Endometriosis is a condition in which the tissue normally found inside the uterus (the endometrium) begins to grow outside of the uterus on the bladder, ovaries, bowel and pelvic sidewall.
What are the typical symptoms of pelvic endometriosis?
Although symptoms may vary from woman to woman, classical presentation of pelvic endometriosis includes:
- Severe menstrual cramps and pain
- Pain during sex
- Persistent pelvic pain
- Pain with urination and bowel movements, especially around the period
What causes endometriosis?
The scientific community is still debating the true cause of pelvic endometriosis. One widely accepted theory is "Retrograde Menstruation," which posits that, during menstrual bleeding, blood with endometrial tissue gets into the pelvis and the abdomen. If not cleared by body's immune system, the endometrial tissue becomes implanted on the other organs (such as the ovaries). That tissue then "bleeds" under hormonal influence, causing pain during each menstrual cycle.
Other theories, such as genetic predisposition to endometriosis, autoimmune dysfunction, environmental theory and others also exist. In reality, the development of pelvic endometriosis is probably the result of multiple mechanisms, including those mentioned above.
How is pelvic endometriosis treated?
There are several medical (conservative) treatment options available. Hormone therapy (HT) in the form of an injection, pill or IUD are the first line of management. Unfortunately, in many cases, medical treatment is inadequate at controlling symptoms of pelvic endometriosis. In those cases, surgical management is the only option.
How is surgery performed?
In the majority of cases, surgical management of pelvic endometriosis is performed through a minimally invasive approach -- several 5 to 10 mm (1/3 of an inch) incisions are made, and the abdomen and pelvis are examined under high magnification with the laparoscope.
The endometriotic tissue is removed with the help of tiny scissors, lasers or electrosurgery (burning). Some tissue samples are sent to the laboratory to confirm the presence of the disease.
In severe cases of endometriosis, which involve the bladder or bowel, consultation with a urologist and/or colorectal surgeon is needed. In those instances, secondary surgery might be necessary to perform a potential bladder or bowel resection.
After surgery, you will be placed on a comprehensive therapy regimen, including suppression of the menstrual cycle to a minimum, as well as a pain modification protocol aimed at your central nervous system.