Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The most common symptom of endometriosis is pain in the lower abdomen or
pelvis, or the lower back, mainly during menstrual periods. The amount of pain a
woman feels does not depend on how much endometriosis she has. Some women have
no pain, even though their disease affects large areas. Other women with
endometriosis have severe pain even though they have only a few small growths.
Symptoms of endometriosis can include:
Very painful menstrual cramps; pain may get worse over time
Chronic pain in the lower back and pelvis
Pain during or after sex
Intestinal pain
Painful bowel movements or painful urination during menstrual periods
Spotting or bleeding between menstrual periods
Infertility or not being able to get pregnant
Fatigue
Diarrhea, constipation, bloating, or nausea, especially during menstrual
periods
Recent research shows a link between other health problems in women with
endometriosis and their families. Some of these include:
Learn more about autoimmune diseases, chronic fatigue syndrome, and
fibromyalgia.
Allergies, asthma, and chemical sensitivities
Autoimmune diseases, in which the body's system that fights illness attacks
itself instead. These can include hypothyroidism, multiple sclerosis, and lupus.
Chronic fatigue syndrome (CFS) and fibromyalgia
Being more likely to get infections and mononucleosis (ma-no-nu-klee-OH-suhs)
Mitral valve prolapse, a condition in which one of the heart's valves does
not close as tightly as normal
Frequent yeast infections
Certain cancers, such as ovarian, breast, endocrine, kidney, thyroid,
brain, and colon cancers, and melanoma and non-Hodgkin's lymphoma
Endometriosis is a common disorder of the female reproductive organs and is the leading cause of chronic pelvic pain in women.
In women who have endometriosis, tissue similar to the lining of the uterus (endometrium)
develops in other areas of the body, most commonly within the pelvic area or the abdominal cavity. The endometrial tissue may attach itself to the ovaries, the outside of the uterus, the intestines, or other abdominal organs.
Rarely, endometriosis occurs outside the abdominal cavity, such as in the brain or lungs. Endometriosis may also develop in surgical scars following surgery on pelvic organs. The term
"implant" is used to refer to a specific area of endometriosis in a certain tissue.
It is estimated that over 5.5 million American women will experience problems with endometriosis, but an exact determination of the number of women affected is difficult, since many women may have the condition and do not have symptoms. In other
situations, women may also have symptoms that could be attributed to endometriosis, but never undergo formal diagnostic studies to confirm that the condition is present. Most women who are diagnosed with endometriosis are between 25 and 35 years of age. Women may have symptoms for years before a definitive diagnosis is made.
During pelvic surgery for any gynecologic condition, about 1% of women are
observed to have endometriosis. The percentages are much higher in young women
undergoing laparoscopic surgery for pelvic pain and in women undergoing
laparoscopic surgery to evaluate infertility.
Endometriosis is more common in Caucasian women than in African American or Asian women. Studies have also reported that endometriosis tends to occur most commonly in taller, thin women with a low
body mass index (BMI).
Women with first degree relatives who have endometriosis are also more
likely to develop the condition, suggesting that the genes a woman inherits
from her parents can sometimes predispose her to develop endometriosis.
Endometriosis Causes
In reviewing the causes of endometriosis, it is important to first understand the regular
menstrual cycle and how hormones in
the body affect the menstrual cycle and the uterus itself.
The endometrium is the inner layer of uterine tissue that is shed during
menstruation.
The thickness of the endometrial layer is related to the egg-producing (ovulatory) cycle and the hormonal levels that regulate this cycle.
The endometrium is at its thinnest immediately following menstruation and
thickens during the first two weeks of the menstrual cyle.
Once the release of the egg (ovulation) has occurred, the endometrial tissue becomes rich in glands.
The whole process prepares the uterus for the attachment of a fertilized egg. If implantation does not occur, the endometrial layer is shed, and bleeding, known as menstruation (a period), begins.
Endometriosis occurs when growth of this endometrial tissue develops outside the uterus. This growth usually occurs within the pelvic region on the ovaries and other pelvic structures, such as the bladder and colon, but it may also occur within the abdominal cavity and as far away as the lungs, arms, legs,
and even the brain.
Hormone levels affect the course of endometriosis.
Because the levels of hormones that affect endometriosis are related to the menstrual cycle, it is uncommon for women to develop endometriosis before menstrual cycles begin or after menopause.
Endometriosis is also noted to be less severe when hormone levels are more constant. These conditions include pregnancy and other times when there is lack of a menstrual cycle.
Several theories may explain how endometriosis develops as follows:
One popular theory focuses on a potential process known as retrograde menstruation. Retrograde menstruation can be thought of as backward flow during a period.
This is also known as the implantation theory.
Menstrual products, including endometrial cells, may escape into the body through the
Fallopian tubes and are deposited onto internal structures such as the ovaries, the bladder, and portions of the large intestine.
These cells, once deposited, are able to respond to progesterone and estrogen in much the same way as normal endometrial tissue within the uterus.
The growth of this misplaced endometrial tissue can cause distortion of abdominal and pelvic structures and causes the development of adhesions
(scars) within the abdominal and pelvic cavities.
Endometrial tissue can be found on the outside of the uterus, the space between the uterus and the colon known as the posterior cul-de-sac, the supporting ligaments of the uterus, the ovaries, the urinary bladder, and other internal structures.
However, it is unlikely that retrograde menstruation alone is the cause of endometriosis, since retrograde menstruation has been shown to occur commonly in many women. Other causative factors may play roles in determining which women develop endometriosis.
Another theory, also known as coelomic metaplasia, suggests that a layer of cells surrounding the ovaries and other cells within the pelvic region are able to change into endometrial cells that are much the same as normal endometrial tissue. It is not certain what causes this development, but evidence suggests irritation by retrograde menstrual flow or infections may be the culprit.
Transfer of endometrial tissues by a surgical procedure might be the cause for endometriosis implants seen in surgical scars (for example,
episiotomy or
Cesarean section scars).
The rare cases of endometriosis that develop in the brain or other distant organs are likely due to the spread of endometrial cells via the bloodstream or lymphatic system.
Some studies have shown alternations in the immune response in women with endometriosis, suggesting that
abnormalities in the immune system may play a role in the development of the condition.
Laparoscopy is a way of performing a surgery. Instead of making a large incision (or cut) for certain operations, surgeons make tiny incisions and insert tiny instruments and a camera into a site, such as into the abdomen, to view the internal organs and repair or remove tissue.
Laparoscopy was first performed in animals in the early 1900s, and the Swedish surgeon Jacobaeus coined the term laparoscopy (laparothorakoskopie) in 1901. However, better techniques were not developed until the 1960s, when laparoscopy was accepted as a safe and valuable procedure.
Early on, the technique of laparoscopy, sometimes referred to as keyhole surgery, was used only to diagnose conditions. Then doctors began to perform surgeries such as tubal sterilization in women using laparoscopy. The technique has evolved so much that operations that once required doctors to make a very large incision, such as to remove the gallbladder, can now all be ...
Endometriosis, the presence of endometriumlike glands and stroma outside the uterus, is a common, poorly understood, and extremely debilitating benign gynecological condition.
