Gynecologic Health

Wanted: An Easy Test for Endometriosis

Then there's a whole myriad of other symptoms such as diarrhea or constipation and urinary symptoms such as pain when urinating, though those symptoms could be due to a lot of other things, too.

Does the tissue respond to the hormonal changes of the menstrual cycle?
The lining of the uterus responds to estrogen/progesterone, so this tissue will also respond to variations in estrogen and progesterone levels or the lack of estrogen and progesterone. The degree of the response may differ from patient to patient and by location. These hormones are the basis of some of the things that we use as treatment, such as the birth control pill; other times we remove hormones like estrogens with drugs that induce menopause.

Although there are differences between the hormonal receptors in the endometrium and the receptors in the endometrial tissue that is found elsewhere, endometrial tissue outside of the endometrium will still respond to hormonal changes.

Why does scarring form and what are the consequences of it?
Scarring forms in endometriosis patients as a result of the chronic inflammation. The scarring that involves structures like the vagina is deeply infiltrating and may involve nerve endings. This causes pain. If extensive, the uterus becomes immobile and fixed in place, and this can make sexual intercourse very painful. The extensive scarring can involve the fallopian tube and ovaries and impair the process by which the tube picks up the egg from the ovary. This can cause infertility.

Also, scar tissue may not respond to the hormonal therapies or to a woman's hormonal changes.

Is endometriosis often mistaken for other conditions?
If women have a lot of bowel symptoms, then it's confused with irritable bowel syndrome, which is a common problem in women and men. It can be confused with interstitial cystitis, which is an inflammation of the bladder. If someone has pain, you also have to think of nerve pain, which can be due to a hernia or an entrapped nerve or some musculoskeletal problem of the interior abdomen. So if a woman has pain of the lower abdomen, you have to go through this careful history and physical examination.

What is the first step in diagnosing endometriosis?
For the moment, the only true and standard way to make the diagnosis of endometriosis is by taking a sample piece of tissue during a surgical procedure called a laparoscopy.

How is the condition treated?
Most of the time, we just treat the endometriosis without the surgery. If someone says, "I have bad periods," then you say, "Well, look, if I do surgery, there's risks. Why don't you take some ibuprofen?" And if the ibuprofen works, fine. The next step is to try the birth control pill.

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