Endometriosis is an often very painful disorder. During a woman’s menstrual cycle, tissue similar to the tissue that lines the uterus — the endometrium — grows outside the uterus. Endometriosis most commonly involves the ovaries, fallopian tubes, and the tissue lining your pelvis. Rarely does endometrial tissue spread beyond pelvic organs.
With endometriosis, the endometrial-like tissue thickens, breaks down, and bleeds with each menstrual cycle. This tissue has no way to exit your body, so it becomes trapped. When endometriosis involves the ovaries, cysts may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other.
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What Causes Endometriosis And What Are The Symptoms?
The exact cause of endometriosis is not certain. Possible explanations include:
Retrograde menstruation. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
Transformation of peritoneal cells. In what’s known as the “induction theory,” experts propose that hormones or immune factors promote transformation of peritoneal cells — cells that line the inside of your abdomen — into endometrial-like cells.
Embryonic cell transformation. Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial-like cell implants during puberty.
Surgical scar implantation. After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
Endometrial cell transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
Immune system disorder. A problem with the immune system may make the body unable to recognize and destroy endometrial-like tissue that’s growing outside the uterus.
Several factors place you at greater risk of developing endometriosis, such as:
- Never giving birth
- Starting your period at an early age
- Going through menopause at an older age
- Short menstrual cycles — for instance, less than 27 days
- Heavy menstrual periods that last longer than 7 days
- Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces
- Low body mass index
- One or more relatives (mother, aunt, or sister) with endometriosis
- Any medical condition that prevents the normal passage of menstrual flow out of the body
- Reproductive tract abnormalities
Endometriosis usually develops several years after the onset of menstruation. Signs and symptoms of endometriosis may temporarily improve with pregnancy and may go away completely with menopause, unless you’re taking estrogen.
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Can Endometriosis Affect Fertility?
The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant.
For pregnancy to occur, an egg must be released from an ovary, travel through the neighboring fallopian tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development. Endometriosis may obstruct the tube and keep the egg and sperm from uniting. But the condition also seems to affect fertility in less-direct ways, such as by damaging the sperm or egg.
Even so, many with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise those with endometriosis not to delay having children because the condition may worsen with time.
Fortunately, effective treatments are available for endometriosis such as minimally invasive surgery, to remove the tissue. The key to catching endometriosis early is not to ignore pelvic pain — and see your doctor if you experience pelvic pain.
What Is Minimally Invasive Surgery?
Minimally invasive surgery is a surgical approach in which small skin incisions (less than an inch in size) and specialized tools are used to perform the surgery. This includes specialized procedures such as hysteroscopy, laparoscopy, and even robotic assisted surgery. It differs from traditional surgery where larger incisions usually need to be made to perform the procedure.
- Hysteroscopy uses a small, narrow telescope (a hysteroscope) to allow for visualization of the inside of the uterine cavity without the need for any incisions. This is often performed when evaluating for abnormal uterine bleeding.
- Laparoscopy uses a small telescope through small abdominal skin incisions to evaluate the pelvic anatomy (uterus, ovaries, fallopian tubes). The laparoscope (camera) sends live pictures to a video monitor, which allows the surgeon to visualize the anatomy and perform complex surgeries with minimal trauma to the patient.
What common gynecologic conditions can be treated with minimally invasive surgery?
- Abnormal bleeding (heavy periods)
- Adenomyosis — a condition in which the inner lining of the uterus breaks through the uterine wall
- Fibroids — can be done to preserve fertility
- Ovarian cysts
- Pelvic pain
What are some benefits of minimally invasive surgery?
Minimally invasive techniques offer a safer and effective alternative to traditional open surgery by avoiding a large abdominal incision. With minimally invasive gynecologic surgery, our patients can have:
- Smaller incisions
- Less blood loss
- Less pain
- Shorter hospital stays — some procedures can be done on an outpatient basis
- Faster recovery and return to daily activities
- Reduced scar tissue
- Less risk of infection or other complications
For more than a century, UPMC Magee-Womens Hospital has provided high-quality medical care to women at all stages of life. UPMC Magee is long renowned for its services to women and babies, but also offers a wide range of care to men as well. Nearly 10,000 babies are born each year at Magee, and the hospital’s NICU is one of the largest in the country. The U.S. Department of Health and Human Services recognizes Magee as a National Center of Excellence in Women’s Health, and the Magee-Womens Research Institute is the largest research institute in the U.S. devoted exclusively to women’s health and reproductive biology.