Endometriosis, fertility, and treatment

Question: What is endometriosis? What are its symptoms?

Answer: Endometriosis is the implantation of endometrial cells outside the uterus. These are the cells that line the uterus, and they are shed every month during a woman's period.

In some women, endometrial cells spill through the fallopian tubes and implant in the pelvis, on the uterus, ovaries, fallopian tubes, bladder, and bowel. There are plenty of theories about exactly how this happens, but no one knows for sure.

The endometrial implants are active with the menstrual cycle and sensitive to the female hormones that control it. As a result, women with endometriosis may experience very painful periods, heavy bleeding, painful intercourse, and possible infertility. They may also experience chronic pelvic pain that is not associated with the cycles. Still, some women with endometriosis have no symptoms.

The condition appears mostly in women in their mid-20s and 30s. Diagnosis would most likely start with an exam by your OB/GYN, who may order a pelvic ultrasound to help evaluate the symptoms.

First-line treatment for endometriosis usually is birth control pills. For some women who do not respond to oral contraceptives, or who are trying to conceive, laparoscopic surgery may be necessary.

Many women believe endometriosis will prevent them from having children. This is a myth. Although some do experience infertility, about 70 percent of women with endometriosis do not.

There are no preventive measures to avoid the condition. A woman can manage the symptoms only if she is diagnosed. - Dr. Diane Robinson

Clearing the Record

Last week's "Q&A" gave the wrong affiliation for Robinson. She is a gynecologist at Nazareth Hospital.

It also gave incorrect information about cancer risk after menopause. Cervical cancer risk generally rises until menopause and is lower in the postmenopausal period. But there is an increased risk of breast, ovarian, and endometrial/uterine cancer after menopause.