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Endometriosis is a condition in which tissue similar to the cells of the lining of the uterus

(endometrium) grows in other areas of the body_ This abnormal growth can cause pelvic

pain, irregular bleeding, and infertility. The most commonly affected areas are the

ovaries, bowel, or the lining of the pelvis.


Just like normal cells of the lining of the uterus, endometriosis implants are stimulated

by estrogen (the principal female sex hormone). This stimulation produces thickening

and a small amount of bleeding inside the pelvis. Chronic inflammation produced by

these changes can cause pain and scar tissue in the internal pelvic organs. Typically,

pain related with endometriosis is worse during the period. Pain can also be present

with intercourse, bowel movements, or urination.




To diagnose endometriosis your doctor will ask you to describe the symptoms, including

the location of the pain and when it occurs. This will be followed by a pelvic exam on

which the doctor will palpate the pelvic organs and will identify the areas that are tender. In most cases, the lesions of endometriosis are small and therefore cannot be palpated. A vaginal ultrasound is another way in which your doctor can evaluate the reproductive organs. It will not definitively diagnose endometriosis, but it can identify cysts associated with endometriosis (endometriomas).


The diagnosis of endometriosis can only be certain after a laparoscopy. During this

surgery the surgeon insufflates the abdomen with carbon dioxide and then introduces a

camera (laparoscope) through a small incision in the navel. By moving the laparoscope

your doctor can visualize the uterus, ovaries, fallopian tubes, bowel, and lining of the

pelvis and look for signs of endometrial tissue outside the uterus.





o Non-steroidal anti-inflammatory drugs: Medications like Advil, Aleve, and

Ibuprofen may be recommended. This group of medications is more effective

when taken at the first sign of the period or pain.

o Hormonal contraception (birth control pills): Normal fluctuations in the

hormone levels during the menstrual cycle causes endometrial implants to

thicken, break down and bleed. Birth control pills work by limiting the growth of

the endometrial cells by eliminating the rise and fall of hormones during the

menstrual cycle.

o Depo Provera: This injectable medication can stop menstruation and decrease

the growth of endometriosis.

o Gonadotropin-releasing hormone agonist and antagonist: These drugs block

the production of ovarian stimulating hormones that are produced in the pituitary.

By stopping the stimulation to the ovaries the production of estrogen is greatly

reduced. Lower estrogen levels can cause endometrial implants to shrink. These

hormones mimic menopause and therefore common side effects include hot flashes,

mood-swings insomnia, and vaginal dryness.


Other Treatments:

o Regular exercise produces chemicals that may block the pain. For some patients

a regular exercise regimen, especially around their menstrual period may

decrease the symptoms.

o Heat: a warm bath or a heating pad on the abdominal/pelvic area.

o Relaxation, yoga, acupuncture: These techniques can help some patients cope

with the pain.




When treatment with medications is not effective, the next step in management is

surgery. The definitive surgical management is a total hysterectomy during which the

uterus and ovaries are removed. Such surgery will cause menopause and therefore

eliminate the production of estrogen by the ovaries. The absence of estrogen will

eliminate the stimulation of the endometriosis implants and permanently treat

endometriosis. This type of surgery is the last resort and is not an option in younger

patients who want to become pregnant.


Another option is conservative surgery during which the endometrial tissue that is

growing outside the uterus can be removed or destroyed. This tissue may return after

surgery, but removing it may reduce pain for a significant period of time.


An endometrial biopsy is a procedure performed in our office to obtain a sample of the

lining of your uterus (endometrium). Your practitioner may suggest an endometrial

biopsy to assess the following:

o Abnormal uterine bleeding

o Bleeding after menopause

o Infertility

o Results of Pap smears


Preparing for an endometrial biopsy

Anesthesia is not needed for this procedure. It is suggested that you take Ibuprofen

600-800 mg as recommended by your provider prior to your appointment to relieve

cramping associated with the procedure, as long as you are not allergic to it or to



During the procedure

The entire procedure takes only a few minutes. You will lie on the exam table with your

feet in the stirrups. Your practitioner will place a speculum in your vagina and will apply

an antiseptic solution to your cervix, He or she will insert a tiny straw-like tube through

the cervical opening into the uterine cavity. Using the tube, the doctor will take a sample of cells from the inner layer of the uterine wall. During the procedure you may

experience menstrual-like cramping.


After the procedure

After the procedure it is normal to experience some cramping and bleeding from the

biopsy. Expect spotting for one to two days after the biopsy. If necessary, you can take

an over-the-counter pain reliever like Ibuprofen 600-800 mg or Aleve 200 mg to control

discomfort, as long as you are not allergic to these products or to aspirin. The biopsy

sample wilt be sent to a lab for further analysis. We will discuss your results with you at

a follow-up appointment or during a follow-up phone can. Avoid sexual relations and

tampon use for twenty four hours after the biopsy.


Risks associated with this procedure


As with all procedures) there are some risks involved, With an endometrial biopsy,

serious complications are extremely rare. Risks can include:

o Severe bleeding from the biopsy site

o uterine injury/perforation

o Infection

o Inability to complete the procedure