Endometriosis is one of the most common gynecological disorders. Although it occurs more often in women in their 20s and 30s, endometriosis can affect women at any time during the childbearing years. It is estimated that it affects approximately 10-20 percent of premenopausal women in the United States.

What is Endometriosis?
Endometriosis occurs when endometrial tissue, the tissue that lines the uterus and is shed during menstruation, grows outside of the uterus and implants on the ovaries, fallopian tubes, the ligaments that support the uterus and other organs in the pelvic cavity. Other possible sites include the bladder, bowel, and vagina. Endometriosis can occur in other places in the body as well.

In some cases pelvic scarring and adhesions occur. This scarring may prevent a woman from becoming pregnant. Areas of endometriosis respond to the hormones of the menstrual cycle. The endometrial tissue bleeds during menstruation each month as if they were in the uterus. When this occurs it irritates the tissue around it and causes your body to form scar tissue around the endometrial tissue.

The development of scar tissue in the pelvic cavity causes women with endometriosis to experience chronic pelvic pain. The amount of pain a woman experiences is NOT related to the extent of her endometrial growths. Some women with severe endometriosis experience no pain while others with minimal endometriosis experience severe pain.

What causes endometriosis?
The exact cause of endometriosis is unclear but there are several theories. One theory is called retrograde menstrual flow. This is when the menstrual flow flows from the uterus backwards and out through the fallopian tubes causing endometrial tissue to implant on pelvic cavity organs such as the ovaries, bladder and bowel. Endometriosis can lead to chronic pelvic pain, pain during sexual intercourse, painful menstrual discomfort and infertility.

How is endometriosis diagnosed?
It is often diagnosed through laparoscopy. This is a minor surgical procedure in which a camera is inserted into the abdomen and any visible signs of endometriosis are biopsied. Often however, a patient’s symptoms, history, and clinical work up are sufficient to make a clinical diagnosis and begin treatment.

How is endometriosis treated?
Physicians can remove endometrial lesions surgically and use a medicine called Depo-Lupron to treat any remaining lesions. Depo- Lupron is an injection that you will receive either once a month or once every 3 months for a 6 month treatment period. It lowers the levels of female hormones and interrupts the menstrual cycle, which decreases the growth of endometrial tissue.

By lowering the female hormones it creates menopause-like side effects such as hot flashes and bone loss.

In order to manage this side effect “add-back” therapy may be prescribed. “Add-back” therapy affects hormonal levels and reduces the menopause-like symptoms and reduces the menopause-like symptoms of bone loss and hot flashes. The therapy is a pill you would take each day.

If after the 6 months your pain returns, your physician may prescribe Depo-Lupron plus add-back for another 6 months. Definitive therapy would require removal of the uterus and ovaries.