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Endometriosis is a female disease that is characterized by having cells from the lining of the uterus grow in other areas of the body. These cells respond to the hormonal changes of the cycle and produce pain before or during the period. Just like the response of the lining of the uterus, the implants of endometriosis thicken, break down and bleed. Since this tissue stays in body, it produces an irritation to surrounding tissue and can produce scar tissue and adhesions. The most common sites for implants of are the outside surface of the uterus, cervix, vagina, ovaries, fallopian tubes, bladder and colon. Medical literature has found rare cases where endometriosis was found in the liver, lungs, surgical scars, lung or brain. The most common fear for women is the risk of cancer, but these implants are benign.

What are the signs and symptoms of endometriosis?
The common symptoms may include:

  • Pain with menstruation (dysmenorrheal) – Pelvic pain and cramping usually begins just prior to the onset of bleeding and may extend during bleeding period. It can be in the lower abdomen or in the low back.
  • Pain with bowel movement or urination – Usually occurring during the time of the period and may signify involvement of implants on the bladder or colon.
  • Pain with intercourse – Most commonly occurring around the time of the period and most commonly with deep penetration.
  • Infertility – May produce scarring of the ovary or fallopian tube, decreasing fertility. It is often first diagnosed when a women who are seeking evaluation for infertility.
  • Increased bleeding with menstruation – In a smaller number of women, increased flow with the period and bleeding between periods may rarely occur.

Severity of the symptoms is not a reliable indicator for the severity of the disease. Studies have shown that women with mild disease may have severe pain while women with severe disease may report having only minimal pain. It can also mimic symptoms of other diseases including irritable bowel syndrome (IBS), pelvic inflammatory disease (PID) or ovarian cysts.

What causes endometriosis to develop?
The cause of endometriosis is unknown. There are several theories but no conclusive studies have shown the exact cause. One of the most commonly discussed causes is retrograde menstruation, in which the flow of menstrual blood flows backward through the fallopian tubes and out into the abdominal cavity. These cells in the blood may implant into tissues of the abdominal cavity and develop into the implants. Another theory that has been often discussed is that women with endometriosis have an impaired immune system that may allow the cells to grow outside the uterine cavity. The following patterns have been identified with endometriosis:

  • It is most commonly diagnosed between ages 25-35, but sometime can be diagnosed at other ages.
  • It is more frequent in women with a family history and most frequent if her mother or sister has been diagnosed with it.
  • It is more common if a woman has never been pregnant.
  • It is sometimes seen more commonly if a woman has periods closer than 28 days apart or the flow lasts more than seven days.
  • The younger a woman starts her period may increase the frequency of the disease slightly.

How is endometriosis diagnosed and how is it treated?
The diagnosis of endometriosis is difficult. Pelvic exams may show signs of pain or discomfort in a specific area of the pelvis. Ultrasound is of limited basis since it may only show signs of tissues being thickened, but can not definitively diagnose the condition. Laparoscopy still remains the most reliable means to diagnose the condition. Once diagnosed, there are several approaches for therapy. Treatment decisions will ultimately hinge on the woman’s age, severity of symptoms and disease and whether she desires to maintain fertility. In mild cases, regular exams at six to twelve month intervals can attempt to monitor for worsening of the disease. The pain may be controlled by using exercise and relaxation techniques and nonsteroidal anti-inflammatory drugs. In more severe cases, medications such as progesterone and Depo Lupron may be needed. Surgery may become necessary in cases where medications are not helpful. Birth control pills may help prevent endometriosis or slow down its advancement.

If you have symptoms or concerns about endometriosis, contract you physician for an exam and discussion of symptoms.

More about Dr. Aulds

Donald G. Aulds, MD is an Obstetrician and Gynecologist and currently serves as the Medical Director for both the Women's Center and the Best Start Program of North Alabama. He is a Diplomat of the American Board of Obstetrics and Gynecology and Fellow of the American College of Obstetricians and Gynecologists.

Dr. Aulds completed his medical education at Louisiana State University School of Medicine, New Orleans, LA and his Internship and Residency in Obstetrics and Gynecology at Ochsner Medical Foundation, New Orleans, LA.

Dr. Aulds has been an active member of the Huntsville Hospital Medical Staff since 1980.