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Endometriosis
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Endometriosis

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Endometriosis is a condition in which the endometrium, tissue that normally lines the uterus, grows in other areas of the body, causing pain, irregular bleeding, and frequently infertility.

Risk factors

Some women may have an inherited tendency to develop endometriosis. A woman whose mother, sister or daughter has endometriosis is 10 times more likely to have endometriosis than a woman without an affected relative. Rarely, a woman may be at increased risk because of a medical problem that prevents the normal passage of menstrual flow. In addition, some evidence suggests that damage to cells that line the pelvis caused by a previous infection can lead to endometriosis.

Endometriosis can affect menstruating women of any age or race and usually takes several years after the onset of menstruation (menarche) to develop. When menstruation ends permanently with menopause or temporarily with pregnancy, symptoms of endometriosis stop. They can begin again after pregnancy when menstruation resumes. Very rarely, hormone replacement therapy after menopause can reactivate the disorder.

Screening and diagnosis

To diagnose endometriosis and other conditions that can cause pelvic pain, your doctor will ask you to describe your symptoms, including the location of your pain and when you notice it. Your doctor will perform a pelvic exam to check for any abnormalities, such as cysts on your reproductive organs or scars behind your uterus. Often it's not possible to feel small areas of endometrial implantation unless they've caused a cyst to form.

Other tests to check for physical clues of endometriosis include vaginal or pelvic ultrasound. During a vaginal ultrasound, a wand-shaped scanner (transducer) is inserted into your vagina. In a pelvic ultrasound, a small scanner is moved across your abdomen. Both tests use sound waves to provide a video image of your reproductive organs.

Endometrial implants often cannot be felt or clearly seen in these or other tests. The only way a doctor can make a definitive diagnosis of endometriosis is through a minor surgical procedure called laparoscopy.

A general anesthetic is given before the procedure begins. Using a special needle, the abdomen is expanded (distended) with carbon dioxide gas so that reproductive organs are easier to see. A tiny incision is made near the bellybutton, and a slender viewing instrument (laparoscope) is inserted. By moving the laparoscope around, the surgeon can view the pelvic and other abdominal organs, looking for signs of endometrial tissue outside the uterus.

If you have endometriosis, laparoscopy will provide you and your doctor with information about the location, extent and size of the endometrial implants. This information will help your doctor guide you through treatment options.

A blood test to diagnose endometriosis may someday be available. One test currently under study looks for a protein that's commonly found in the blood of women with endometriosis. Until such a test is shown to be dependable and becomes widely available, however, laparoscopy is necessary to diagnose endometriosis.

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