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Endometriosis is a relatively common condition affecting 5-10% of women in the general population causing pelvic pain, severe cramping with menses, painful urination, painful and possibly bloody bowel movements, pain during intercourse (dyspareunia), and infertility. It is estimated that endometriosis is present in 38-50% of all infertile  women, and in 70-80% of women with chronic pelvic pain.
Every month the lining of the uterus, the endometrium, thickens and becomes more vascular in order to support the implantation of an embryo, and fetal development. The cells lining the uterus (endometrium) have the capacity to grow and divide rapidly to accommodate this development. The hormones progesterone and estrogen function as “fuel” stimulating normal endometrial development.
Endometriosis occurs when endometrial cells enter the pelvic cavity and attach to the reproductive and other organs. In fact, endometrial cells can enter the bloodstream or the lymphatic system and implants have been reported in distant areas such as the lungs and brain.
There are various theories to explain the cause(s) of endometriosis and most agree that there is a genetic component. The incidence of endometriosis is higher in daughters of mothers who had the disease. The most commonly accepted theory is that menstrual blood “back flows” into the pelvic cavity when the endometrium “breaks down” at the end of the ovulatory cycle. This blood is very rich in endometrial cells.
Endometriosis can cause damage and blockage of the fallopian tubes, and it can attach to the ovaries and other reproductive organs. Because endometriosis is “foreign” to the pelvic cavity, the body can mount an immunologic attack to try and destroy it, thus creating an inflammatory environment in the pelvis.
Endometrial cells need estrogen to support their growth and survival. Therefore, the most common medical treatment for endometriosis is leuprolide acetate (Lupron®). Lupron® lowers estrogen levels by competing with binding sites at the hypothalamus. Lupron also inhibits the production of FSH and LH.
Endometrial implants can be removed surgically by laparoscopy. Since this surgery often involves delicate reproductive organs, such as the tubes, it should be performed by a skilled fertility specialist, reproductive surgeon. Members of the Society of Reproductive Surgeons (SRS) usually have extensive experience in this type of surgery. These specialists have years of advanced training in microsurgical techniques. It is very important that the organs not be “damaged” and that scar tissue is kept to a minimum.
Our reproductive surgeons, fertility specialists are board certified in reproductive endocrinology and infertility and have extensive surgical experience. Oftentimes, they will treat conditions, such as endometriosis, during diagnostic laparoscopy.
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