Introduction

“Endometriosis is a chronic disease that affects 5½ million women and girls in North America and millions more world-wide. A disease of the reproductive years, it affects approximately 2% to 10% of women." Of these women, approximately 30% to 40% are infertile. Not only can it cause infertility, but some women have severe pain.

Endometriosis is a condition where endometrial tissue grows outside the uterus and responds to hormones just like the uterine endometrial tissue. The tissue can grow on:

• The ovaries
• In the fallopian tubes
• The ligaments supporting the uterus
• Between the vagina and rectum
• The outer surface of the uterus
• The lining of the pelvic cavity
• The vagina
• The bladder
• The bowel
• The cervix
• The vulva
• Along abdominal scars

Although these are the most common spots, it can also grow in less common areas. Other areas where endometrial tissue has been found are the lung, arm, thigh, and other locations.

Causes

Although the cause of endometriosis is unknown, there are numerous theories why some women have endometriosis. The following causes my be responsible:

• Retrograde menstruation - Rather than the menstrual lining being expelled with the blood, it backs up through the fallopian tubes and implants itself in the abdominal area. Furthermore, the endometrial fragments may be carried through the lymphatic system or blood system and implant itself elsewhere. This may explain why endometriosis can be found in the lung,
• Environmental Toxins - Organochlorines are found in pesticides and other products. They produce estrogen-like effects on the ovaries. They are associated with infertility, certain reproductive cancers, and autoimmune disorders. These same problems are also associated with endometriosis.
• Impaired immune system - In some women, an impaired immune system may be responsible for why the endometrial tissue implants itself and grows elsewhere in the body. Women with endometriosis may have less natural killer cells. Without these killer cells, the endometriosis may be able to take root easier and spread.
• Autoimmune disorder - Although researchers do not understand the link, women with endometriosis have a higher prevalence of inflammatory autoimmune disorders such as rheumatoid arthritis, lupus, and multiple sclerosis.
• Angiogenesis and growth factors - When blood loss occurs and oxygen levels drop in uterine endometrial tissue after menstruation, the uterus secretes vascular endolethial growth factor or VEGF. VEGF promotes the growth of new blood vessels to repair the uterus. Endometrial tissue outside the uterus may spread by the same process.
• Genetic factors - Endometriosis is more prevalent if there is a family history. If a mother or sister have endometriosis, the chances of developing endometriosis are ten times higher.
• Menstrual variations - Women who have endometriosis tend to have shorter times in between menstrual cycle, longer periods of menstruation, and a heavier menstrual flow.
• Not having children - Having children at a younger age may prevent endometriosis. Cervical dialation during labor reduces the chances of menstrual retrograde later on.

Symptoms

Dependent upon where the endometrial tissue is growing, the symptoms can vary. Some of the symptoms can be:

• Pain before and during menstruation
• Pain during sex
• Infertility
• Fatigue
• Painful urination or bowel movements during menstruation
• Diarrhea, constipation, nausea
• Allergies
• Chemical sensitivites
• Frequent yeast infections
• Abnormal bleeding. This can include heavy menstrual flow; spotting; bleeding between periods; bleeding after sex; and blood in the urine or stool.

Stages

There are four stages of endometriosis. The stages are not based on pain levels or fertility They are based on the location, amount, and depth of the endometriosis. These four stages are minimal, mild, moderate, and severe.

Endometriosis and Infertility

Infertility is one of the syptoms of endometriosis. It can cause infertility in several different ways.

• Endometriosis causes scarring and/or adhesions in the pelvic cavity. The adhesions and scarring are caused by two factors. First, chronic inflammation from the bleeding implants causes adhesions and scarring. Secondly, as endometrial implants grow, the body tries to isolate and surround the fibrous connective tissue (scar tissue) to prevent them from doing damage. However, the fibrous connective tissue also causes the implants to stick to adjacent and surrounding tissue. Dependent where the implants are located, the fallopian tubes, uterus, or ovaries may adhere to the lining of the pelvis or the organs may bind together. The displacement of the these structures may prevent the egg from entering the fallopian tubes or traveling to the uterus.
• Implants or growths can block the fallopian tubes.
• Implants on the ovaries may prevent the release of an egg.
• Prostaglandins produced by active endometrial implants and other chemicals produced by white blood cells may interfere with the reproductive system by causing muscular contractions and spasms. The fallopian tubes may be unable to pick up the egg and the uterus may reject the embryo.
• There is a small amount of fluid in the pelvic cavity which is in contact with the fallopian tubes and ovaries. The fluid of women with endometriosis may carry molecular messengers which reduce sperm motility and sperm velocity. This fluid may also affect embryo development.
• Endometriosis may also cause ovulation defects like an ovulation, luteal phase defects, and luteinized unruptured follicle syndrome.
• Antibodies may form from the misplaced endometrial tissue. These antibodies may attack the uterine lining too and cause an increased incidence of spontaneous abortion.
• Defects in the immune systems may not only cause endometriosis, but it may cause the associated infertility too. Women with endometriosis have more immune system

Endometriosis and Pain

The pain of endometriosis varies from the time of the month to the intensity of the pain. Just like the uterine endometrial tissue, the endometrial tissue outside the uterus bleeds too. However, unlike with the uterine endometrial tissue, the other tissue has no where for the blood to escape to. The endometrial implants make chemicals that cause inflammation and irritate surrounding tissue and cause pain. Some implants may be closer to pain sensitive nerves too.

 Diagnosis

Endometriosis can be difficult to diagnose. Sometimes when a physician is performing a rectovaginal exam, nodules can be felt behind the uterus and along the ligaments that attatch to the pelvic wall. However, for an accurate diagnosis, a laparoscopy needs to be performed.

During a laparoscopy, the abdominal area is inflated with carbon dioxide through a small opening in the naval. After the area is inflated, a thin instrument called a laprascope is inserted through the naval to examine the abdominal and pelvic area. If endometrial implants are found, they are usually burned off with laser. If endometrial implants are not found, biopsies are taken because endometriosis can be microscopic.

Treatment

There are no known cures for endometriosis. Treatment is aimed at reducing the progression of endometriosis and relieving pain. Listed below are some of the common treatments:

• NSAIDs. Reduce pain and bleeding. However, if you do become pregnant, they can increase your chances of miscarriage.
• Birth contol pills. Shrinks implants and reduce pain by simulating pregnancy.
• Hormone therapy. Eliminates menstruations and shrink implants.
• Laprascopy surgery. Removes implants and scar tissue. Although laparoscopic surgery can reduce pain, surgery is controversial. In advanced stages of endometriosis, surgery may improve fertility, but in less advanced cases, surgery has not been shown to improve fertility.

Conclusion

Endometriosis is a complicated disease. Although there are many theories about the causes, scientists still do not understand the disease fully. However, the associated pain and infertility can be devastating for a woman. If you have any of the associated symptoms of endometriosis and have been unable to concieve after a year of frequent, unprotected sexual intercourse, see a doctor. Although there is no cure, treatment may reduce the pain and progression of the disease.

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