Endometriosis is a condition in which the endometrium or lining of the uterus is found outside the uterus (often called implants). It occurs in approximately 10% of reproductive age women, most often in women in their 30s and 40s.

Endometriosis can be present in the peritoneum, ovaries, fallopian tubes, surfaces of bladder, ureters, intestines and rectum. The implants respond to changes in estrogen and may grow, bleed and create chronic inflammation in the pelvic region. The breakdown and bleeding of this tissue each month can cause scar tissue and adhesions leading to pelvic pain, especially before and during menses.

Almost 40% of women with infertility have endometriosis. The chronic inflammation from endometriosis may damage the sperm or egg and interfere with the process of fertilization by blocking the fallopian tubes due to adhesions or scar tissue.

The most common symptom of endometriosis is pelvic pain that can occur during periods, sexual activity, bowel movements and during urination. Many women with endometriosis have no symptoms.

The only way to tell for sure you have endometriosis is by taking a biopsy through a surgical procedure called laparoscopy.

Treatment for endometriosis depends on the extent of the disease, symptoms and reproductive plans of the patient. It can be treated with medications, surgery, or both.

When pain is the primary problem, medication is tried first. The medication that are used to treat endometriosis include analgesics and hormonal medications. Hormonal therapy helps slow the growth of the implants and may keep new implants and adhesions from forming but typically do not destroy endometriosis that is already present. Surgery can be done to relieve pain and improve fertility but the role of hormonal therapy after conservative surgery (when uterus and ovaries are preserved) is necessary to help extend the pain-free periods and preserve fertility.

If pain is severe and hormonal therapies failed more definitive therapies such as hysterectomy (removal of the uterus) and oophorectomy (removal of ovaries) may be a last resort alternative. Endometriosis is less likely to come back if the ovaries are removed.

March is endometriosis awareness month, if you have further questions contact Evelyn Zeda, MD, FACOG at 939-261-2222.