Endometriosis

IMORTANT DEFINITIONS: 

Endometrium: the inner lining of the uterus. The lining is made up of specialized endometrial glands and stromal cells. The endometrial glands  make and secrete nutrients essential for survival and development of the baby. Whereas, the stromal cells make up the largest portion of the endometrium. Under the direction of estrogen and progesterone, the stromal cells direct the growth, remodeling, and the breakdown of of the endometrium throughout the woman's normal healthy reproductive cycle. 

Menses: the "breakdown" or shedding of the endometrium (ie: your period).  

Ectopic: in an abnormal place or position. Eg: an "ectopic pregnancy" is when the baby is growing somewhere else outside of the uterus, such as in the fallopian tubes. Whereas, ectopic endometrial tissue is when endometrial glands and stromal cells are growing somewhere outside of the uterus. 

• A condition where a woman has ectopic endometrial tissue, often referred to as "ectopic implants".
• Common sites are: ovaries, uterine ligaments, bladder, the Pouch of Douglas (a space between the uterus and the rectum), on the outside on the uterine wall and hidden within folds of the membrane that lines the abdominal and pelvic cavities called the peritoneum.  
• Endometrial implants can occur in the vagina, on the cervix, on the intestines, liver or pancreas. 
• Endometrial implants have even been found in the breasts, kidneys, lungs and bones of some women. 

• The ectopic endometrial implants grow in response to estrogen, and they elicit an inflammatory response. 
• Implants can invade and cause damage to the tissues, furthering inflammation and predisposing the woman to chronic pain and reproductive complications. 

• pelvic pain- premenstrual and at other times in the cycle; 70% of women presenting with chronic pelvic pain will have endometriosis. 
• infertility - 50% of women presenting with infertility will have endometriosis.
• menorrhagia: heavy menstrual bleeding
• dysmenorrhea: painful periods
• dyspareunia: pain with sexual intercourse 
• nausea and/or vomiting premenstrually or during your period
• dyschezia: pain with bowel movements, especially premenstrually
• post-coital bleeding: spotting after sexual intercourse
• mid-cycle spotting: spotting around ovulation time  
• urinary frequency: especially premenstrually

Note: 

- hormonal birth control (pill or IUD) will suppress your natural cycle and often mitigate or abate your symptoms. 

- during pregnancy, the ectopic tissue undergoes regression and symptoms often lessen or disappear. 

• A definitive diagnosis of endometriosis can only be made by visualization of the ectopic tissue via laparoscopy (see below for more detail on laparoscopy). Sadly, the diagnosis of endometriosis is made on average of 9 years after the woman first reports her symptoms. 
• A woman with a mother or sister with endometriosis has a 7-fold higher risk of having endometriosis. 
• Evidence to predict endometriosis based solely on the patient's report of symptoms alone is weak. 
• A report of multiple symptoms listed above should increase the clinician's suspicion that endometriosis is present. 
• A history of pelvic inflammatory disease (PID) and/or irritable bowel syndrome (IBS) should further increases suspicion of endometriosis. 

• Although the endometrial implants typically regress in women during pregnancy, studies show the risk of pregnancy complications in women with endometriosis is significantly increased. Such complications include: miscarriage, ectopic pregnancy, preterm birth, low birth weight, preeclampsia, placenta previa and hemorrhage. 
• Women with endometriosis in their ovaries are at increased risk of developing ovarian cancer later in life. 
• Some studies even show that women with endometriosis have a higher risk of developing cardiovascular disease.