Five Things You Should Know
4. The Cause Is Not CertainThere are many theories about what causes endometriosis, ranging from genetic causes to faulty immune system to whether it is a disease of the endocrine system.
Immune system disorders and certain cancers are more common in women with endometriosis, according to recent research. "Research in the mid- to late-1980s demonstrated that almost every immune cell studied in women with endo was malfunctioning in some way," Drury says. "Now we know that women with endo are at high risk for certain autoimmune diseases. The infertility associated with endometriosis may be related to immunological abnormalities."
Research also shows a link between dioxin (a toxic chemical from pesticides and burning waste) exposure and endometriosis. "In 1992, the Endometriosis Association was instrumental in the discovery of the link between exposure to the man-made chemical dioxin and endometriosis," Drurysays. "Laparoscopies of a research colony of rhesus monkeys revealed that 79 percent of the monkeys exposed to dioxin had endometrial growths on their abdominal organs, with a correlation between doses of dioxin and severity of the disease."
While there is no way to prevent getting endometriosis, you can try to lower estrogen levels in your body since it is the hormone involved in thickening the uterus. Some ways to do that include: exercising regularly, lowering your body fat and avoiding large amounts of alcohol and caffeine.
5. There Is No 'Cure' for Endometriosis, but Treatment May Help Symptoms and FertilityYour endometriosis treatment plan may depend on your age, symptoms and plans for getting pregnant. Often, you may hear that pregnancy, birth control pills or surgery will "cure" endometriosis. There is no cure for endometriosis.
Getting pregnant and hormonal drug treatments — such as birth control pills, progestins, Danazol and GnRH-analogues — suppress symptoms, but do not cure the disease. Symptoms usually recur after the birth of the child or stopping the hormonal treatment. Hormonal treatments may be best for women with milder disease who do not experience as much pain.
Surgery provides the best option for long-term relief of endometriosis, but it does not cure the underlying cause of the disease. Surgery is usually the best choice for women with severe endometriosis and for those who are having fertility problems. "The most common misconceptions are that everyone with endometriosis is infertile and that treatment restores fertility," Dr. Grunert says. "Endometriosis can decrease fertility, but may not prevent pregnancy. Treatment may improve fertility, but does not restore it to the same level as for women without a history of endometriosis."
During the laparoscopy to diagnose endometriosis, the fertility doctor can also treat the disease by removing growths and scar tissue or burning them away without harming the health tissue around it. A more complex surgery is a laparotomy, which involves a much larger cut in the abdomen and allows the doctor to remove growths in the pelvis or abdomen. The surgery of last resort is a hysterectomy, in which the doctor removes the uterus. By removing the ovaries as well as the uterus, the endometriosis is less likely to return; however, the woman will not be able to get pregnant.
"The most important things to keep in mind are early diagnosis and treatment," Dr. Grunert says. "For fertility patients, the first treatment is the most effective — subsequent surgeries and treatments do not improve success and should be discouraged."
There are some new developments in surgery for endometriosis, that may help in the patient with fertility problems. "For patients with documented endometriosis, serial trans-vaginal drainage of ovarian endometriosis cysts may be better than surgical excision," Dr. Grunert says. "This may be associated with less ovarian injury and with greater preservation of ovarian function."