The normal tissue lining the uterine cavity is called the endometrium. Endometriosis is a condition in which the presence of this endometrial tissue moves outside the uterus. The most common places for implantation are the ovaries, fallopian tubes, bladder and intestines, uterine wall, and the lining of the pelvis. In very rare cases it may be found in the lungs, surgical wounds (cesarean section scars), brain tissue and the vaginal wall.
The explanation on how this tissue moves outside the uterine cavity is under debate. It is thought that during menstruation, blood can regurgitate out of the fallopian tubes and into the abdominal cavity. This process is known as retrograde bleeding.
How common is endometriosis?
The true incidence of Endometriosis is not really known, but it is thought that 10-15% of all women of reproductive age will develop Endometriosis and 25-35% of all infertile women have Endometriosis. The risk of this disease is seven times greater if a mother or sister have had the disease.
What are the symptoms of Endometriosis?
Many times Endometriosis shows no symptoms (asymptomatic). Some women may have extensive disease yet no pain, whereas others with only minimal disease may experience severe pain.
This pain can vary. It may start just prior to menstruation or even several days before menstruation begins. The pain is generally at its worst during the point of heaviest flow. Frequently, large clots are seen. Pain can also be present in other locations during the period (i.e. a previous Ceasarian section incision or in the back).
Pain During Intercourse (Dyspareunia)
This usually results from tissue implants deep in the pelvic wall that have infiltrated the lining of the abdomen (peritoneum), and from adhesion (scar tissue) formation.
This usually results from a collection of shed (regurgitated) menstrual blood in the abdominal cavity causing local abdominal (peritoneal) inflammation. These implants may also attach to the ovaries and intestines. In rare situations, the tissue implants itself on the appendix. Pelvic pain can be very similar to that of appendicitis; patients complain of pain in the lower right region of their abdomens.
This is usually seen when the endometrial tissue or implants involve the intestinal tract, specifically the colon and rectum.
Other Gastrointestinal Symptoms:
- Rectal bleeding
- Obstruction of intestines due to adhesions (scar tissue), although this is rare.
How is Endometriosis diagnosed?
Talking to your doctor and giving a good description of your symptoms is important to correctly diagnose Endometriosis. Noting a family history of Endometriosis will assist your physician in diagnosing the disease.
Sometimes implantation in certain areas (vagina, cervix) can be identified during a pelvic exam. It is important to note that you should see your doctor if you are having exceptional pain during menstruation. Although implantations are rare, if they are present, this is when these implants are at their largest and are easiest to detect.
Blood Test (CA 125)
This is a tumor marker most commonly used to diagnose ovarian cancer. It has been found that 30-60% of all cases of Endometriosis can have an elevated level of this blood test. It is important to note that a high CA 125 level isn’t necessarily cause for alarm. Moderate to severe cases of Endometriosis can have normal levels yet mild cases can sometimes have high CA 125 levels.
At the Institute, Dr. Del Junco Jr. has treated many women who have had both an elevated CA 125 level and an ovarian mass detected by ultrasound. These women had all received several medical opinions recommending hysterectomy and removal of the ovaries (oophorectomy). We at the Institute, however, council women that if their ovarian masses prove benign, radical surgery would be unnecessary.
Often times, during surgery, we find the presence of an endometrioma (Endometriosis of the ovary). Female Alternative Surgery focuses on the removal of these cysts while at the same time, preserving the ovary.
Ultrasound, CT Scans, MRI
These tests are often unable to show specific findings to assist in the primary diagnosis.
This is the best way to diagnose and in most cases to treat the Endometriosis. Laparoscopy is an outpatient procedure in which a small incision is made under the belly button (umbilicus). CO2 gas is inserted into the abdomen to help separate the organs. A small telescope is inserted to view the female reproductive organs, intestines and pelvic wall. The surgeon is then able to see the tissue implants which may have attached themselves to the ovaries, fallopian tubes, uterine walls, rectum, bladder and/or pelvic wall.
Can Endometriosis cause infertility?
Adhesions (scar tissue) can block the fallopian tubes and prevent the egg from entering the uterus. There is a 25-35% rate of infertility in moderate to severe cases of Endometriosis, resulting primarily from damage incurred to the ovaries and fallopian tubes.
Can Endometriosis be treated without surgery?
Each case requires a treatment unique and specific to itself. The following are some of the treatments available. Please be sure to consult with your physician before beginning any treatment, whether it is described below or not.
Estrogen is known to stimulate the growth of Endometriosis. Therefore, any hormonal treatment prescribed is designed to suppress estrogen and reduce its circulation in the body.
Birth Control Pills
Birth Control Pills simulate a pregnancy state in the body. They reduce menstrual bleeding by thinning the endometrial lining, thereby shortening and lightening the period. These pills must be taken for a minimum of six months.
This drug suppresses estrogen levels and increases the amount of testosterone circulation. This form of medical therapy stops patients from ovulating and menstruating. It also shrinks the uterine lining and prevents new tissue implants from forming. However, side effects may occur, such as:
- Fluid retention
- Hot flashes
- Dry vaginal wall (atrophic vaginitis)
- Increased hair growth
These symptoms abate once treatment is discontinued. This drug therapy must be taken for 6 months to up to 1 year. Dr. del Junco Jr. reserves this form of treatment for very severe cases of Endometriosis that persist with symptoms even after being treated with laser laparoscopy.
Can Endometriosis reoccur?
Yes, Endometriosis tends to reoccur. About 5-20% of patients have symptoms again within 5 years. Patients treated only medically, without surgery, can have higher recurrence rates. A second examination is recommended 3-4 months after the first laparoscopy if symptoms continue or in cases of severe Endometriosis when recurrence of the disease or the formation of adhesions is anticipated.
How can Female Alternative Surgery help Endometriosis?
Laparoscopy affords the patient the best results for fertility and resolution of the symptoms. First a biopsy is taken of the tissue implants and is sent to pathology for definitive diagnosis. If Endometriosis is found, treatment may begin. At the Institute, we utilize two different lasers to treat the disease. A CO2 yag laser is used to break down adhesions and remove the endometrial implants. An Argon laser can also be used to ablate or remove the endometrial implants on the ovaries. Dr. del Junco Jr. prefers the Argon laser method because it causes only minimal thermal injury to the tissues and preserves as much normal tissue as possible. The success of this procedure depends on the experience of the surgeon and the thoroughness of the organ evaluation.
It is important to note that this procedure may be conducted during menstruation. Due to their increased size during menstruation, recognizing and locating the endometrial implants is easier.
Remember: Every form of treatment should be tried before a hysterectomy is ever considered.