Download Endometriosis - Gina Nelson MD, Obstetrics and Gynecology

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Endometriosis
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What is endometriosis?
Endometriosis is a condition in which the type of tissue that forms the lining of the uterus (the endometrium) is found
outside the uterus.
How common is endometriosis?
Endometriosis occurs in about one in ten women of reproductive age. It is most often diagnosed in women in their 30s and
40s.
Where does endometriosis occur?
Areas of endometrial tissue (often called implants) most often occur in the following places:
UÊ Peritoneum
UÊ Ovaries
UÊ Fallopian tubes
UÊ "ÕÌiÀÊÃÕÀv>ViÃʜvÊ̅iÊÕÌiÀÕÃ]Êbladder]Êureters]ʈ˜ÌiÃ̈˜iÃ]Ê>˜`Êrectum
UÊ Õ‡`i‡Ã>Vʭ̅iÊë>ViÊLi…ˆ˜`Ê̅iÊÕÌiÀÕî
How does endometriosis cause problems?
Endometriosis implants respond to changes in estrogen]Ê >Ê vi“>iÊ hormone. The implants may grow and bleed like
̅iÊÕÌiÀˆ˜iʏˆ˜ˆ˜}Ê`œiÃÊ`ÕÀˆ˜}Ê̅iʓi˜ÃÌÀÕ>ÊVÞVi°Ê-ÕÀÀœÕ˜`ˆ˜}Ê̈ÃÃÕiÊV>˜ÊLiVœ“iʈÀÀˆÌ>Ìi`]ʈ˜y>“i`]Ê>˜`ÊÃܜi˜°Ê/…iÊ
LÀi>Ž`œÜ˜Ê >˜`Ê Lii`ˆ˜}Ê œvÊ Ì…ˆÃÊ ÌˆÃÃÕiÊ i>V…Ê “œ˜Ì…Ê >ÃœÊ V>˜Ê V>ÕÃiÊ ÃV>ÀÊ ÌˆÃÃÕi]Ê V>i`Ê adhesions]Ê ÌœÊ vœÀ“°Ê -œ“ï“iÃÊ
>`…iȜ˜ÃÊV>˜ÊV>ÕÃiʜÀ}>˜ÃÊ̜ÊÃ̈VŽÊ̜}i̅iÀ°Ê/…iÊLii`ˆ˜}]Êinflammation]Ê>˜`ÊÃV>ÀÀˆ˜}ÊV>˜ÊV>ÕÃiÊ«>ˆ˜]ÊiëiVˆ>ÞÊLivœÀiÊ
and during menstruation.
What is the link between infertility and endometriosis?
Almost 40% of women with infertilityʅ>ÛiÊi˜`œ“iÌÀˆœÃˆÃ°Ê˜y>““>̈œ˜ÊvÀœ“Êi˜`œ“iÌÀˆœÃˆÃʓ>ÞÊ`>“>}iÊ̅iÊëiÀ“ÊœÀÊi}}Ê
œÀʈ˜ÌiÀviÀiÊ܈̅Ê̅iˆÀʓœÛi“i˜ÌÊ̅ÀœÕ}…Ê̅iÊv>œ«ˆ>˜ÊÌÕLiÃÊ>˜`ÊÕÌiÀÕðʘÊÃiÛiÀiÊV>ÃiÃʜvÊi˜`œ“iÌÀˆœÃˆÃ]Ê̅iÊv>œ«ˆ>˜ÊÌÕLiÃÊ
may be blocked by adhesions or scar tissue.
What are the symptoms of endometriosis?
/…iÊ “œÃÌÊ Vœ““œ˜Ê Ãޓ«Ìœ“Ê œvÊ i˜`œ“iÌÀˆœÃˆÃÊ ˆÃÊ V…Àœ˜ˆVÊ ­œ˜}‡ÌiÀ“®Ê «iÛˆVÊ «>ˆ˜]Ê iëiVˆ>ÞÊ ÕÃÌÊ LivœÀiÊ >˜`Ê `ÕÀˆ˜}Ê Ì…iÊ
“i˜ÃÌÀÕ>Ê«iÀˆœ`°Ê*>ˆ˜Ê>ÃœÊ“>ÞʜVVÕÀÊ`ÕÀˆ˜}ÊÃiÝ°ÊvÊi˜`œ“iÌÀˆœÃˆÃʈÃÊ«ÀiÃi˜Ìʜ˜Ê̅iÊLœÜi]Ê«>ˆ˜Ê`ÕÀˆ˜}ÊLœÜiÊ“œÛi“i˜ÌÃÊ
V>˜Ê œVVÕÀ°Ê vÊ ˆÌÊ >vviVÌÃÊ Ì…iÊ L>``iÀ]Ê «>ˆ˜Ê “>ÞÊ LiÊ viÌÊ `ÕÀˆ˜}Ê ÕÀˆ˜>̈œ˜°Ê i>ÛÞÊ “i˜ÃÌÀÕ>Ê Lii`ˆ˜}Ê ˆÃÊ >˜œÌ…iÀÊ Ãޓ«Ìœ“Ê œvÊ
endometriosis. Many women with endometriosis have no symptoms.
How is endometriosis diagnosed?
ʅi>Ì…ÊV>ÀiÊ«ÀœÛˆ`iÀÊwÀÃÌʓ>ÞÊ`œÊ>Ê«…ÞÈV>ÊiÝ>“]ʈ˜VÕ`ˆ˜}Ê>Êpelvic exam°ÊœÜiÛiÀ]Ê̅iʜ˜ÞÊÜ>ÞÊ̜ÊÌiÊvœÀÊÃÕÀiÊ̅>ÌÊޜÕÊ
have endometriosis is through a surgical procedure called laparoscopy. Sometimes a small amount of tissue is removed
during the procedure. This is called a biopsy.
How is endometriosis treated?
/Ài>̓i˜ÌÊvœÀÊi˜`œ“iÌÀˆœÃˆÃÊ`i«i˜`Ãʜ˜Ê̅iÊiÝÌi˜ÌʜvÊ̅iÊ`ˆÃi>Ãi]ÊޜÕÀÊÃޓ«Ìœ“Ã]Ê>˜`Ê܅i̅iÀÊޜÕÊÜ>˜ÌÊ̜ʅ>ÛiÊV…ˆ`Ài˜°Ê
˜`œ“iÌÀˆœÃˆÃʓ>ÞÊLiÊÌÀi>Ìi`Ê܈̅ʓi`ˆV>̈œ˜]ÊÃÕÀ}iÀÞ]ʜÀÊLœÌ…°Ê7…i˜Ê«>ˆ˜ÊˆÃÊ̅iÊ«Àˆ“>ÀÞÊ«ÀœLi“]ʓi`ˆV>̈œ˜ÊÕÃÕ>ÞʈÃÊ
tried first.
What medications are used to treat endometriosis?
i`ˆV>̈œ˜ÃÊ Ì…>ÌÊ >ÀiÊ ÕÃi`Ê ÌœÊ ÌÀi>ÌÊ i˜`œ“iÌÀˆœÃˆÃÊ ˆ˜VÕ`iÊ «>ˆ˜Ê ÀiˆiÛiÀÃ]Ê ÃÕV…Ê >ÃÊ ˜œ˜ÃÌiÀœˆ`>Ê >˜Ìˆ‡ˆ˜y>““>̜ÀÞÊ `ÀÕ}ÃÊ
­ -î]Ê>˜`ʅœÀ“œ˜>Ê“i`ˆV>̈œ˜Ã]ʈ˜VÕ`ˆ˜}ÊLˆÀ̅ÊVœ˜ÌÀœÊ«ˆÃ]Êprogestin‡œ˜Þʓi`ˆV>̈œ˜Ã]Ê>˜` gonadotropin-releasing
hormone agonists°ÊœÀ“œ˜>Ê“i`ˆV>̈œ˜Ãʅi«ÊϜÜÊ̅iÊ}ÀœÜ̅ʜvÊ̅iÊi˜`œ“iÌÀˆ>Ê̈ÃÃÕiÊ>˜`ʓ>Þʎii«Ê˜iÜÊ>`…iȜ˜ÃÊvÀœ“Ê
forming. These drugs typically do not get rid of endometriosis tissue that is already there.
How can surgery treat endometriosis?
-ÕÀ}iÀÞÊV>˜ÊLiÊ`œ˜iÊ̜ÊÀiˆiÛiÊ«>ˆ˜Ê>˜`ʈ“«ÀœÛiÊviÀ̈ˆÌÞ°ÊÕÀˆ˜}ÊÃÕÀ}iÀÞ]Êi˜`œ“iÌÀˆœÃˆÃʈ“«>˜ÌÃÊV>˜ÊLiÊÀi“œÛi`°Ê
Does surgery cure endometriosis?
vÌiÀÊ ÃÕÀ}iÀÞ]Ê “œÃÌÊ Üœ“i˜Ê …>ÛiÊ ÀiˆivÊ vÀœ“Ê «>ˆ˜°Ê œÜiÛiÀ]Ê >LœÕÌÊ {äqnä¯Ê œvÊ Üœ“i˜Ê …>ÛiÊ «>ˆ˜Ê >}>ˆ˜Ê ܈̅ˆ˜Ê ÓÊ Þi>ÀÃÊ œvÊ
ÃÕÀ}iÀÞ°Ê /…iÊ “œÀiÊ ÃiÛiÀiÊ Ì…iÊ `ˆÃi>Ãi]Ê Ì…iÊ “œÀiÊ ˆŽiÞÊ ˆÌÊ ˆÃÊ ÌœÊ ÀiÌÕÀ˜°Ê />Žˆ˜}Ê LˆÀÌ…Ê Vœ˜ÌÀœÊ «ˆÃÊ œÀÊ œÌ…iÀÊ “i`ˆV>̈œ˜ÃÊ >vÌiÀÊ
…>ۈ˜}ÊÃÕÀ}iÀÞʓ>Þʅi«ÊiÝÌi˜`Ê̅iÊ«>ˆ˜‡vÀiiÊ«iÀˆœ`°Ê
What if I still have severe pain that does not go away even after I have had treatment?
vÊ«>ˆ˜ÊˆÃÊÃiÛiÀiÊ>˜`Ê`œiÃʘœÌÊ}œÊ>Ü>ÞÊ>vÌiÀÊÌÀi>̓i˜Ì]Ê>Êhysterectomy may be a “last resort” option. Endometriosis is less
ˆŽiÞÊ̜ÊVœ“iÊL>VŽÊˆvÊޜÕÀʜÛ>ÀˆiÃÊ>ÃœÊ>ÀiÊÀi“œÛi`°ÊvÊޜÕʎii«ÊޜÕÀʜÛ>ÀˆiÃ]Êi˜`œ“iÌÀˆœÃˆÃʈÃʏiÃÃʏˆŽiÞÊ̜ÊVœ“iÊL>VŽÊˆvÊ
endometriosis implants are removed at the same time you have the hysterectomy.
There is a small chance that pain will come back even if your uterus and ovaries are removed. This may be due to
endometriosis that was not visible or could not be removed at the time of surgery.
Glossary
Adhesions: Scarring that binds together the surfaces of tissues.
Biopsy: A minor surgical procedure to remove a small piece of tissue that is then examined under a microscope in a
laboratory.
Bladder: A muscular organ in which urine is stored.
Endometriosis:ÊÊVœ˜`ˆÌˆœ˜Êˆ˜Ê܅ˆV…Ê̈ÃÃÕiÊȓˆ>ÀÊ̜Ê̅>ÌʘœÀ“>Þʏˆ˜ˆ˜}Ê̅iÊÕÌiÀÕÃʈÃÊvœÕ˜`ʜÕÌÈ`iʜvÊ̅iÊÕÌiÀÕÃ]ÊÕÃÕ>ÞÊ
œ˜Ê̅iʜÛ>ÀˆiÃ]Êv>œ«ˆ>˜ÊÌÕLiÃ]Ê>˜`ʜ̅iÀÊ«iÛˆVÊÃÌÀÕVÌÕÀið
Endometrium: The lining of the uterus.
Estrogen: A female hormone produced in the ovaries.
Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.
Gonadotropin-Releasing Hormone Agonists: Medical therapy used to block the effects of certain hormones.
Hormone: A substance produced by the body to control the functions of various organs.
Hysterectomy: Removal of the uterus.
Infertility: ÊVœ˜`ˆÌˆœ˜Êˆ˜Ê܅ˆV…Ê>ÊVœÕ«iʅ>ÃÊLii˜Ê՘>LiÊ̜Ê}iÌÊ«Ài}˜>˜ÌÊ>vÌiÀÊ£Óʓœ˜Ì…ÃÊ܈̅œÕÌÊ̅iÊÕÃiʜvÊ>˜ÞÊvœÀ“ÊœvÊ
birth control.
Inflammation: *>ˆ˜]ÊÃÜiˆ˜}]ÊÀi`˜iÃÃ]Ê>˜`ʈÀÀˆÌ>̈œ˜ÊœvÊ̈ÃÃÕiÃʈ˜Ê̅iÊLœ`Þ°
Laparoscopy: A surgical procedure in which an instrument called a laparoscope is inserted into the pelvic cavity through
Ó>Êˆ˜VˆÃˆœ˜Ã°Ê/…iʏ>«>ÀœÃVœ«iʈÃÊÕÃi`Ê̜ÊۈiÜÊ̅iÊ«iÛˆVʜÀ}>˜Ã°Ê"̅iÀʈ˜ÃÌÀՓi˜ÌÃÊV>˜ÊLiÊÕÃi`Ê܈̅ʈÌÊ̜ʫiÀvœÀ“ÊÃÕÀ}iÀÞ°
Ovaries: /ܜÊ}>˜`Ã]ʏœV>Ìi`ʜ˜ÊiˆÌ…iÀÊÈ`iʜvÊ̅iÊÕÌiÀÕÃ]Ê̅>ÌÊVœ˜Ì>ˆ˜Ê̅iÊi}}ÃÊÀii>Ãi`Ê>ÌʜÛՏ>̈œ˜Ê>˜`Ê̅>ÌÊ«Àœ`ÕViÊ
hormones.
Pelvic Exam: A physical examination of a woman’s reproductive organs.
Peritoneum: The membrane that lines the abdominal cavity and surrounds the internal organs.
Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.
Rectum: The last part of the digestive tract.
Ureters:ÊÊ«>ˆÀʜvÊÌÕLiÃ]Êi>V…ʏi>`ˆ˜}ÊvÀœ“Êœ˜iʜvÊ̅iʎˆ`˜iÞÃÊ̜Ê̅iÊL>``iÀ°Ê
Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.
If you have further questions, contact your obstetrician–gynecologist.
+ä£Î\ÊDesigned as an aid to patients, this document sets forth current information and opinions related to women’s health. The information does not dictate an exclusive course
of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations, taking into account the needs of the individual
patient, resources, and limitations unique to the institution or type of practice, may be appropriate.
Copyright October 2012 by the American College of Obstetricians and Gynecologists.