Endometriosis and ConceptionEndometriosis is a common, yet poorly understood disease. It can strike women of any socioeconomic class, age, or race. It is estimated that between 10 and 20 percent of American women of childbearing age have endometriosis.
While some women with endometriosis may have severe pelvic pain, others who have condition have no symptoms. Nothing about endometriosis is simple, and there are no absolute cures. The disease can affect a woman's whole existence--her ability to work, her ability to reproduce, and her relationships with her mate, her child, and everyone around her.
What is Endometriosis?
The name endometriosis comes from word "endometrium," tissue that lines inside of uterus. If a woman is not pregnant, this tissue builds up and is shed each month. It is discharged as menstrual flow at end of each cycle. In endometriosis, tissue that looks and acts like endometrial tissue is found outside uterus, usually inside abdominal cavity. Endometrial tissue residing outside uterus responds to menstrual cycle in a way that is similar to way endometrium usually responds in uterus.
At end of every cycle, when hormones cause uterus to shed its endometrial lining, endometrial tissue growing outside uterus will break apart and bleed. However, unlike menstrual fluid from uterus, which is discharged from body during menstruation, blood from misplaced uterus has no place to go. Tissues surrounding area of endometriosis may become inflamed or swollen. The inflammation may produce scar tissue around area of endometriosis. These endometrial tissue sites may develop into what are called "lesions," "implants," "nodules," or "growths."
Endometriosis is most often found in ovaries, on fallopian tubes, and ligaments supporting uterus, in internal area between vagina and rectum, on outer surface of uterus, and on lining of pelvic cavity. Infrequently, endometrial growths are found on intestines or in rectum, on bladder, vagina cervix, and vulva (external genitals), or in abdominal surgery scars, Very rarely, endometrial growths have been found outside abdomen, in thigh, arm, or lung.
Physicians may use stages to describe severity of endometriosis. Endometrial implants that are small and not widespread are considered minimal or mild endometriosis. Moderate endometriosis means that larger implants or more extensive scar tissue is present. Severe endometriosis is used to describe large implants and extensive scar tissue.
What are Symptoms?
Most commonly, symptoms of endometriosis start years after menstrual periods begin. Over years, symptoms tend to gradually increase as endometriosis areas increase in size. After menopause, abnormal implants shrink away and symptoms subside. The most common symptom is pain, specially excessive menstrual cramps (dysmenorrhea) which may be felt in abdomen or lower back or pain during or after sexual activity (dyspareunia). Infertility occurs in about 30-40 percent of women with endometriosis.
Rarely, irritation caused by endometrial implants may progress into infection or abscesses causing pain independent of menstrual cycle. Endometrial patches may also be tender to touch or pressure, intestinal pain may also result from endometrial patches on walls of colon or intestine. The amount of pain is not always related to severity of disease. Some women with severe endometriosis have no pain; while others with just a few small growths have incapacitating pain.
Endometrial cancer is very rarely associated with endometriosis, occurring in less than 1 percent of women who have disease. When it does occur, it is usually found in more advanced patches of endometriosis in older women and long-term outlook in these unusual cases is reasonably good.
How is Endometriosis Related to Fertility Problems?
Severe endometriosis with extensive scarring and organ damage may affect fertility. It is considered one of three major causes of female infertility. However, unsuspected or mild endometriosis is a common finding among infertile women. How this type of endometriosis affects fertility is still not clear.
While pregnancy rates for patients with endometriosis remain lower than those of general population, most patients with endometriosis do not experience fertility problems. We do not have a clear understanding of cause-effect relationship of endometriosis and infertility