis during thelaparoscopy. Additional small incisions allow your physician to
insert surgicalinstruments. Endometriosis may be coagulated, vaporized, burned or
excised,and scar tissue or ovarian cysts may be removed. During laparoscopy, your
doctor can determine if your fallopian tubes are open by injecting dye through
the cervix into the uterus. If the tubes are open, the dye will flow out the ends of
the fallopian tubes.

Additional treatments of endometriosis are available. What treeatment is best
for you is determined by the stage of your endometriosis, whether or not you have pain,
your desire to have children, and your life circumstances. You and your doctor will
determine your best course of treatment.