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What is endometriosis?

Endometriosis is a condition where the uterine lining, called the endometrium, grows outside the uterus.  Endometriosis implants are most commonly found in the pelvis, and may involve the ovaries, fallopian tubes, external uterine surface or lining of the pelvis known as the peritoneum.  Endometrial tissue that grows on the ovary may cause a specific type of cyst to form, called an endometrioma.What are the common symptoms of endometriosis?

The most common symptom of endometriosis is pelvic pain, which can manifest a painful intercourse, painful menstrual periods, or even pain with urinating or having a bowel movement.    Endometriosis may also be associated with infertility.   As a clinical condition, endometriosis is unique because the severity of a patient’s pain symptoms do not always correlate with the severity of endometriosis.

How is endometriosis diagnosed?

Endometriosis may be suspected based on a clinical history, certain physical exam findings on pelvic exam, or presence of an ovarian cyst on ultrasound that looks like an endometrioma.   However, the only way to definitively diagnose endometriosis is to actually look inside the abdominal cavity with a special surgery called laparoscopy (insert link to laparoscopy).   At the time of laparoscopy endometriosis can be visually identified and a biopsy may be performed to confirm the diagnosis.

How is endometriosis treated?

Endometriosis may be treated with medication or surgery, and the recommended treatment depends on severity of disease and whether or not a patient desires future pregnancy.   Treatment may relieve pain and infertility temporarily, but symptoms can recur after treatment. 

Medical treatment usually involves a combination of nonsteroidal-anti-inflammatory drugs (NSAIDs), like ibuprofen, to relieve pain symptoms, and hormonal medications to slow the progression of the endometriosis.  Hormonal medications can slow the growth of current endometriosis and prevent new areas of endometriosis from developing.  The most commonly used hormonal treatments are traditional birth control pills, progesterone, the Mirena IUD, and a class of medications called gonadotropin-releasing hormone (GnRH) agonists.  

The most commonly prescribed GnHR agonist is called Depo Lupron.  GnRH agonists temporarily decrease circulating estrogen levels by blocking ovarian estrogen production.  Consequently, the primary side effects of this medication class are similar to menopausal symptoms, and may include hot flushes, headaches, vaginal dryness, and temporarily absent menstrual periods.  These symptoms may be partially relieved by adding an additional oral progesterone medication to the treatment regimen.  GnRH agonists are typically used for 3-6 months, but fortunately, the symptom relief usually extends well beyond this treatment period.  Menopause-like side effects are only temporary and limited to the treatment duration.

Surgery to diagnose and treat endometriosis is usually accomplished with laparoscopic surgery.   During laparoscopy the endometriosis lesions may be excised or burned, and a pathological diagnosis confirmed.  Following surgical treatment, patients who are not immediately trying to conceive will benefit from a form of hormonal medication to keep endometriosis suppressed.    In patients with severe cases of endometriosis and those who have completed childbearing, hysterectomy with removal of one or both ovaries may be the best treatment option.  

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