This disease is very common in women with fertility problems. It can cause infertility in a number of ways. The disease leads to a reaction in the tissue which then produces of a high level of chemicals which hinder the normal contraction of both the uterus and fallopian tubes. This leads to poor sperm, egg and embryo transport. The same chemicals (known as prostaglandins) can stimulate nerves which cause pain with periods or with sex. Occasionally, when endometriosis is very severe it can cause damage to the ovaries, fallopian tubes and surrounding structures.
Symptoms
Endometriosis is a disease where tissue similar to the lining of the uterus (endometrium) is present outside the uterus (usually elsewhere in the pelvis). It is a relatively common condition occurring in 8-15% of the female population. It causes a variety of symptoms including:
- Infertility
- Pelvic Pain
- Pre-menstrual spotting
and more rarely
- cyclical rectal bleeding or pain
- urinary urgency or pain
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Cause
The exact cause of endometriosis is unknown but there are several theories:
§ Cells from the lining of the uterus reflux back up the tubes at the time of your period and then grow inside the pelvis (retrograde menstruation)
§ Defects in your immune system fail to “mop up” the refluxed cells
§ The endometrial cells from women with endometriosis may be inherently different to normal women with an exaggerated tendency to implant
§ Peritoneal transformation - a change in the nature of the lining of the pelvis
High local concentrations of Oestradiol (ovarian hormone) encourage this process and allow the continuing growth of the implants.
Diagnosis
The diagnosis is always made by laparoscopy, which should be performed when ever the disease is suspected. There should be a high level of suspicion if you have any of the symptoms mentioned above.
Treatment
Initial treatment can be provided in a majority of cases during investigation, at the time of diagnosis by laparoscopically directed diathermy (burning away the disease). When the disease is severe open surgery is the mainstay of direct treatment, particularly if infertility is the problem. On occasions the disease can be ignored and other treatment such as IVF can be used to bypass the effect of the endometriosis. Other therapies such as hormones (Progestagens and Gonadotrophin releasing hormone analogues) are more commonly used if the disease is causing pain.