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When cells that line the uterine cavity take hold and develop outside of the uterus, it is called endometriosis. While endometriosis may be suspected based on your medical history and physical exam, diagnosing endometriosis requires surgery. As outlined below, however, surgery may not be necessary.
Endometriosis commonly affects women of reproductive age and has an observed association with infertility. There are several theories as to how endometriosis develops. Rarely the reason, endometriosis tissue has been reported to spread via the blood stream. For almost all menstruating women, the uterine lining is shed with bleeding noted both from the cervix and the fallopian tubes. The flow of uterine material from the tubes during the period can lead to seeding of the pelvic organs with uterine lining cells that posses the ability to root themselves where they do not belong. The body recognizes their foreign nature and attempts to remove them using the immune system.
Most women are efficient at this removal process, however in some women the immune response is overly aggressive leading to damage of the native pelvic structures. In addition, endometriosis tissue is sensitive to the hormones produced during the menstrual cycle and responds similarly to the normal lining leading to further distortion of the pelvic contents. The resultant scar tissue translates to the potential of distorted anatomy, tubal blockage or an inability of the tubes to pick up the eggs. Overwhelming ovarian endometriosis can lead to a decrease in egg production.
While a small amount of endometriosis can interfere with fertility, surgery to remove the endometriosis offers only a marginal benefit and other treatments are equally if not more effective. Furthermore, endometriosis tends to recur after surgery. With severe endometriosis and anatomic distortion, IVF may be offered.
