What is Endometriosis?
Endometriosis is a benign and common disease. The definition of endometriosis is the presence of endometrial-like tissue outside of the uterus. It is often characterized by a history of pelvic pain, sub-fertility and impaired quality of life and tends to occur in women who are in their reproductive years up to their early 40s. It is estimated that endometriosis is active in 10% of women in this group, making it more common than diabetes.
When discussing the definition of endometriosis, it is important to first understand how the hormones in the body affect the menstrual cycle and the uterus itself.
The endometrium is the inner layer of uterine tissue that the body sheds during menstruation. The thickness of this layer is related to the egg-producing (ovulatory) time and the hormone levels that regulate this cycle. The endometrium is at its thinnest immediately following menstruation and thickens during the next two weeks as a result of increasing levels of the hormone estradiol. Once the egg is released at ovulation, the endometrial tissue becomes rich because of increased progesterone levels. The whole process prepares the uterus for the attachment of an embryo. If this does not occur, the endometrial layer is shed, and bleeding occurs.
Where does it Occur?
Endometriosis is when the growth of this endometrial tissue occurs outside the uterus. This occurs generally in the pelvic region, for example, on the ovaries, fallopian tubes, bowel, bladder and on the ligament supporting the uterus. This tissue, like the endometrium, responds to the monthly hormonal changes. When a women with endometriosis menstruates, the endometriosis breaks down, but because these cells are trapped inside the pelvis, and cannot escape, they form cysts filled with dark blood (known as chocolate cysts) and this causes chronic inflammatory reactions and adhesions which may damage the fallopian tubes. Some women with endometriosis may have no symptoms, but others may experience considerable pain during their menstruation or during intercourse and their periods tend to be heavy.
How do I know I have it?
Because endometriosis is a chronic disease, and there may be no symptoms, diagnosis can be difficult. Endometriosis is mostly diagnosed on the basis of a history of pelvic pain and physical examination. However, pelvic pain may occur without disease or may be symptomatic of many disorders, such as pelvic inflammatory disease (PID), ovarian cysts, and ectopic pregnancy. The only definitive diagnostic tool is by laparoscopy. Laparoscopy is an exploratory surgical procedure that permits the clinician to see inside the pelvic region to observe any endometrial growths, inflammation or adhesions. Early diagnosis will result in a more focused and effective care for endometriosis.
How common is it for the infertile woman?
Endometriosis is more common in infertile women. It has been reported that infertile women are six to eight times more likely to have endometriosis than fertile women. The reasons for decreased infertility are not clearly understood, but it seems likely that anatomical distortion of the pelvic area and hormonal factors play a part.
Can I still conceive?
Most women with endometriosis will still be able to conceive. Infertility associated with endometriosis is more common in women with severe forms of the disease. In these cases early diagnosis, surgical intervention and assisted reproduction treatment will enable these women a relatively increased fertility and pregnancy rate.
