Endometriosis is a chronic gynecological condition in which cells from uterine lining are found outside uterus (mostly in the abdomen, but also in other tissues and organs). As these cells are sensitive to hormonal changes, even when in abdomen, they function in the same way as if they were in the uterus – they grow and bleed which can cause chronic pains and scarring of the tissue. The causes of endometriosis are still unknown. There are many theories of their etiology, but commonly most accepted theory is the one of retrograde menstruation – during the period menstrual blood not only flows out, but flows back through Fallopian tubes into the abdominal cavity.
It is believed that about 10-15% of all women between the ages of 16 and 40, suffer from endometriosis. Most common symptoms are painful periods, painful ovulation, painful intercourse, chronic pelvic pain and pain with urination and bowel movement. Symptoms also include irregular, excessive and prolonged bleeding and infertility.
Besides damaging the oocyte quality, it is assumed that endometriosis causes scars and adhaesions that can damage and block the Fallopian tubes so there is a physical obstruction to conception.
If there are endometrial cysts on ovaries, a gynecologist can palpate or see them with an ultrasound. Elevated tumor marker, CA 125, additionally confirms suspected endometriosis. If no cysts are present and endometriosis is suspected, the only ways to confirm it, are MRI and laparoscopy. If cysts are small (<4 cm), no surgery is required, only more frequent check-ups. Irregular bleeding can be controlled by means of contraceptive pills. If cysts are larger, or severe symptoms occur, endometriosis is surgically treated, usually laparoscopically.
A disorder very similar to endometriosis, which was not properly recognized before the high resolution ultrasounds were introduced, is adenomyosis. Similar to endometriosis, during the period menstrual blood not only flows out but somehow ends up in muscle tissue of the uterus. This causes enlargement of the uterus, heavy periods and severe pain, and is associated with infertility. Adenomyosis is found in 10-15% of women, especially older than 40 years, and is diagnosed by ultrasound with color Doppler. Characteristic findings include thickening of one of the uterine walls, heavy Doppler flow through that wall, and small cysts in the muscle.