They might also be in the vagina and the bladder and on rare occasions, in locations outside the pelvis.
Endometriosis usually affects women during their childbearing years. Over one million women in the United States alone are affected by this and it is one of the primary reasons for laparoscopic surgery and hysterectomy in the country.
There seems to be a definite correlation between endometriosis and fertility. Estimates suggest that between 20% and 50% of women being treated for infertility have endometriosis.
While most women diagnosed with endometriosis fall in the age group between 25 to 35 years, cases as young as 11 years have also been reported. Race also seems to play a role in the incidence of endometriosis, with white women being more prone to it than women of African or Asian origin. Some studies suggest that women who get pregnant at an older age have a higher chance of developing endometriosis.
To understand how endometriosis can contribute to infertility, one must first try to understand the causes of endometriosis. However, medical science has not yet been able to discover the exact cause of this condition. There are many theories regarding this subject. Some researchers speculate that endometrial tissue gets deposited outside the uterus by menstrual flow backing up into the fallopian tubes and the abdominal cavities during menstruation. This phenomenon is known as retrograde menstruation. While retrograde menstruation may be one of the factors responsible for endometriosis, it cannot be the only cause of many women with retrograde menstruation do not develop endometriosis.
Not all women with endometriosis have a problem conceiving. For those with severe endometriosis who do have a problem conceiving, surgery can provide a solution. Removal of endometriosis implants can clear the reproductive system and allow them to conceive. However, the chances of endometriosis returning are high as long as the woman in question still has her reproductive organs intact.
Endometriosis can be treated with either medication or surgery with the goal being to provide relief from pain or to enhance fertility.
Medicines are usually prescribed to provide relief from pain. Some of the commonly used medications include non-steroidal anti-inflammatory drugs or NSAIDs. Examples of these drugs include ibuprofen and naproxen sodium. They are prescribed to provide relief from menstrual cramps and pain in the pelvic region but they do not have any effect on the endometriosis implants. Since a diagnosis of endometriosis can only be confirmed after surgery, NSAIDs are commonly given as a first line of treatment. If they work and control the pain, no further action or treatment is usually required.
Other medications used to treat endometriosis include gonadotropin releasing hormone analogs, oral contraceptive pills and progestins. Progestins such as medroxyprogesterone acetate (Cycrin, Provera) are more effective than birth control pills and can be taken by women who cannot take birth control pills.
If the patient does not respond to medications, surgery is often recommended. Surgery can be either conservative or definitive. Conservative surgery preserves the uterus and is used to enhance fertility or when the woman plans on having children in the future. Definitive surgery involves the removal of the uterus or hysterectomy. The ovaries may or may not be removed.
For those women who still cannot conceive even after surgery, assisted reproductive therapies may offer a solution. However, such cases are rare and it has been estimated that up to 70% of women with mild to moderate endometriosis will conceive without the need for any treatment.
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