Dr. M.J. Bazos, MD Patient Handout

ENDOMETRIOSIS


About Your Diagnosis
Endometriosis is a condition in which tissue similar to the lining of the uterus, the endometrium, grows in abnormal places in the abdominal cavity,
usually the pelvic area. The most common sites for endometriosis to grow are the ovaries, the fallopian tubes, and the lining (the peritoneum) of the pelvis, especially behind the uterus. The cause of endometriosis is unknown although there are several theories. Endometriosis may be familial. Endometriosis can be found in 5% to 15% of women of reproductive age. Sometimes a presumptive diagnosis is made by the presence of certain symptoms. However, the only way endometriosis can be diagnosed definitively is by laparoscopy. This is a minor surgical procedure in which a telescope-like instrument is placed through a small incision into the abdominal cavity to visualize the endometriosis. Sometimes biopsy specimens may be taken to confirm the presence of endometriosis, especially if the appearance of the endometriosis is not typical. Endometriosis can be very effectively treated with birth control pills or other medications. If you have been diagnosed with endometriosis, you will always have the possibility of developing problems from it until you go through menopause. Endometriosis is stimulated by estrogen, so when your estrogen levels decrease in menopause, the endometriosis is no longer a problem.

Living With Your Diagnosis
Endometriosis may not cause any symptoms. Many women have endometriosis and have no symptoms, and it is only discovered because they have surgery for some other reason (e.g., a tubal ligation). The most common symptoms are:
• Dysmenorrhea (pain in association with periods).
• Pelvic pain that is associated with periods.
• Painful intercourse, usually deep pelvic pain.
• Infertility.
Endometriosis can cause scar tissue to form around the pelvic organs, the uterus, fallopian tubes, and ovaries. The scar tissue can cause pelvic pain and infertility by blocking the fallopian tubes. Occasionally, the scar tissue can block bowel (intestines) or the ureters (the tubes that connect the kidneys to the bladder).

Treatment
Birth control pills are a very effective way to treat endometriosis. Birth control pills are not risky for most women and are usually well tolerated. Also, women can stay on birth control pills for many years, as long as necessary, to keep the endometriosis suppressed. If pregnancy is desired, then the birth control pills are discontinued and attempts to conceive are started right away (discuss with your doctor). Danazol is also a very effective treatment. Some of the common side effects include weight gain, oily skin or acne, hot flashes, deepening of the voice, emotional lability, facial hair, and water retention. Gonadotropin-releasing hormone agonists, such as Lupron or Synarel, are also very effective in treating endometriosis. These types of medications turn off the ovaries so menopause is induced. Without estrogen, the endometriosis is no longer active. The most common side effects are hot flashes and vaginal dryness. A potential complication is osteoporosis, a loss of bone density, so it is usually only prescribed for 6 months at a time. Often laparoscopy is used to diagnose and treat endometriosis. At the time of surgery, the endometriosis is cauterized or lasered. This will provide immediate relief in many cases. However, because endometriosis will grow back, most patients should be placed on some type of medical treatment after surgery.

The DOs
• If you are started on birth control pills or on medication, do take it as directed.
• If your endometriosis causes cramping with your periods, exercise may help relieve some of the cramps.
• Ibuprofen and ibuprofen-like medications can also help relieve painful periods.

When to Call Your Doctor
• If your treatment is not helping your symptoms.
• If you are not tolerating your medication or birth control pills. Sometimes another medication will be better tolerated.
• Don’t take any herbal therapies without checking with your doctor. Some of the herbal remedies may have estrogen-like molecules and may stimulate your endometriosis.