Endometriosis is the abnormal growth of cells (endometrial cells) similar to those that form the inside of the uterus, but in a location outside of the uterus such as the fallopian tubes, ovaries, bowel or urinary tract. The exact cause of endometriosis has not been identified. Endometriosis is more common in women in the 25-35 year old age range but can occur later or earlier. Most women with endometriosis have no symptoms, however, for those with symptoms pelvic pain during menstruation, ovulation or during intercourse can be a symptom. Endometriosis can damage organs in the pelvis including the ovaries, fallopian tubes, ureters, bladder or bowel. Endometriosis can be suspected based on the woman's pattern of symptoms, and sometimes during a physical examination, but the definite diagnosis is confirmed by surgery, usually laparoscopy.
Treatment of endometriosis includes medication and surgery for both pain relief and treatment of damage to other organs.
Surgical treatment for endometriosis can be useful when the symptoms of endometriosis are severe or when there has been an inadequate response to medical treatment. Surgery is the preferred treatment when there is anatomic distortion of the pelvic organs or obstruction of the bowel or urinary tract. Surgical therapies for endometriosis may be either classified as conservative, in which the uterus and ovarian tissue is preserved, or definitive, which involves hysterectomy (removal of the uterus), with or without removal of the ovaries.
Conservative surgery is typically carried out by laparoscopy. Endometrial implants may be excised or obliterated. If the disease is extensive and anatomy is distorted, laparotomy (opening of the abdominal wall via a larger incision) may be required.
While surgical treatments can be very effective in the reduction of pain, the recurrence rate of endometriosis following surgical treatment can be high therefore often women are advised to take oral or injectable medications after surgery to help suppress the disease.