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April 2006 – Endometriosis
Women Have Many Options for Treating EndometriosisEndometriosis, a chronic disease, can vary greatly from woman to woman. It may cause no or mild symptoms or may cause severe pain (usually during menstruation). Some women with the disease will be unable to conceive. Endometriosis affects 6 percent to 15 percent of women, and up to 40 percent of infertile women have the disease. The cause is unknown.
“This tends to be a lifelong disease, with peaks and valleys along the way,” said Estil Strawn, MD, obstetrician/gynecologist at Froedtert & the Medical College of Wisconsin and director of the Reproductive Medicine Clinic. “Our staff is dedicated to evaluating and treating even the most difficult cases of endometriosis.
“Many medical and surgical treatments are available to treat the disease as well as infertility that may result. We offer advanced laparoscopic procedures to evaluate and treat endometriosis and state-of-the-art approaches to achieving fertility.”
Cell GrowthIn endometriosis, cells that normally grow inside the uterus instead grow outside the uterus. When endometrial cells grow outside the uterus, they attach to many parts of the body. They often embed in and on the fallopian tubes and outside the ovaries. They also can be found on the surface of the uterus, intestines, rectum, and throughout the pelvic area. The cells develop into small growths, or tumors, that are usually benign (noncancerous).
The endometrial cells outside the uterus respond in the same way as cells inside the uterus — they shed each month during menstruation. Hormones cause the cells to swell and thicken, and then to shed. The blood that is shed in the abdomen has no place to go and can lead to inflammation and the formation of scar tissue.
SymptomsCommon symptoms and signs of endometriosis are pelvic pain (usually during menstruation) and infertility. Some women, however, have no or mild symptoms.
About 30 percent to 40 percent of infertile women have endometriosis, and many discover that they have the disease during an infertility evaluation. It’s believed that the scar tissue that forms with the disease can block the fallopian tubes or form cysts on the ovaries, interfering with ovulation and a woman’s ability to conceive.
“Women who have minimal endometriosis may be more common than we think,” Dr. Strawn said. “It’s controversial whether minimal endometriosis plays a role in infertility for women.”
DiagnosisWhile a physician may suspect that a woman has endometriosis, he or she must actually see the disease surgically and do a biopsy to make an accurate diagnosis. Laparoscopy (minimally invasive surgery) can be performed to detect the disease in the majority of women.
Unlike traditional (open) surgery that uses a large incision, laparoscopic surgery uses a few, very small incisions in the abdomen. The laparoscope and surgical instruments are inserted through the incisions, allowing the surgeon to view the abdominal organs on a monitor. Laparoscopy often results in less pain and scarring after surgery, and a more rapid recovery.
Treatment OptionsTreatment for endometriosis depends on the extent of a woman’s sympoms, the extent of the disease, the woman’s desire to become pregnant and her age. There is no permanent cure, but treatment — pain medication, hormone therapy and surgery — can be affective for many women, and most can be treated without the need for surgery.
“Treatment is individualized for each woman and may involve one or a combination of therapies,” Dr. Strawn said. “If pain is a woman’s main concern, we explore medication options. If fertility is the main concern, we look at ways to treat the disease to increase the chance for fertility, or we may explore other options for conception. For some women, pain control and fertility are equally important.”
- Medication for Pain
Pain medications for women not concerned about pregnancy include:
- Non-steroid anti-inflammatory medications such as ibuprofen and aspirin in high doses to relieve pain and inflammation
- Oral contraceptives at higher estrogen doses that reduce the number of menstrual periods to four per year
- Injectable contraceptives (most women require a minimum of two injections over six months and some may need them for many years)
- An intrauterine device that releases a low dose of progesterone and reduces the bleeding and cramping associated with endometriosis
- Drugs such as Lupron and Danazol that place a woman in a temporary menopausal state.
- Surgery for Pain
Women with significant endometrial growths such as large ovarian cysts, and whose pain is not relieved with medication, may need surgery to remove as much of the disease as possible. The surgery usually can be done using laparoscopy. After surgery, a combination of medications may be used to control remaining pain related to the disease.
- Treatment for Women Desiring Pregnancy
Most women whose infertility is caused by endometriosis can become pregnant despite having the disease. Some women require surgery (usually laparoscopy) to remove as much of the disease as possible. Because the disease tends to come back and can hamper pregnancy, fertility-inducing medication also is given to help achieve pregnancy sooner. For infertile women with minimal endometriosis, surgery won’t necessarily increase their chance for pregnancy.
In addition to surgery, women with significant endometriosis may need the aid of advanced reproductive technology such as in vitro fertilization or artificial insemination to become pregnant. Repeated surgeries may not improve the chance of becoming pregnant.
Additional ResourcesSmall Stones, a health resource center of Froedtert & the Medical College of Wisconsin, offers many resources on endometriosis. The following books are available to check out from the Small Stones Library:
- Endometriosis: The Complete Reference for Taking Charge of Your Health by Mary Lou Ballweg and the Endometriosis Society
- Explaining Endometriosis by Lorraine Henderson and Ros Wood
- The Essential Guide to Hysterectomy by Lauren F. Strecher, MD
- Women’s Bodies, Women's Wisdom by Christiane Northup, MD
- Endometriosis by C. Everett Koop, MD, and Time-Life Libraries (video)
- The Gynecological Sourcebook by M. Sara Rosenthal
Author: Marla Fraunfelder Date: April 1, 2006 Online Editor(s): Christopher Sadler
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