Endometriosis

From Encyclopedia of Sex and Sexuality

A small number of women—possibly 1 percent—suffer from a condition in which tissue resembling endometrium, the mucus-like internal layer of the uterus, which is sloughed off during menstruation, is found outside the uterus, principally in other parts of the pelvic cavity. (Tissues that occur in places other than where they are normally found are referred to as “ectopic.”) Ectopic tissue and lesions common to endometriosis can be found in many locations — the ovaries, uterine walls or ligaments, vagina, appendix, vulva, and cervix. In rare cases the lesions have been found in the bladder, intestines, and lungs. The condition can lead to pain and abnormalities in menstruation, intercourse, and other sexual functions.

The disease has been diagnosed with increasing frequency during the past three decades. Its exact prevalence is difficult to fix because it has been found that many women have the disease without clinical symptoms and are unaware of it. Endometriosis is most commonly found in women in their thirties, among those of higher social class who have had few children or have deferred having children. In the United States it is more commonly found among Caucasian women, but with increased screening and improved diagnostic procedures, the disease has been found increasingly among African-American women and those of Japanese origin.

The symptoms of endometriosis include:

• Dysmenorrhea (painful menstruation), starting prior to the woman’s period and persisting until it is over. The cause of the pain is unknown but is probably related to secretory changes in the ectopic endometrial tissue with subsequent bleeding;
• Dyspareunia (painful intercourse), which can occur when endometrial lesions appear near uterine ligaments or the vagina;
• Premenstrual staining and a reduced volume of menstrual bleeding. In cases of extreme involvement of the ovaries, there may be abnormal menstrual periods;
• Bowel obstruction and blood in stools and in urine, which can be caused by endometrial lesions outside the abdominal cavity.

Infertility is often associated with endometriosis. It is estimated that 15 to 20 percent of women afflicted with infertility suffer from some degree of endometriosis. While women who have the disease may conceive normally, the probability is low and is lower still if the disease is severe; endometrial lesions can result in scarring around the ovaries or fallopian tubes and interfere with ovulation.

Pregnancy has been found to be the most curative treatment for endometriosis. Where it is not possible because of a patient’s age, infertility, or disinterest in motherhood, hormonal treatment aiming at producing a pseudopregnancy or pseudomenopause is often recommended. Introduction of a state of pseudopregnancy is most effective for the treatment of small lesions and is usually achieved by administration of steroid preparations, androgens, estrogens, and any of the currently used oral contraceptives. Surgery is usually recommended only when symptoms are severe and have not been relieved by other means or when the patient is trying to become pregnant. A radical surgical approach is usual only if symptoms are extensive and the woman has completed her family and is near menopause.