What is Endometriosis?

Endometriosis  is a gynecological medical condition in which cells from the lining of the uterus (endometrium) appear and flourish outside the uterine cavity, most commonly on the ovaries. The uterine cavity is lined by endometrial cells, which are under the influence of female hormones. These endometrial-like cells in areas outside the uterus (endometriosis) are influenced by hormonal changes and respond in a way that is similar to the cells found inside the uterus. Symptoms often worsen with the menstrual cycle.

Endometriosis is typically seen during the reproductive years; it has been estimated that endometriosis occurs in roughly 5–10% of women. Symptoms may depend on the site of active endometriosis. Its main but not universal symptom is pelvic pain in various manifestations.

Endometriosis is one of the most common health problems that women and girls face.  This disease is common in women in their 30’s and 40’s but any female with a menstrual cycle can develop it.  The average age of someone that is diagnosed is 27 years old.  It is estimated that more than $22 billion is spent every year on treatment for Endometriosis.

Most women do not get diagnosed until they have problems becoming pregnant.  30-40% of women with Endometriosis are infertile.  Endometriosis is the third most common cause for infertility. 

Red Endometriosis

White Endometriosis (these are new growths)

Endometriosis on the ovary 

Signs and Symptoms of Endometriosis 

Pelvic Pain

• Dysmenorrhea – painful, sometimes disabling cramps during menses; pain may get worse over time (progressive pain), also lower back pains linked to the pelvis
• Chronic Pelvic Pain – typically accompanied by lower back pain or abdominal pain
• Dyspareunia – painful sex
• Dysuria – urinary urgency, frequency, and sometimes painful voiding

Infertility  
Constipation
Chronic Fatigue 

Complications of Endometriosis includes:

• Internal scarring
• Adhesions
• Pelvic cysts
• Chocolate cyst of ovaries
• Ruptured cyst
• Bowel obstruction
• Infertility

Generation of pain

The way endometriosis causes pain is the subject of much research. Because many women with endometriosis feel pain during or around their periods and may spill further menstrual flow into the pelvis with each menstruation, some researchers are trying to reduce menstrual events in patients with endometriosis.
Endometriosis lesions react to hormonal stimulation and may "bleed" at the time of menstruation. The blood accumulates locally, causes swelling, and triggers inflammatory responses with the activation of cytokines. It is thought that this process may cause pain.
Pain can also occur from adhesions (internal scar tissue) binding internal organs to each other, causing organ dislocation. Fallopian tubes, ovaries, the uterus, the bowels, and the bladder can be bound together in ways that are painful on a daily basis, not just during menstrual periods.
Also, endometriotic lesions can develop their own nerve supply, thereby creating a direct and two-way interaction between lesions and the central nervous system, potentially producing a variety of individual differences in pain that can, in some women, become independent of the disease itself.

Localization

Most endometriosis is found on these structures in the pelvic cavity:

• Ovaries (the most common site)
• Fallopian tubes
• The back of the uterus and the posterior cul-de-sac
• The front of the uterus and the anterior cul-de-sac
• Uterine ligaments such as the broad or round ligament of the uterus
• Pelvic and back wall
• Intestines, most commonly the rectosigmoid
• Urinary bladder and ureters

Bowel endometriosis affects approximately 10% of women with endometriosis, and can cause severe pain with bowel movements.
Endometriosis may spread to the cervix and vagina or to sites of a surgical abdominal incision.
Endometriosis may also present with skin lesions in cutaneous endometriosis.
Less commonly lesions can be found on the diaphragm. Diaphragmatic endometriosis is rare, almost always on the right hemidiaphragm, and may inflict cyclic pain of the right shoulder just before and during menses. Rarely, endometriosis can be extraperitoneal and is found in the lungs and CNS.