Question:

I have a family history of endometriosis. I have heard this condition could lead to infertility. What treatments are available, and how do you know for sure if you have it?

Answer:

Endometriosis is a condition in which the endometrial tissue that normally lines the uterus is found on other organs. The organs are usually in the pelvis and include the ovaries, bladder, bowel, and peritoneum (the sheet of tissue that lines the pelvis).

Most cases probably occur when the endometrial tissue sheds from the uterus during a menstrual period. But instead of exiting the body through the vagina as the menses, the tissue flows backward through the Fallopian tubes to the pelvic cavity.

Most women with endometriosis have no symptoms. The condition is discovered during an operation for an unrelated reason. However, endometriosis can cause pelvic pain, painful periods, pain during intercourse, abnormal bleeding and infertility. The best way to diagnose the condition in women who have these symptoms is to examine the tissue directly with laparoscopy.

Endometriosis requires support from the ovarian hormones, so it is essentially only seen in women of reproductive age. The most common approach to treatment is to alter the hormones. This disrupts the growth of the endometriosis. Oral contraceptive pills and other hormone treatments including Lupron, danazol, and progesterone may be used. Pain is treated with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen.

Endometriosis may be treated surgically if the above treatment fails. The stray endometrial tissue can be removed or destroyed with a laser or cautery device. If the endometriosis forms a cyst on the ovary (an "endometrioma") the cyst can be surgically excised. In rare cases when there is no response to conservative measures, a hysterectomy may be performed.

Definitive diagnosis requires a surgical procedure (laparoscopy) and there is a wide range of available treatments. Each patient should consider the options and her goals carefully, review them with her doctor, and together they can choose the best approach to the diagnosis and deciding on treatment.

— Joan Bengtson, M.D.
Assistant professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School
Department of Obstetrics, Gynecology and Reproduction, Brigham and Women's Hospital