Endometriosis is a chronic inflammatory disorder in which endometrial tissue (the tissue lining the uterus) grows outside the uterus, usually the pelvic cavity. In extreme cases, endometriosis can show up in other places in the body as well.
This condition affects at least 1 in 10 women in the United States. Among women with infertility, the rate is much higher, around 40-50%. Endometriosis frequently goes undiagnosed, and women may suffer for years with painful periods, pelvic pain or infertility. For women with infertility, timely diagnosis and treatment of endometriosis is important since those with untreated endometriosis have only a 4-5% chance of achieving pregnancy each cycle.
While most women with endometriosis have a mild form of the condition (Stage I or II), some have more severe forms (Stage III or IV). Advanced stages cause more scar tissue, ovarian cysts and inflammation, therefore having a greater negative effect on fertility.
What causes endometriosis?
Although the causes of endometriosis are still not fully understood, the leading theories include:
- Retrograde menstruation, in which menstrual blood flows into the pelvic cavity, allowing endometrial cells to attach to pelvic tissues, growing and bleeding with each cycle
- Endometrial cell transport, in which the lymphatic system or blood vessels bring endometrial cells to areas outside the uterus
- Immune system disorder, in which the body is unable to destroy endometrial tissue outside the uterus
It is well known that genetics can plan an important role in the development of endometriosis, as women who have a sister or mother with this disorder have a 7-10 times higher risk of developing endometriosis than women who do not have a family history of the disease.
What are the symptoms of endometriosis?
Endometriosis causes chronic inflammation in the pelvic cavity, which means many women with the condition experience:
- Painful periods
- Heavy bleeding with periods
- Pain during ovulation
- Pain with intercourse
- Painful bowel movements, particularly during periods
Women may also experience bloating before or during periods, as well as nausea, vomiting or diarrhea. The severity of pain is not necessarily an accurate indicator of how extensive the disease is when diagnosed with laparoscopy.
How is endometriosis diagnosed?
While physicians may suspect endometriosis if a woman experiences significant pain, some women with this condition have little or no pain with periods, making the diagnosis more difficult. With more advanced stages of the disease, endometriosis cysts in the ovaries (called endometriomas) are sometimes seen on ultrasound. Ultimately, an official diagnosis can only be made by a diagnostic laparoscopy with tissue biopsy.
How is endometriosis treated?
Both medical and surgical treatments exist for endometriosis.
Medical treatments include pain killers (such as ibuprofen or narcotics) and hormonal suppressive treatments (such as birth control pills). While such treatments can help improve symptoms in some cases, they do not treat or cure the condition. These treatments could be compared to pouring water on a fire – while the fire may go out momentarily, the embers continue to smolder and the fire can reignite later. In a similar way, when pain medications and hormonal suppressive treatments are stopped, the disease can flare up once more.
Laparoscopic surgery is the best option for treating endometriosis, both for alleviating pain and improving fertility. There are two ways endometriosis can be treated surgically, with either fulguration or excision.
During a fulguration procedure, endometrial tissue is burned away with a cautery device. This kind of treatment has significant downsides, however, the most important being the likelihood that endometriosis is not fully treated by cauterization, meaning that a woman’s symptoms can return sooner.
Additionally, women who undergo fulguration of endometriosis have a 70-80% chance of the disease returning, even as early as six months after surgery. This often results in women having multiple surgeries to treat this condition, which can lead to more scar tissue.
In contrast, excision of endometriosis involves complete removal of the disease with a more advanced laparoscopic procedure, leading to significant improvements in pain and fertility and decreased risk of recurrence (just a 10-20% chance of endometriosis returning within 5 years after surgery). Excision is less commonly performed since few surgeons have the training or experience needed to perform laparoscopic excision.
At Veritas Fertility & Surgery, we care for many patients with endometriosis suffering with pain and infertility. Dr. Puthoff and Dr. Yeung are surgical specialists who exclusively perform laparoscopic excision surgery for endometriosis, never advocating for less effective treatments such as fulguration. With his training in advanced reproductive surgery, Dr. Puthoff utilizes high-definition near-contact laparoscopy to complete an in-depth surgical evaluation, identifying all lesions of endometriosis, including atypical lesions. During this surgery, Dr. Puthoff uses a CO2 laser to completely excise all endometriosis lesions, and pelvic tissues are reconstructed to allow for rapid healing. This approach is highly effective for pain resolution and fertility improvement and we feel strongly that this is the best surgical care for patients with endometriosis.