Endometriosis

Endometriosis is a chronic gynecological condition affecting approximately 10% of reproductive-aged women, characterized by the presence of endometrial-like tissue outside the uterine cavity. This tissue can implant on various pelvic organs including the ovaries, fallopian tubes, pelvic ligaments, and bowel, where it responds to hormonal changes just like the normal endometrium. During menstruation, this displaced tissue bleeds but has no way to exit the body, leading to inflammation, scarring, and adhesion formation.

The most common symptom of endometriosis is pelvic pain, which typically worsens during menstruation but may be present throughout the menstrual cycle. Other symptoms include heavy or irregular menstrual bleeding, pain during sexual intercourse, painful bowel movements or urination during periods, and infertility. Some women may experience fatigue, nausea, and bloating. The severity of symptoms doesn't always correlate with the extent of the disease, as some women with minimal endometriosis experience severe pain while others with extensive disease have mild symptoms.

Diagnosis of endometriosis can be challenging as symptoms often overlap with other conditions. While imaging studies such as ultrasound or MRI can detect endometriomas (ovarian cysts filled with endometrial tissue), definitive diagnosis typically requires laparoscopic surgery with tissue biopsy. However, many physicians now make a presumptive diagnosis based on symptoms and physical examination findings, especially in young women where surgical intervention may be deferred.

Treatment for endometriosis is individualized based on symptom severity, extent of disease, age, and desire for future fertility. Options include pain management with NSAIDs, hormonal therapies such as birth control pills or GnRH agonists to suppress ovulation, and surgical interventions ranging from conservative removal of implants to hysterectomy in severe cases. For women with infertility related to endometriosis, fertility treatments may be necessary. Our comprehensive approach addresses both symptom management and fertility preservation when appropriate.