Endometriosis is a benign condition in which cells that function like endometrial cells (cells that line the uterus) are found on the lining of pelvis including structures such as the ovaries, uterus, bowels and other pelvic organs. Endometriosis involving the ovaries commonly results in cysts (chocolate cysts). Affecting approximately 10 percent of women, endometriosis can cause pelvic pain during her menstrual period, on an ongoing basis and during intercourse. Endometriosis is also associated with infertility.
Symptoms of Endometriosis
Symptoms of endometriosis include pelvic pain and, in some cases, infertility, irregular ovulation and abnormal menstrual periods.
The endometrial-like cells found outside the uterus respond to a woman's hormones (made from her ovaries) just as normal uterine cells. When menstrual bleeding begins, the sites of these abnormally located cells swell, bleed and produce substances that result in pain and scar tissue formation. This may explain why some women will experience chronic pain symptoms and disturbances of the organ's normal function. Retrograde menstruation (when menstrual blood flows backwards out of the fallopian tubes) may play a part in developing endometriosis. Most women have some degree of retrograde menstruation and never develop endometriosis. Ongoing research studies may provide more insight into why this occurs. Altered immunity is also thought to play a role in developing endometriosis.
Although no medical cure exists for endometriosis, medications and surgery can help lessen its severity, often providing long, if not indefinite periods of relief. At Cedars-Sinai, our physicians offer patients the most current and innovative treatment options for patients with endometriosis. We hope to improve upon current standard therapies and introduce new ways of addressing this common condition.
Doctors initially treat this condition with hormones that suppress growth of these abnormal cells, as well as alternative remedies including diet. Many women treated this way will not experience relief from their symptoms and surgery is the next line of treatment. Women who are experiencing fertility-related problems are not candidates for medications since most of these prevent conception. Surgical treatment may be either conservative (removing the endometriosis and scar tissue) or definitive (removing the uterus, ovaries and fallopian tubes) using laparoscopy, which is less invasive than traditional surgery and usually enables a woman to resume her normal activities more quickly. Hysterectomy is reserved for women who no longer want to have children.
The skilled surgeons at the Center for Minimally Invasive Gynecologic Surgery at Cedars-Sinai have extensive experience caring for women with endometriosis and provide individualized care and treatment options.
Endometriosis Related Pelvic Pain
A number of medications are available to treat endometriosis, and women should discuss these options with their doctors. Through our research, we have developed therapeutic protocols that can provide good results and minimize side effects. As a result, many women with endometriosis can avoid surgery. For women whose pain does not respond to medication or for those who are actively trying to conceive, surgery may help. The surgery can usually be done with laparoscopy (a minimally-invasive one-day surgery), using a number of innovative tools.
One of the primary issues related to endometriosis is the affect it has on some women's ability to conceive. For some, surgery can improve the chance of natural conception. For others, infertility therapies, such as ovulation induction or in vitro fertilization (IVF), may be more effective, sometimes alongside surgical treatment. Endometriosis often results in the scar tissue formation, which not only affects fertility, but is thought to be associated with pain symptoms as well.